How long could humans live? A staple of of fiction, research, and debate that has bordered on the esoteric for the majority of human history. However the last century has seen development across all areas of the human condition, from flight to space travel, from antibiotics to organ transplants. Humanity’s reach has expanded to the point where we really do need to ask, when should people die?
Your scientists were so preoccupied with whether or not they could, they didn’t stop to think if they should. - Dr Ian Malcom
In an attempt to pull order and compartmentalise the jumble and figurative minefield these question pose, I’ve decided focus on three main areas:
- How we die today
- Living for long life
- Looking and living to the future
How we die today
Take a straw poll on how people want to die and the answer will probably be something quick, heart attack is a common crowd favourite. What you probably won’t hear is something slow and drawn out, a feeling strengthened by the experience of seeing someone go through cancer or a degenerative disease. Yet these choice are rarely borne out in peoples’ choices about their own or their relatives end-of-life care.
Obviously it is absurd to accuse those going through such questions of hypocrisy, the purpose instead is to see if this disparity poses a disconnect in our feelings about death dependent on it’s presumed proximity. When it is more a theoretical notion the key motivator appears to be the manner of death, the underlying assumption being that it is a reasonable amount of time away. Oppositely when death becomes a very real concern, choices are generally made that prolong life in many cases at the expense of quality.
We have entered a period of our history where we can reason and decide about the manner of our deaths. Whether or not euthanasia is legal in a particular country, choices such as advanced decisions (living wills) are likely present and the right to refuse treatment is virtually universal.
However in the grand of scheme of things this has not been the case for all too long. Death was seen as an inviolable truth that fate would lead you towards. Perhaps therefore it is not surprising that we are not good at reasoning about death as we’ve been given the tools to partially avoid it and have learned that it is not immutable.
Potentially part of the problem is lack of experience. While on the face of it that suggestion seems ridiculous, but not many people have a dry run of dying. However turning to people who have more experience of seeing people deal with death we see that doctors have significantly different end-of-life choices than members of the public, seeming to opt for the less involved interventions.
It bears mentioning that this isn’t a quest for the correct answer. I am not trying to tell someone how much a month of their life is worth. The question of involved intervention vs palliative care is an enormously complicated one and likely has no definitive answer in most cases. At the end of the day the goal is to see that the person and the people around them take the solution that best fits them. However there is potential for our beliefs and social attitudes to interfere with finding that solution. Were we less afraid of death might we opt less for brutal interventions, or were we more determined we might try that last treatment option.
At this point I must refer to an episode of the freakonomics podcast entitled Are You Ready for a Glorious Sunset. It trials the theoretical idea of patients being paid to forego treatment by the bill payer, such as the insurer or the state. While some will recoil with horror at this idea it does raise the issue of how much life is worth, a kind of dreadful algebra, but one that is made routinely.
Healthcare is expensive. From drugs, to buildings, to people, all of it costs. Organisations like the NHS and health insurers have to put caps and restrictions on the kind of care they will provide. Suddenly the choices surrounding death must include some thought about the cost. How insulated you are from this decision depends on the state of healthcare in your country.
Ultimately an idea like the glorious sunset is unlikely to be implemented. There are too many ways it can foster inequality or allow people to be exploited. But it neatly introduces how someone’s death can be dependent on those around them.
Everyday people quite literally make life or death decisions about their family, their relations, or their patients. Not even dying is a one-person activity. The traditional system has been one of medical proxies, people appointed in advance to make the decisions when the person can’t. This is all well and good if there is warning, the same goes to living wills, yet all too often people are unprepared and so their relations or carers have to make those choices for them. As I’ve previously mentioned peoples’ preferences differ depending on how proximal death may be. Imagine the difference may be when the arbiter isn’t thinking about their own end.
This piece has been slightly sprawling, but I hope I’ve highlighted some of the difficulties surrounding this rather contentious topic. Although it sounds pessimistic and morbid, having an idea about how you would like to die can prevent much strife in later life.