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Six million couples get engaged on Valentine’s Day. The kneeling, the ring, the gasping, the kiss – the etiquette is familiar, the roles set in stone. You’ve seen it in movies and TV series, on Facebook and Instagram, in restaurants, and maybe in your own life too.
These moments are precious, romantic and irresistible – they invariably make me cry. But, just as invariably, they strike me as a harmful, flawed model for married life. I’d advise you to resist them.
For more than a decade, I’ve been studying medical decision making. Now, as I write a book on our barriers to making such decisions, and especially as I’m in the chapter on end of life, etiquette feels crucial. Patients and doctors alike aren’t sure about their roles: doctors fear crushing their patients’ hopes by fully disclosing poor prognosis; patients fear upsetting their doctors by asking ‘difficult’ questions. Therefore, too many things are left unspoken, patients who want to cannot properly prepare for what lies ahead, and doctors sometimes veer toward unnecessary treatments to avoid spelling out the truth.
The lack of communication, the unrealistic expectations – that there will always be a cure, that nobody’s feelings will get hurt – are typical of doctor-patient relationships as well as of the model marriage proposals set for married life. I propose that marriage proposals embody many of the perils to marriages themselves. Among the many potential reasons for divorce are money, lack of communication, and unrealistic expectations. All these, I claim, are foreshadowed in the proposal.
First, let's look at lack of communication. Etiquette dictates who says what to whom, and who initiates the conversation. Given that marriage is a partnership, can’t both sides initiate the discussion, expressing their wants, needs, and fears? Saying more about starting a life together than ‘Will you marry me?’ and ‘Yes’?
Above all, this rigid division of labor is obsolete. In medicine, we have moved from a paternalistic model, where the doctor knows everything and decides for the patient, to a more varied menu, with shared decision making, and even informed choice, where the patient calls the shots. But, around the end of life and other topics, some – doctors and patients alike — still cling to the idea that, like in marriage proposals, there are rules to follow, and until they find out what these are, they cannot say a word.
Next, unrealistic expectations. The ‘surprise!’ nature of proposals carries an unrealistic element, highlighted by the following example. For gay couples, etiquette and roles aren’t set in stone, and expectations aren’t clear. Alaina Leary proposed to her partner, Macey, and then they talked about whether Macey should also propose to her. This discussion, she says, may seem unromantic and overly practical. I find it blissfully refreshing – hoping your partner would divulge your unexpressed wishes is unrealistic. Finding out the partner’s expectations can save disappointments and disputes. Similarly, in medicine, if doctors asked dying patients what their wishes are and how much they want to know, many would die less lonely.
Money is directly tied in with communication, and unrealistic expectations. The man is expected to produce a ring, the average cost of which ran between $4,770 and $5,580 in 2019. According to the Bureau of Labor Statistics, this is more than 10 percent of the average annual wage for a man, age 29, the average age at which American men first marry. It’s a considerable sum which he is supposed to spend on his own for someone else. If you’ve watched Girls, you’ll remember Desi and Marnie’s short-lived marriage, and the many asinine financial decisions Desi has made for them both. Though running a household together requires talking about money as astutely as possible, might Desi have used the proposal as his model?
The average cost of a ring could buy a household-full of appliances, including that four-slice toaster to save many morning arguments (constant arguing is yet another cause of divorce). When a friend of mine was proposed to, she told the man to skip the ring and buy a good refrigerator instead. Twenty years and two kids later, they are still happily married.
Health spending is greatest toward the end of life. But is it spent according to patients’ wishes? Or is it spent with fear of lawsuits in mind, and a starry-eyed approach of ‘let’s do everything’ even if the gain is uncertain at best, painful at worst? Many patients would opt for end-of-life palliative care, if only they were told what it was, and were guided toward realistic expectations about what lay ahead of them. It’s time to open up end-of-life conversations, just as it’s time to have more open, unromantic, overly realistic conversations about marriage.
