In the winter of 1919, my great uncle Roy McCoy developed a cough and fever. The story goes that the country doctor was called and came to his bedside. The doctor didn’t have anything to offer except the basic treatments of the day. Roy got sicker and the doctor was called again. When the doctor left, he told the family that Roy was likely going to die. He was the oldest boy in the family. He had 5 younger brothers. He was told that he likely would not survive. The story that has been passed down reveals that he said the most amazing and simple thing to his parents. He said, “I am not afraid to die, but I do not want to.” At the age of 21, he had a mature view of life. Death was accepted as a part of life in those days. Even the death of a child was considered a part of life.

Almost 100 years later, we view death very differently. Death is now viewed as the ultimate enemy. Death is thought of as the result of failure. We don’t accept that death is a part of life, even at a very advanced age. Watching someone die and surviving the death of a loved one has always been painful. It will always be painful. However, our perspective today involves avoiding death at any cost. When a person has walked the path of watching someone die, they gain insight into the reality that death is a part of life. Not long ago the son of a patient of mine visited with me about his dying mother. He related that a few months ago he watched another relative get sick and die. He came to the conclusion that, “There are worse things than death.” 

Often in patient care during a hospitalization it becomes very apparent that the patient will not survive the illness. If they do survive, they will never return to their usual activity level and living environment. This fact is often more clear to the medical staff than family. It is difficult to approach families with the possibility that maybe doing less is the right thing. We fear that families won’t understand that we want what is best for the patient, even if that is death. Not long ago I was dealing with a dying patient with pneumonia. Despite our best efforts she was getting worse. I approached the subject of backing off on treatment several times with the daughter. She interrupted me during one of my clumsy attempts to say “I think we should let your mother die.” She said something like, “Dr, I think you want to say something and you don’t think we can stand hearing it. I want you to tell me what you want to say.” I did tell her openly that her mother was not going to survive. Our best attempts were only prolonging her suffering. We were doing more harm that good. I ended my visit with her by saying, “Helping your mother die is the last loving thing you can do for her.” She cried and thanked me for saying that. We stopped all treatment that afternoon. The next morning her mother was gone, and the suffering was over. 

I hope we can develop a mature appropriate view of death in this country. My hope is to help minimize and ease the suffering of the dying. We must learn to openly discuss and not fear death as failure. We must learn to allow people the freedom to die once we have done all there is to help them live.