Art Buchwald was a most remarkable man, funny and unique, and his death is a loss to legions of fans. Much as he has been hailed for his courage in the face of mortality, however, his predicament was far from uncommon. The reality is that every day, thousands of Americans watch the end of their lives approaching. They just don’t have nearly as dignified an experience.
In recent years, the manner in which Americans die has changed utterly. The leading causes of death used to be sudden – heart attacks, strokes and accidents topped the list. Between prevention programs, emergency tools like E-911 and portable defibrillators, and enhanced safety of products and workplaces, these sudden causes have fallen dramatically. Now most people die slowly – of Alzheimer’s disease and AIDS, Lou Gehrig’s disease and cancer.
This shift from fast to slow creates an opportunity for people to shape the end of their lives in a way never before possible. In polls, most people say they’d like to spend their final days among loved ones, their pain managed and affairs in order, hopefully with some degree of spiritual calm. That sounds a lot like Art Buchwald, who spent his last months among family and friends. He kept writing, even authoring a new book. He maintained his optimistic, hilarious personality right to the end.
Most people are not so fortunate. They encounter a medical system that exerts life-prolonging technology even when it is clearly futile. They deal with doctors who are experts at everything but listening. They endure untreated pain and needless emotional suffering. They discover that health insurance and Medicare set frightening limits on how much end-of-life care they can receive. They reckon with backbreaking expenses; indeed health care costs are now the nation’s leading cause of personal bankruptcy, even for people with insurance. And they realize to their chagrin that the advance directive they hoped would spare them from unnecessary interventions actually carries no legal weight.
A lucky few find themselves in hospice and palliative care, which focus on comfort and involve the patient’s family in caretaking and decision-making. These people experience a dignified and fulfilling final phase of life. But that’s a rarity. Three-quarters of Americans do not end their lives in such a warm medical embrace.
It will take a revolution among health care consumers, when they decide they have seen enough of their loved ones’ preventable suffering, to make every person’s final months as peaceful and humane as Art Buchwald’s. It will take better end-of-life training for doctors and nurses, as well as reformed insurance and Medicare rules. It may even require expansion of the Patients’ Bill of Rights to include such things as pain control and access to hospice. With these steps the nation will save money even as it improves the quality of care.
Twenty years ago my father was inexplicably seated beside Art Buchwald at a fund-raising dinner. I’d just been admitted to graduate school in writing, and my conservative banker dad told Art he was worried I would never make a decent living. In reply, Art regaled him with story after story from the rich and rewarding life he had led as a writer. The message worked. When I went off to grad school my father was still concerned, but he gave me his blessing. After I published a book last year, Art was kind enough to write me a note saying he’d bet my dad would be proud.
It was an incredibly touching gesture, but that’s not all. His letter also manifested what is possible when a dying person has the twin benefits of a loving family and good medical care. There is time for all kinds of meaningful final actions.
As we now praise Art for how generously and entertainingly he wrote his life’s final chapter, we should also advocate for health care policies that make his achievement as everyday as aspirin.