As new generations age, with some 10,000 Americans expected to turn 65 every day over the next 15 years, the ability to extend life is increasing. But a logistical conversation about death is one that families, couples and policymakers can't avoid.
"Have you had the conservation?"
That's what 73-year-old Pulitzer prize winning journalist Ellen Goodman will ask when she's talking about the experience caring for her elderly mother that prompted her to co-found The Conversation Project, an initiative encouraging families to discuss their wishes early on.
Americans of a certain age -- you know who are, Baby Boomers -- may be having this conversation on end of life wishes with parents, while starting to think about having the conversation with adult children.
"The one thing that everyone has in common is that we're all mortal," said Goodman, who'll be exploring the topic at the AHIP Institute 2014 conference in Seattle along with Ira Byock, MD, a Dartmouth professor and advocate of "dying well," and Diane Meier, MD, the director of Mount Sinai's Center to Advance Palliative Care.
"Everybody has a story," said Goodman, a longtime Boston Globe columnist. "It's usually a story of a good death or a hard death."
Goodman isn't quite sure whether her mother, who suffered from dementia and passed away at an assisted living center in Greater Boston at the age of 92, had a good or bad death. That issue is a subjective one, and she has a larger goal.
"Basically a good death to me is one in which you are comfortable and not in pain and that leaves your survivors not depressed, anxious or guilty about whether they've done the right thing," Goodman said. "That varies tremendously among people."
The Conversation Project did a survey last fall and found that 90 percent of Americans think it is important to discuss end of life wishes, but that only 30 percent have had such a discussion with family members.
"We really need to change the culture," she said. "Our goal is to get people to the kitchen table and get them to talk."
"My mother and I had talked about all things except this one thing," Goodman recalled. "She would point to people in a bad place and say 'Pull the plug' but there's often no plug."
"It would have been much easier for me if I had heard her voice in my ear saying, 'I don't want any more treatment.' Or conversely, 'I want to stay alive as long as possible.'"
There is a conversation about death facing American society, from paying for experimental treatments, hospice and palliative care to whether terminally ill patients of sound mind should have legal rights to compassionate aid in dying. These issues are not going away.
Physician-assisted suicide, or death with dignity, is rare in the states that allow it -- Oregon, Washington, Vermont and Montana -- but its emergence is something the public will have to confront, either via their state legislatures or by popular referendum. In 2012, Massachusetts voters rejected the Death with Dignity Initiative by a vote of 51.9 percent to 48.1 percent.
The other two end of life specialists speaking at AHIP -- Dartmouth's Byock and Mount Sinai's Meier -- are both opponents of assisted suicide on principle.
In practice, they hope palliative care, like the initiatives they are plying, can reduce interest in legalizing the practice to begin with, in part through creating new ways of dying that address and avoid the concerns of death with dignity proponents -- loss of quality of life, emotional suffering and intensive hospital care.