Accepting Death Is Harder Than Ever

I’ve been a member of a hospital ethics committee for nearly 30 years. During that time, there have been patients on respirators for an extended period. The patients couldn’t breathe without the respirator. Yet, when the physicians in charge of the patients’ care concluded that there was no hope for recovery, often families didn’t want the machines turned off. A miracle is always possible, they argued, if not through divine intervention then by the new cure that will be announced tomorrow.

Effect of Advances in Medical Care

Advances in health care make death more difficult to accept than ever before. Death is no longer an inevitable reality for many, the end point of having been born. Death is viewed as a defeat, and anything less than heroic measures to keep someone breathing is considered a failure to treat fully.

As I surpass the age at which three of my four grandparents died, I marvel at the advances that have kept me healthy, active, and relatively free of pain. Luck and genetics play a large part in my healthy condition, but equally so have been the advances in all aspects of medical care, from dentistry to pharmaceuticals to prostheses and surgical equipment, and now artificial intelligence.

There is a downside to this, though. There is a disconnect between ourselves and nature, a hubris that believes that with enough effort and determination, nature itself can be vanquished; death can be postponed indefinitely.

Questioning the Definition of Death

Medical technology has even muddied the definition of death itself. Traditionally, the medical profession determined death by taking a pulse, listening for breathing, and holding a mirror under the nose to look for condensation. No breathing, no pulse: dead.

Not only has technology made these methods of determining the time of death inadequate, but medical advances have also even questioned the definition of death itself. As pointed out by bioethicist David DeGrazia,

The widespread dissemination in the 1960s of such technologies as mechanical respirators and defibrillators to restore cardiac function highlighted the possibility of separating cardiopulmonary and neurological functioning. Quite rapidly, the questions of what constituted human death and how we could determine its occurrence had emerged as issues both philosophically rich and urgent.

Hope has beneficial qualities but it also can become a destructive force. When hope crosses the line into wishful thinking, harm can be done. As pointed out by neurosurgeon Harold Wilkinson,

when promised improvements or recoveries fail to materialize, the impact on the patient and on the patient’s family is at times profoundly negative...If false hope built expectations that were unrealistic and not attainable, the lack of attainment of those goals will be viewed as failure—although partial improvement has in fact been achieved.

Not only does false hope erode trust between patients and doctors, but wishful thinking can also be cruel to the patient. A friend who had terminal cancer told me he felt guilty for being ill, that he had brought it on himself because of a negative attitude. Even at this late stage (he died within two weeks after our conversation), his psychotherapist assured him that with positive thinking and meditation he could get better.

Increasing Acceptance of Hospice and Palliative Care

Fortunately, increasing acceptance of hospices and palliative care, where the focus is on symptom care and not cures, are encouraging signs that attitudes toward death may be changing. Comfort can be more merciful than medical interventions; letting go can be a kindness. As MSN Robin B. Rome writes,

While dying is a normal part of life, death is often treated as an illness. As a consequence, many people die in hospitals, alone and in pain...The ultimate goal of palliative care is to improve quality of life for both the patient and the family, regardless of diagnosis. Although palliative care, unlike hospice care, does not depend on prognosis, as the end of life approaches, the role of palliative care intensifies and focuses on aggressive symptom management and psychosocial support.

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All creatures born are destined to die. Philosopher Massimo Pigliucci writes, “death itself is not under our control (it will happen one way or another), but how we think about death most definitely is under our control. That’s the part we can work on.” The place to begin is acknowledging that we don’t stand apart from nature but within it. The Hebrew Bible states, “all are of the dust, and all turn to dust again,” while the Book of Common Prayer, often recited at Christian funeral services, says, “Earth to earth, ashes to ashes, dust to dust.” This view isn’t confined to the Western world. The Dalai Lama gives this advice: “We’re all going to face death, so we shouldn’t ignore it. Being realistic about our morality enables us to live a full, meaningful life. Instead of dying with fear, we can die happily because we’ll have made the most of our lives.”

There are different views of what happens after death: bodily resurrection (traditional Judaism), paradise (Christianity and Islam), reincarnation (several Asian religions), and returning to what one was before being born (various Humanist philosophies). What all agree upon is that death is inevitable. Medical advances and its ancillary technology can make us healthier, but it can’t make us immortal. Palliative medicine and hospice care are steps in the right direction, bringing dying back to its rightful place. It is a good beginning.