In 1945 most deaths occurred in the home, by the 1980s just 17% of people died at home. Modern scientific capability has profoundly altered the course of human life allowing people to live longer and better than at any other time in history. But scientific advances have turned the process of aging and dying into “medical experiences” to be managed by Healthcare professionals. Yet the medical field has proved alarmingly unprepared to do so. We are all aging from the day we are born. There is no escaping death which is the destination we will all reach. For all but most recent human history, death was a common, ever present possibility. It didn't matter whether you were age 4 or 64, every day was a roll of the dice. People accepted that illness and death were a part of everyday life, no matter your age or circumstances. Old age was the exception and not the rule.
With modern medicines and medical interventions, life expectancy has continued to rise. But those same medicines and interventions have catered to our desire for unlimited life – a refusal to accept the inevitable end-of-life that comes to all. We have drugs, surgery, and intensive care units to get people through until the next health crisis. The pattern of health decline has changed allowing for many ups and downs. Our health may precipitously drop, but may also include long stretches at a new, lower health plateau. On the journey, we may not be able to stave off the damage created by illness and accident, but we can stave off death.
The job of any doctor is to support quality-of-life, which means two things - as much freedom from the suffering of disease as possible and the retention of enough function to allow for active engagement in life. Now we must ask ourselves if the sick and aged are being sacrificed on the altar of modern medicine at the expense of their quality of life. Most people can accept that aging will not be easy but that does not mean they are ready to handle all the conditions that may come with it. Atul Gawande, American surgeon, public health researcher and writer records the following in his book Being Mortal, “It is not death that the very old tell me they fear. It is what happens short of death losing their hearing, their memory, their best friends, their way of life. Old age is a continuous series of losses.”
It is imperative that we re-evaluate the individual’s right to determine his/her own ending, not based on medical interventions, but on the individual’s own determination of a compassionate ending based on their suffering and quality of life. In this way, we as a compassionate society can avoid the ending described so bitterly by author Philip Roth in his novel Everyman, “Old age is not a battle. Old age is a massacre.”