Cultural Fear of Death, Part 2

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Cultural Fear of Death, Part 2

 For to me, living is Christ and dying is gain. Philippians 1:21

Last week I referred in passing to the high cost of dying. The costs can be financial, emotional, physical, and/or spiritual. Those costs go up when death is needlessly delayed in ways that are based more on the fear of dying – fear on the part of the patient and/or the patient’s loved ones – than on what can be reasonably expected to prolong a decent quality of life. I want to begin this week by sharing some of the financial costs of dying in America. The costs vary by state, and I did not find a lot of specific information about the costs, except that these cost averages include both funeral expenses and end-of-life healthcare costs. The most expensive state in which to die is Hawaii, which in 2019 was estimated to cost an average of $41,467. The least expensive state was Mississippi, which in 2019 was a mere $18,500. A measure of the high financial cost of prolonging imminent death came from a study several years ago estimating that an average of 80% of one’s lifetime healthcare costs were accrued in the last two months of life. Although I am not certain of the accuracy of that figure today, I know that the average cost of being on life support is over $10,000 per day. Twelve years ago (in 2008), Medicare reported paying $50 billion in physician and hospital bills for patients during the last two months of their lives. No doubt, that number has increased exponentially since that time. My point is not so much the actual numbers, but that dying is expensive, both to individuals and to society, and unnecessarily prolonging death drives the costs even higher. As I noted last week, I am not arguing that reasonable steps to prolong life should not be taken. If, as I suspect, many of the financial resources spent at or near death are justified by our unreasonable fear of death, then I think we, as a society, must carefully examine the sources of that fear. At some point we must ask if there are better ways to spend the money.

Obviously, the emotional costs of dying are impossible to quantify, nor is such quantification necessary. Death is an emotional experience for all involved, so it is safe to assume the burden is high. The question, from a utilitarian standpoint, is whether the emotional costs go higher when the dying process is needlessly prolonged. My sense is that they probably do, although I think that is somewhat time-dependent. For example, if someone receives a terminal injury from a car accident or other immediate and unexpected cause and has been kept alive on life-support while medical professionals assess the extent of the injuries and the prognosis for recovery, I believe some amount of prolonging life is helpful for the family to emotionally process what has happened and to be counseled that the chances for their loved one to recover are essentially nil; and to say “Goodbye.” At the other end of the spectrum is someone who slips into a coma from which they are unlikely to recover after being terminally ill for an extended period. In this latter case, the loved ones have (hopefully) had the opportunity to understand the course of the illness and prepare themselves for the inevitable end. If they have not had that opportunity, the fault would point to an obvious shortcoming in our care system. On the other hand, those who have had an extended amount of time to process the impending death and who still refuse to accept the medical reality of the situation may be of a nature such that they will never accept death as inevitable, regardless of any counseling or comfort measures offered. In the case of my grandfather, my sense was that he needlessly prolonged an emotional, extended, and painful dying process because of his own refusal to accept the end of his earthly existence. I hope I am not being unfair, but that is how it appeared to me after many months of being shuffled between the hospital and a nursing home. I write this not as a criticism of him, but as a reminder to myself that perhaps there comes a time to not hold on so tightly. It might ease the dying process.

Clearly, the costs of dying are only one part of the equation of dying well, but when money is tight and the basic needs of the living are overwhelming, I believe the wisdom of extending life at any cost needs to be examined. I will consider the physical and spiritual costs of dying next week.

This is the 28th in the series of Life Notes titled, If I Should Die Before I Wake. I invite your thoughts, insights, and feedback via email at ghildenbrand@sunflower.com, or through my website, www.ContemplatingGrace.com. At the website, you can also sign up to have these reflections delivered to your Inbox every Thursday morning, if you are not receiving them in another manner.

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