Steve Lopez would prefer to go out on a cloud when the time comes -- preferably… (Dai Sugano / San Jose Mercury…)
Back when my father's life was coming to an end at an excruciatingly slow pace, my brother and I vowed not to die like that, with so much compromise and indignity.
But hanging on seems to be the norm in our culture, thanks to advances in medical technology and the widely held opinion that death is optional. Lots of folks seem convinced that even aging is avoidable — if you just keep getting more work done.
Is it like that in other cultures?
Last week, I chatted with several people who will speak next weekend at a Claremont Lincoln University bioethics conference, discussing cultural and spiritual traditions about dying, among many other topics.
Dr. Faisal Qazi, an Inland Empire neurologist who will talk about brain death from an Islamic perspective, told me he recently had two medical students from Pakistan make the rounds with him. As he checked on elderly patients diagnosed with Parkinson's disease and dementia, the students told him that where they came from, such patients might well be diagnosed simply as having "old age."
The U.S. has the best tools in the world to diagnose and treat illness, Qazi said. "But I think we are miserably failing in quality of life."
"Can I put a bee in your bonnet?" University of Hawaii professor emeritus S. Cromwell Crawford asked in a telephone interview. "If you really want to get into this death and dying conversation, in the medieval period they used to have publications addressing the subject, and they were collectively known as the 'Ars moriendi.' The art of death."
Ars moriendi, written in the time of a killer plague, concluded that death was not something for Christians to fear.
But there were, of course, no ventilators or antibiotics back then.
"If technology is available, it's going to be used," said Crawford, who is 84 and makes daily visits to a 24-hour gym in Honolulu. "Then people wise up after some time, because technology is never free. There's a cost to it … and there is moral reflection. All right, we've got the money and we're spending it, but is this the right thing we're doing, morally?"
Whitny Braun, a bioethicist at Loma Linda Medical Center, will speak at the Claremont conference about a dying tradition from the Jain religion called Sallekhana.
"I got invited to a birthday party for an 80-year-old man," Braun said of a research trip to India. At the party, the man asked for permission to die from a guru who denied the request, saying the man still had some productive years ahead of him.
"Sallekhana is the Jain belief that you pick the time at which you think it is best for you to exit this world, and you do so in the most nonviolent way, which is to starve yourself very slowly."
The tradition is thousands of years old, but it's now being challenged as a form of suicide and inappropriate in a country that wants to become a fully developed democracy. But to many Jains, Braun said, Sallekhana is not suicide, but a good and honorable death.
"For Judeo-Christians the body is the temple of the soul, so you want to maintain, protect and keep the temple going as long as possible," Braun said. "Whereas with Jains, Hindus and Buddhists, the body is a prison for the soul, so you're trying to extricate your soul as quickly as possible.... Death is followed by immediate rebirth."
Dr. Nitin Shah, who works in critical care and internal medicine in Long Beach, will chair the conference. As a Jain, he can talk about the role of religion in the deaths of his wife and parents, and how he applies those experiences in his medical practice.
"My wife got breast cancer when she was 29," said Shah, who was born in India, worked in Zambia and Zimbabwe, and moved to New York in 1987 so his wife could get better treatment. The cancer had moved to her lungs and bones.
After surgery, three rounds of chemotherapy and two rounds of radiation, she was in remission. But in November 1989, she told Shah that if the cancer came back, she would refuse the rigors of continuing to fight a terminal disease, be grateful for the time she'd had with her husband and their 7-year-old son, and leave this world.
"Three months later, the disease started coming back and she said, 'I'm sticking to my decision….' She died at home, in her own bed, with a lot of family around…. It was a very smooth transition from life to death."
In later years, Shah's father decided not to fight lung cancer when told that chemotherapy would have unwanted side effects and perhaps give him only a few extra months. And his mother refused bypass surgery after a heart attack and soon died.
Shah said he shares these experiences with his critical elderly patients, as he tells them about the benefits and burdens of life-extending measures.
"We as Americans refuse to accept death as an eventuality," Shah said. "But we're all going to go, some sooner, some later."
Though I respect the Sallekhana tradition of starvation, and the Christian tradition of suffering as an act of redemption, I'd prefer to go out on a cloud when the time comes — preferably with a fast-acting doctor-prescribed medication — and be less of a burden on loved ones.
Braun suggested that if I don't move to Oregon or Washington, I might consider the Netherlands or other parts of northern Europe. That's a largely agnostic region, she said, and though you'd think religious societies would be more comfortable with death, in some respects it's the nonbelievers who have better hospice centers and more end-of-life options.
(For more information on the conference next weekend, go to http://www.jain.claremontlincoln.org).