Hospice care offers peace, comfort for terminally ill

As our population ages, much literature has appeared concentrating on living well in our final years. But publications aimed at helping people die with grace have virtually disappeared.

In the age of faith, by contrast, there were many guides to the art of dying. In the Aug. 2 issue of The New Yorker, Dr. Atul Gawande, who teaches at Harvard Medical School, noted that a Latin guide to "the good death" was published in the year 1415 and reprinted in more than 100 editions across Europe.

Acknowledging that everyone is destined to die, the guide cautioned against the futility of mere materialism, because one can't carry material things into eternity. However, the manual added, many things can be cultivated in this life that will be possessed fully in the next, among them love, knowledge, appreciation and even adventure.

The book deemed wealth, honor, power and lust to be vanitas vanitatum (vanity of vanities). The faithful were urged instead to approach death by focusing their lives on the love of God.

Such guides, Gawande notes, "provided families with prayers and questions for the dying in order to put them in the right frame of mind during their final hours." A dying person's last words came to hold a certain reverence.

Before medical technology became sophisticated, death came relatively swiftly. But today, Gawande notes, "for most people death comes only after long medical struggle with an incurable condition — advanced cancer, progressive organ failure (usually the heart, kidney or liver) or the multiple debilities of old age. In all such cases, death is certain, but the timing is not. So everyone struggles with this uncertainty — with how, and when, to accept that the battle is lost."

The cost of postponing the inevitable is pain and helplessness for the terminally ill, and incredible expense for medical care.

Gawande notes that "25 percent of all Medicare spending is for the 5 percent who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit."

The article noted that surveys of terminally ill patients reveal that their own priorities are to avoid suffering, be with loved ones, have the touch of others, be clear-minded and not be a burden to others. "Our system of technological medical care has utterly failed to meet these needs," Gawande laments.

For the terminally ill, the art of dying is best practiced at home or in a homelike hospice rather than in a hospital room. Instead of fighting for an impossible cure, hospice care fosters peace with one's mortality.

Hospice care deploys nurses, doctors, and social workers to assist people with a fatal illness to be free from pain and discomfort, remain mentally alert and enjoy family and friends. It means welcoming the inevitable instead of fighting impossible odds.

David Yount is author of 14 books, including "Making a Success of Marriage" (Rowman and Littlefield). He answers readers at P.O. Box 2758, Woodbridge, VA 22195 and dyount31@verizon.net