Dying well is among our top concerns

Gertrude Weaver died in Camden, Ark., on April 6 at the age of 116. She was officially the oldest person in the world when she passed away.

"She was a really sweet lady. She was relatively perky and coherent when I talked with her," Camden Mayor Marie Trisollini said. "When you asked for advice on how to live a long life she would say, 'Use a lot of skin moisturizer, treat everyone nice, love your neighbor and eat your own cooking. Don't eat at fast food places.'"

I'll probably start using more hand cream but that will be about the extent of my quest for longevity. In that respect, I am bucking what is reported to be a megatrend among the richest of the extremely rich in the princely kingdom of Silicon Valley: investing in and donating to the search for the fountain of the youth.

This is an old idea. But for some of today's more utopian technologists, aging is just another problem to solve using big data, disruptive science, innovative research and other reformulations of what the ancients called reason.

Peter Thiel, a founder of PayPal, is a leader of the charge to conquer the four-score life span. "I believe that evolution is a true account of nature," he told the Washington Post recently. "But I think we should try to escape it or transcend it in our society."

A lot of great science and medicine will come from this wave of venture and philanthropic capital. But the people I actually know, stuck in the shackles of evolution as we are, care a lot more about dying well than hitting 100 or transcending Darwin.

Indeed, the megatrend I see is the growing preoccupation we have about the modern way of death, about losing control of our lives, dignity and comfort to a medical system that has more reason than wisdom.

Few families today haven't had to deal with a relative lost to dementia, kept alive--sort of--by good medicine; or a loved one who has endured a grueling bout with the latest but still futile chemotherapy; or a decision to end life support.

The preoccupation is most acute among baby boomers who have cared for their parents and looked down the road to their own dotage. But young people see this too. There are good reasons why a book about bringing more humanity to the end of life, Atul Gawande's Being Mortal, has been on top of the best-sellers' list for six months: rational fear and natural compassion.

As I've crawled through middle age, I have already been confronted by end-of-life decisions for my elders three times: once to end life support, once to end chemotherapy against the strong counsel of the doctor, and once a discussion about stopping coronary care that concluded before a decision had to be made. I've seen renowned doctors be helpful, recalcitrant and uninvolved in the end. I don't think there is anything unusual about my experiences.

Debates and conversations about end-of-life care, or care after the loss of agency and awareness, ultimately end up as arguments about the right to die, death with dignity, assisted suicide or physician-assisted death--different names for the same basic idea. The public debates about this aren't frequent. They should be.

But there is also a whole other stratum of less dramatic but more common situations about life and death that don't happen in the final days. These can be decisions about whether to even try a long-shot cancer treatment. Or about whether an Alzheimer's patient wants to live--or be kept alive--past a certain point of incapacity.

As medicine extends life, more tragic choices will have to be made. I don't know how medical providers and medical consumers will prepare for that. It is hard to see how politics and government can be helpful.

But I don't think my fellow baby boomers will tolerate being treated like our parents and grandparents were treated. We are, after all, babies: pushy, needy, impatient, mistrustful of authority (even if we are the authority now) and not very stoic. We have hoisted a lot of cultural, religious and social change on the country. We're not done.

Our next big cause will be the final one.

Dick Meyer is chief Washington correspondent for the Scripps Washington Bureau and DecodeDC.

Editorial on 04/19/2015

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