by Emrys Westacott

Imagine you are given the following choice:

Option A: You live 34,748 days. Your final four weeks are spent in and out of hospital, alternating between discomfort and semi-consciousness, entirely dependent on family members and health care providers for assistance with every basic function.
You die in hospital or in a nursing home. The cost of home care, hospital services, and medications over this period depletes your estate by thousands of dollars.

Option B: You live 34,720 days–that is, 28 days less. The 28 days you give up are those last four weeks just described. You die at home. The money you save helps put a grandchild (or great grandchild) through college.

To my mind, this is a no-brainer. Option B is clearly preferable. In both cases you live until you are 95, a good long life. Everything significant that you were able to enjoy or accomplish will have happened. All you miss out on if you choose Option B is a few days of humiliation, discomfort (occasionally rising to out-and-out pain), guilt about the burden you are imposing on others, and anxiety about how your final pitiable condition might affect the way you are remembered. I assume most people will share my view that B is the better option. So the question arises: Why do the final days of so many people resemble Option A rather than Option B?

This question was prompted by two very good bestselling books that I read during the recent holidays: Atul Gawande's Being Mortal, and Roz Chast's Can't we talk about something more pleasant? Gawande, a physician, addresses an increasingly important problem. Due to the tremendous progress made in medicine over the last century, dying is often a much more complex and protracted process than it used to be. Doctors today have the know-how and the technology to keep us alive a lot longer after we are stricken with illness or old age. Unfortunately, says Gawande, doctors, other care-providers, and family members, often unthinkingly opt for whatever will prolong life without considering sufficiently whether what is being prolonged is really worth living from the perspective of the person who has to live it.

Our worst nursing homes are luxury hotels compared to the old workhouses and almshouses where people used to spend their final days, but they are nevertheless dreaded. Innovative assisted living arrangements make an honest attempt to eliminate some of most objectionable aspects of nursing homes, particularly the lack of independence granted to the residents. But all the same, loss of autonomy, and the blighting of even small pleasures by continual discomfort, seems to be the fate that awaits many of us if we take our time shuffling off our mortal coil.

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