Dying Responsibly

Yesterday the New York Times published a must-read op-ed by Susan Jacoby about the costly disconnect between Americans’ values and their practices when it comes to end-of-life health care. Just a few key statistical takeaways:

A third of the Medicare budget is now spent in the last year of life, and a third of that goes for care in the last month. Those figures would surely be lower if more Americans, while they were still healthy, took the initiative to spell out what treatments they do — and do not — want by writing living wills and appointing health care proxies.


[A]dvance directives aren’t “death panels”; they can also be used to ensure the deployment of every tool of modern medicine. They can be changed or withdrawn at any time by a mentally competent person.

But public opinion polls consistently show that most Americans, like my mother, worry about too much rather than too little medical intervention. In a Pew Research Center poll released in 2006, only 22 percent said a doctor should always try to save a patient’s life, while 70 percent believed that patients should sometimes be allowed to die. More than half said they would tell their doctor to end treatment if they were in great pain with no hope of improvement.

Yet only 69 percent had discussed end-of-life care with a spouse; just 17 percent, or 40 percent of those over 65, had done so with their children. One-third of Americans had a living will and even fewer have taken the more legally enforceable measure of appointing a health care proxy to act on their behalf if they cannot act for themselves.

And Jacoby’s sensible values priorities:

As someone over 65, I do not consider it my duty to die for the convenience of society. I do consider it my duty, to myself and younger generations, to follow the example my mother set by doing everything in my power to ensure that I will never be the object of medical intervention that cannot restore my life but can only prolong a costly living death.

Read More.

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About Daniel Fincke

Dr. Daniel Fincke  has his PhD in philosophy from Fordham University and spent 11 years teaching in college classrooms. He wrote his dissertation on Ethics and the philosophy of Friedrich Nietzsche. On Camels With Hammers, the careful philosophy blog he writes for a popular audience, Dan argues for atheism and develops a humanistic ethical theory he calls “Empowerment Ethics”. Dan also teaches affordable, non-matriculated, video-conferencing philosophy classes on ethics, Nietzsche, historical philosophy, and philosophy for atheists that anyone around the world can sign up for. (You can learn more about Dan’s online classes here.) Dan is an APPA  (American Philosophical Practitioners Association) certified philosophical counselor who offers philosophical advice services to help people work through the philosophical aspects of their practical problems or to work out their views on philosophical issues. (You can read examples of Dan’s advice here.) Through his blogging, his online teaching, and his philosophical advice services each, Dan specializes in helping people who have recently left a religious tradition work out their constructive answers to questions of ethics, metaphysics, the meaning of life, etc. as part of their process of radical worldview change.

  • http://pervasivegoodness.com Donovanable

    Susan Jacoby is amazing. I thoroughly enjoyed her standing column in the Washington Post when she was writing regularly, and Freethinkers is a great addition to grade school history classes.

  • Northern Free Thinker

    [...] medical intervention that cannot restore my life but can only prolong a costly living death.

    I am 100% in agreement. The obsession with longevity that is often obvious in atheist community irks me to no end. Most people who live past the age of menstruation, die of old age. All the wasted investments in pharmaceuticals to extend life beyond menstruation is a misnomer, we do not extend life, we only extend death. Society spends so much time fighting natural death of old age, it’s depressing. Most of the diseases we hear of in our daily news are not diseases, they are simply various symptoms of old age. Most of our elderly live in old age homes, alone, bored, and miserable. Their religion has taught them to fear death, and that “life is precious”. It is not “life” that is precious. What is precious is “quality of life”, and that is getting rarer indeed. I’m 45, my mother is 66. I have discussed my wishes with her, but her wishes have not been made entirely clear to me. Though I’m a third generation atheist, she is more “agnostic” than atheist (on some days, other days she seems more atheist!), and she clings to certain underlying religious values that were more socially present during her formative years.

    • Anat

      What is the relevance of menstruation? Women live meaningfully, and contribute to their families and society in many more ways than by giving birth, and men don’t menstruate at all (nor do they have a clear cut event that signifies no longer being fertile, though their fertility does decline a bit with age). You may be interested in the idea expressed, among others, by Jared Diamond in ‘The Rise and Fall of the Third Chimpanzee’ that human menopause is a selected trait which enables women to live well into grandmotherhood, because their contribution as carer for the young and as a source of memories of lessons learned decades earlier enabled more of their offspring to survive to adulthood than had they kept having babies (with the risk of death from pregnancy/childbirth related complications).

  • oldebabe

    Absolutely. Anyone in their right (and even aging) mind would prefer the cleanness and painlessness of death to the alternative of painful, humiliating dying, let alone the costs, both financial and emotional, to family and/or society of the useless and pointless prolongation.

    I am surprised, and pleased, to hear something like understanding of this issue from young people…

  • http://www.russellturpin.com/ rturpin

    For me, the desire to limit extreme medical intervention has zero to do with any social obligation, and everything to do with not wanting to spend my final hours in the result of that.

