This is not my first posting regarding  end-of life issues and, I surmise, it will not be my last. 

I have no illusions that this posting will do much to bring the topic forward to where it belongs–public discussion and debate.  Ironically, the most personal and private of life's decisions must be discussed publicly and what better forum to begin than on Oprah's show ?

  We must be able to openly and frankly talk about the difficult issues because 1] they will not go away on their own, 2] they will only become more of an issue as our population ages in massive numbers, 3] they will contribute to the demise of our entire health care system as they consume enormous  amounts of economic resources.

Statistics certainly vary regarding how much money is spent on the last six months of anyone's life but they are clearly considerable.  I would be the last one to even consider the amount to be the issue. Yet is it not reasonable to consider the best use of health care dollars?  Is it not possible to shift these financial resources away from fruitless end-of-life care to others who will truly benefit from them?

This is the rare situation in which economics and metaphysics coincide.  It may very well be the case that the  best moral and ethical decision saves society money as well.

What is  at stake is our society's entire metaphysical perspective on life and death.  Attention, attention–death is not a disease.  Just as we were born, we shall die.  You've heard it hear first.

The participants in such a discussion must include, physicians, nurses, economists, ethicists,  philosophers, theologians from the major world's religions and other interested parties.

We need to view death as the normal expected outcome of being born.  Clearly it is to be resisted, confronted, overcome whenever possible I have spent the majority of my life on this planet attempting to do just that.

  Of course it is obvious that we must do  everything reasonable to prolong life.  But the operative word is reasonable.  And granted, there will always be an enormous and troubling gray zone in which much debate will exist as to what constitutes reasonable. 

But there is NO doubt that elderly, demented, cancer ridden individuals [to use three of the stereotypical scenarios] suffering souls have been trapped by the health care system into undergoing painful, expensive and hopeless testing, procedures  and drug therapy.

Society, all of us, must begin to realize that just because we can keep people "alive" in some sense does not mean we should.  We need to see that our loved-ones are not truly living when they are in such a state of existence.  When decisions need to be made regarding prolonging treatment, or placing feeding tubes we need to do what is best for them, not for us. 

 When you love someone, the greatest expression of that love may be to let than go in peace.

Let us openly talk about the good death. The passing from this plane of existence in peace, surrounded by loved-ones and devoid of tubes, catheters and monitors.

My own Mother, suffering from unremitting dementia and weight loss died in her own bed, without a feeding tube. When she was disoriented, she looked up, recognized  her own wallpaper and was temporarily at peace.  Had she spent her last days in a hospital I have no doubt that we would have had to restrain her, restart her iv, replace her foley catheter, strap her into one of those demeaning blue plaid harnesses.  Thankfully we were all spared that scenario.

Just consider what I am saying here. This does not mean turning over these decisions to heartless "death squads" either.

Just because this is a difficult, painful and emotional topic, doesn't mean we can or should continue to avoid it.

I hope 2010 will be the year we begin to talk about it all.  Oprah, are you listening ?

A  happy and healthy and peaceful  2010 to us all.

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