Developments

End Death


My wish is to die in my own bed, cared for by people I love—clean, comfortable and relatively free from pain. I hope to have time to say my goodbyes and give my final blessings. But in our technologically advanced society—despite the billions we spend on end-of-life medical care—this simple, old-fashioned and once-inexpensive death is harder to achieve than you might think.

According to a 2017 Kaiser Foundation study, seven in 10 Americans hope to die at home. But half die in nursing homes and hospitals, and more than a tenth are cruelly shuttled from one to the other in their final three days. Pain is a major barrier to a peaceful death, and nearly half of dying Americans suffer from uncontrolled pain. Nobody I know hopes to die in the soulless confines of an Intensive Care Unit. But more than a quarter of Medicare members cycle through one in their final month, and a fifth of Americans die in an ICU.

In his final year of life, retired IBM manager Ed Walski, who had Parkinson’s disease and dementia, was shuttled nine times between his assisted living apartment and hospitals and nursing homes. “The first few times I’d say, OK, we got him through this, and now he’s going to get rehab and be back where he was,” said his daughter Karen Randall, a veterinarian in Silver Spring, Md. “But he never came back. It was a stair step down to the basement.” Despite financial resources and a devoted daughter, Walski’s dying was far more chaotic and painful than it needed to be.

She engaged another oncologist who asked her, “What do you want to accomplish?” Ms. Berman said that she was aiming for a “Niagara Falls trajectory:” To live as well as possible for as long as possible, followed by a rapid final decline.

It has been eight years since then, and Ms. Berman is now 59. She hasn’t undergone surgery or chemo, been hospitalized or gone into debt. A daily estrogen-suppressing pill slows her disease, and a one-time intense burst of “palliative radiation” eliminated pain from cancer cells that had spread to her spine. She’s kept working, ridden a jet ski to the Statue of Liberty, written for the Washington Post, watched her daughter graduate from college and gone snowmobiling in Iceland. “Most doctors,” she says, “focus only on length of life. That’s not my only metric.”

PANSY died peacefully one winter’s afternoon, her daughter Rosie and her friends Blossom and Chippy by her side. As she lay dying her companions stroked and comforted her; after she stopped breathing they moved her limbs and examined her mouth to confirm she was dead. Chippy tried twice to revive her by beating on her chest. That night Rosie kept vigil by her mother’s side.

Pansy’s death, in December 2008, sounds peaceful and relatively routine, but in fact it was highly unusual. Captive chimpanzees are rarely allowed to die at “home”; they are usually whisked away and euthanised. But the keepers at Blair Drummond Safari and Adventure Park in Stirling, UK, decided to let Pansy stay with her loved ones until the last so that their response to her death could be observed.