  • Eris

    What makes me mad is that many of the people who oppose physician assisted suicide also oppose universal healthcare

    If I’m dying of a treatable disease and want to live, to hell with what I want; I must die unless I have enough money to pay for treatment.

    If I am living and I want to die, to hell with what I want; I must be forced to live unless my body shuts down on its own.

    Before people flutter their hands about how terrible it is to let people choose to die when they are terminally ill and in pain, they should consider that we don’t allow people to live when they are treatably ill and poor.

    • GeorgeM


    • Tony

      I remember hearing about Dr Kevorkian when I was in high school (I think). Even then, before I was more rational and science minded (certainly before I’d given any long consideration to moral/ethical issues beyond the religiously derived ones that permeate society; it took philosophy 101, 201 and intro to ethics for that) the idea the doctor was a criminal was silly. If those looking for his services were of sound mind and all parties agreed, no one should have the right to tell others they can’t put themselves out of misery with some help.
      What’s the deal with theists (yeah, I’m laying the blame at the feet of religion)? It’s basically “live or die by our rules”. Abortion on one end of life. Assisted suicide on the other end (not that everyone seeking that is elderly).

  • Tsu Dho Nimh

    Preventing relatives from being able to override a patient’s wishes could cut some of futile hassles. Keeping granny alive for another week so her children can console themselves that they did everything possible doesn’t help granny.

    In some states, even if there is a clear-cut final directive, it can be set aside if any of a long list of persons objects or if medical staff choose not to follow it.

    Also … if someone with a DNR directive is accidentally put onto life support (perhaps it’s someone with inoperable cancer who gets into an auto accident or has a cardiac arrest in the supermarket, or a stupid ER staff who ignore the person waving the DNR papers), and that’s the only thing keeping them going it should be a matter of minutes for them to be removed from that life support when the paperwork shows up. But it can take days and lawyers and all kinds of hassles.

  • http://www.facebook.com/mchughdj danielmchugh

    Life is to be preserved at all costs even if it isn’t worth living because it is a precious gift to be treasured? Yet somehow if a person can’t afford treatment and dies as a result, that’s all “part of the plan.” It’s a contradiction that just would not happen if the folks running the show didn’t get their morals and professional ethics out of an ancient fantasy book.

    Prolonged terminal illnesses wreak enough havoc on patients and their loved ones without bankrupting them, too. Our family has been through that and we’re fortunate to have been fairly well off; until Mom died the ongoing cost of end-of-life care for her topped out at more than four times the national average yearly household income. That’s way, way beyond wrong. That’s well past terminal care being an impossible hurdle for poor patients- it’d be crushingly unaffordable for most middle class households, too. That I can say we were lucky to have had the money to afford to let Mom die a horrible, long, torturous death is disgusting. I can’t imagine what that hellish experience would have been like if we’d been even slightly less well-off than we are… or if we’d been without insurance.

    My intentions are to move somewhere that will allow me to legally end myself at the first hint I’m headed in that direction; my hope is that such a place would also be less prone to the lost DNR dance (which sadly we had to deal with every step of the way the day Mom died). I know that everyone who knows me already knows what to do, but I’ve seen too much of how things can go off the rails even with all the paperwork in place beforehand to believe I’d fare better without that step having been taken. I never want to leave the people I care about with that kind of burden.

  • Nicoline Smits

    My mother-in-law died last November. Under Dutch law, she was able to choose the exact way she wanted to die, without medical interventions, in her own home, with plenty of pain relief. I miss her, but I’m glad she was able to go with dignity and without having to be hooked up to all sorts of machines for basically no reason at all.
    My husband and I have drawn up living wills and health care proxies for just this reason, because you might very well end up in intensive care or who knows what other kind of medical purgatory and be kept alive for weeks or months, running up huge medical bills for no reason at all. But if I should ever be diagnosed with something irreversible, like Alzheimer’s or some degenerative disease like Lou Gehrig’s Disease or something, I think I’d prefer to kill myself rather than wait for death to overtake me.

  • http://itsmyworldcanthasnotyours.blogspot.com WMDKitty

    We’ll take Rover or Fluffy to the vet and have them euthanized when they’re old or dying or in intractable pain, and call it a kindness, the humane thing to do.

    But we can’t do the same for Grandma?


    If I ever end up with a terminal illness, I want to go out on MY terms. Why should I deny that to anyone else?

  • sundoga

    Well and truly agree. Mind you, my living will would be something like:
    I want you to do EVERYTHING IN YOUR POWER to keep me alive in all circumstances. Yes I DO want to be kept alive by a machine! If ANYONE pulls the plug, charge them with murder! I’m NOT DEAD YET!

  • Arsenal soccer shirt

    I don’t know the answers. However I do agree with Uncle Ben increasing the money supply.