I recently read an article by a doctor who gave his perspective on caring for the elderly. It was very interesting and gave great insight into the American view of death.
Approximately 100 to 150 years ago, American life was predominantly rural. Life on the farm is much different than life in an urban setting. Two things happened to individuals who lived on the farm. First, multiple generations lived together under one roof. Children were able to observe not only the lives of their parents, but the personal struggles of their grandparents. The family unit took care of grandma and grandpa as they aged. As the family cared for their aging grandparents, they were able to experience first-hand the aging process in its entirety. Secondly, life on the farm meant children observed the birth, life, and death of animals. There was an intimate connection with the full circle of life. Death was seen as natural part of that cycle.
Urbanization has created a situation where death is much more foreign to us. Not only do we no longer raise cattle and chickens (we have the pleasure of going to the grocery store for our meat), we now have two income families, where both mother and father work outside the home. Whereas women used to be the predominant caregiver of aging parents, we now have facilities providing such care (assisted livings and nursing homes). This has isolated the daily challenges of the aged and created a society of individuals who are less aware of both aging and death. Death for many people is “unfamiliar and unnatural”.
Couple the separation of the aged from main-stream society with the advances in modern science and technology and it is easy to understand how many view death as a “medical failure rather than life’s natural consequence”.
Modern science has allowed us to do amazing things such as helping to save babies born prematurely, treat certain cancers and even recently perform facial transplants. We are hopeful that the medical community will be able to continue to find ways to prolong life further and further.
Often, families want everything done for their elderly family members who are sick. They want the best of modern medicine: more tests, more medications, and more procedures. When an older adult is at the end of life, family members often want to provide everything possible for their loved ones- to leave no stone unturned. It makes us feel better!
The doctor who wrote this article felt the children who were most willing to let their parents go, were those who were most intimately involved in their care. They were able to see grandmother’s suffering and chose not to continue it with further tests, treatments, etc. These individuals were much more open to Hospice services.
On a personal note, I remember a case from my time as a social worker when an older woman was at the end of life. I don’t remember specific details, but her mind was still quite clear and she communicated to staff that she did not want heroic measures taken to extend her life. Her daughter persuaded her otherwise. The elderly woman was given a feeding tube, her body became swollen and she appeared very uncomfortable.
I believe the elderly woman changed her mind to avoid conflict with her daughter; ultimately make her daughter happy. In doing so, the elderly woman made a personal sacrifice- instead of her daughter making the sacrifice. The woman’s life was only extended a few months.
Even though it is difficult and brings us great sadness, we should uphold the wishes of our elderly family members (don’t we want our children doing the same for us)? It is incredibly important to discuss your desires concerning end-of-life care years ahead with your loved ones. Perhaps it is a discussion important enough to be brought up more than once. Don’t just discuss it with your children or other proxy on a logical level, but on a personal level. If you believe Hospice care is something you value, let your loved ones know you are at peace with that. Finally, don’t just verbalize it, document it and pass out copies to relatives and your doctor.
Consider looking at this site: www.agingwithdignity.org (*See Five Wishes)