Let's talk about dying ...just shoot me is not a plan

According to a 2014 Dying with Dignity Ipsos-Reid Survey, 84% of Canadians agree “a doctor should be able to help someone end their life if the person is a competent adult who is terminally ill, suffering unbearably and repeatedly asks for assistance to die”.  While the push to legalize physician-assisted suicide has Canadians passionately debating the right to die and what it means to die with dignity, the debate has had little effect in motivating those who are healthy to prepare for their own eventual date with the Grim Reaper.

We communicate our fear of dying in subconscious ways

Research indicates that most people are fearful of suffering during the dying process. I think we communicate this fear subconsciously through actions that let us believe we can cheat death. These actions are not necessarily bad for us, and may even motivate us to continue living life to our fullest, but they do nothing to ease the way into death or make our dying easier for those we love.

One way we may communicate our fear of dying is to pretend that we are not getting older, obsessing over aging, or jealously guarding our independence, symbolized in our reluctance to surrender our driver’s license, or downsize our home.

We avoid taking practical steps to make our death and dying easier for others. Only 56% of adult Canadians have a signed will, and less than 29% have appointed a power of attorney; fewer have designated a substitute decision-maker for personal care and health matters.  We are highly unlikely to preplan our funeral, even though 75% of us believe doing so would make things easier for our family.

Even our spiritual preparation for death can be limited to our last days when our families seek out the priest to hear our deathbed confession and administer the last rites. 

We think we have lots of time to prepare ourselves to meet our maker and to get our affairs in order, even though death is the one certainty in life and the Grim Reaper lurks in the shadows.

Creating an Advanced Care Plan

The Canadian Hospice Palliative Care Association, partly in response to the public discussion about euthanasia and physician-assisted suicide, wants to shift the public conversation towards the importance of quality hospice palliative care and away from some of the more negative views of death, which, in my view, have played a significant role in shaping Canadian support for physician-assisted suicide. The organization has a suggestion that can help us prepare for our own death and dying.

It recommends that we start talking about end-of-life issues with our family, friends and health-care providers, and suggests that individuals create an Advanced Care Plan (ACP) that will provide direction for our care when the time comes. An ACP can guide us in articulating our personal beliefs and values, and can help us clarify our own attitude about dying and what constitutes a good death. It gets the discussion moving about the types of medical interventions that we would accept or reject if faced with a chronic illness, or a life-threatening illness or injury. And, it provides information on the legal requirements and documents that will enable others to act on our behalf.  An ACP is not a sign-up sheet for physician-assisted suicide or euthanasia; it is a comprehensive plan that can help us live out our life until its natural end.

While the public discourse has Canadians talking about the death and dying of a small minority, most of us skirt around the topic of our own mortality. We avoid planning for that unavoidable dance with the Grim Reaper.

The Grim Reaper can be a motivating image

The Grim Reaper, incidentally, became embedded in the European psyche during the bubonic plague of the 14^th century, when no one could forget the reality of death. It was sometimes depicted in an embrace with a young woman to symbolize that death is an integral part of life. Rather than frighten us, it is an image that can remind us to live well, to never give up on the journey towards wholeness and holiness, and to follow confidently in the footsteps of Jesus who embraced the world from the cross and shows us the way through suffering.

The conversations I have with others about death are largely superficial because the topic can become morbid and depressing. We talk about avoiding suffering, and we would prefer to die in our sleep after a long, healthy and happy life. And, should we become decrepit or senile, we joke about telling our kids to “just shoot me”, which really is not much of a plan when it comes to preparing for death and dying.