Preparing For End of Life(Death)

In the Mahabharata, a powerful sprit named Yaksa asks the oldest and wisest of Pandava, Yudhishthira, what is the greatest of all mysteries. The answer given resounds across the millennia: “Everyday countless people die, and yet those who remain live as if they are immortals”.
In our mind, we all know that one day we are all going to die. But we do not want to think about it, talk about it or have anything to do with it, let alone plan for it. But people, young and old die every day, everywhere.There is no escape from death, no matter who we are, how good our health is, or how rich or poor we are, or what good health care we can get.
Most people want a good death. But what is good death? Some people would say there is no such thing as a “good death”, and all deaths are unwanted and unwelcome. Deaths of children and young adults are never welcome. But what if you are and sick and no longer able to care for yourself? What if you become demented and no longer recognized your loved ones? What if you have an incurable and painful disease that has progressed to such an extent that you wish to die?
There is no definition of “good death “says Dr Nuland in his classic book “How We Die” (Alfred A. Knopf.1993). He continues: “The classic image of “good death “and “death with dignity” is a mirage for most dying people. The idea must be discarded. Death rarely acts according to our plan or even to our expectations. For most of us, death will be messy. For too many of us, the manner of death will prove to be beyond our control and no knowledge or wisdom can change that.”
In olden days, treatments options were limited and most people died at home surrounded by their loved ones. Now advanced medicine is full of treatments (respirators, dialysis, defibrillators, chemotherapy, and feeding tubes, to name a few) that postpone death and prolong misery without restoring health.
How can you reasonably be prepared for your death?
1- Think of your death as a rite of passage like-birth, infancy, youth, adulthood, old age, and disability. Those who think about their aging, disability, death, often live better lives and experience better deaths than those who do not. They shape lives of meaning, joy and comfort even as their bodies decline. If you accept the reality and plan for it rather than fight it, your final passage will be easier.
2-Discuss your end- of- life wishes with your family, friends and physicians. Do you want to die in your own home or in a hospital’s intensive care unit (ICU)? Do you want CPR (cardio pulmonary resuscitation), breathing machines (respirators), kidney dialysis, tube feeding or not? If you suffer from pain, do you want enough pain medicine to keep you comfortable and may be less alert or you want to bear some pain but stay alert?
3- Know the trajectory of your illness. Modern healthcare is designed to help people stay alive and most patients also want that when they are sick and scared. If you face a frightening diagnosis, ask your doctor about the treatment plan, the cost, the likelihood of its success and how long you might live. Keep in mind that such predictions are unreliable and most doctors tend to overestimate the benefits of a treatment plan. Prediction of how well a particular treatment will work or not work is not an exact science. Medical prognosis is notoriously difficult. It is usually based on medical studies of a large or small patient population which may not be applicable to you. Each patient is different. Based on your doctor’s answers you may shift the emphasis from treatment to comfort care (hospice care). Do not be afraid of hospice. It will not make you die sooner, but you are more likely to die well. Studies have shown that terminal patients under hospice care live few months longer than those who receive aggressive treatments.
4- No matter the age, disease or disability, live the life you want to as much as you can. Visit friends and family, especially grandchildren or have them visit you. Socialize any way you can. Eat the food you want, travel the places you can and see the shows you want to .Exercise- walk, bicycle, swim, garden, help in the household chores and stay engaged as much as you can. Exercise keeps your body stronger and mind more alert.Do not give off on life even if death may be near.
5- Execute a health-care proxy and designate an individual you trust to make healthcare decisions on your behalf in case you became incapacitated. Many times family members do not agree on the course of treatments for their loved ones and that leads to indecision. A person with legal health care proxy will have the final say in the matter and his/her decision will be legally binding on the doctors and the hospital.
6-Execute a Living- Will or Advance Healthcare Directive, stating your end-of life wishes like home or hospital death, CPR or no CPR, organ donation and funeral wishes. It is important to let your wishes known to your family members and the treating doctors. If you are old or suffering from some terminal illness, execute the health-care proxy and the living will as soon as possible.
7- Saying good-byes.
Make peace within yourself and with your family. Ask and extend forgiveness. It will give you peace of mind. Why die as an angry old man or woman?
Conclusion
“Death is certain for the born, and birth is certain for the dead”, says the Bhagavad Gita. ‘A time to be born and a time to die’ says the Bible. We influence our lives, but we do not control them, and the same goes for how they end. No matter how strong we are or how brave we are, or how religious we are, dying will represent the ultimate loss of control. We cannot hope to fully predict death, just as we cannot hope to fully predict life. But we do not have to be a passive victim. We can shape our life to some extent (not always) all the way to the end-as long as we plan for it. The best way to achieve a peaceful death is by planning ahead and enlisting the help of loved ones.