When William Hanley of Ligonier, PA learned that his prostate cancer had spread to his bones, and had become incurable, he did a most unusual thing. He lived his life to the utmost for as long as he possibly could.
William was a devil-may-care man who always affixed tractor-trailer horns to his cars, in order to blast anyone foolish enough to cut him off in traffic. Upon hearing the bad news, one of his first acts was to mix a pitcher of gin and tonics. Then he made a plan: He would work with a medical team to get his pain under control. He would spend the summer enjoying a favorite pastime of his younger days – the shooting game of skeet – and he would under no circumstances die in a hospital.
William spent that summer traveling the south and west in skeet competitions. In one meet he won by scoring 25 straight clays, the equivalent of bowling 300 or batting 1.000. Then he went home into the arms of hospice, where he died a champion.
Skeet may not mean much in the grand scheme of things, but it meant a great deal to William – and his story means even more to the people of Pennsylvania. With the Rendell administration’s release of “Improving End-of-Life Experiences for Pennsylvanians,” the state now has a plan for making dignified endings like William’s far less rare http://www.post-gazette.com/pg/07036/759548-85.stm.
The need for this plan is acute. America’s health system was built to respond to the primary causes of death 30 years ago, all of which were sudden events like heart attacks and strokes. But today most people die slowly, of cancer, Alzheimer’s disease and the like. The health system has not evolved to reflect that reality.
The results are threefold: The first is avoidable suffering. People encounter a health care system that does not know how to treat pain, that does not understand how precious every second is to a person whose life is ending, and that is better at intervening with unwelcome technology than it is as listening to the needs patients and families express.
The second result is financial distress. Medical bills have surpassed credit cards as the nation’s leading cause of personal bankruptcy, even among people with health insurance. Meanwhile each year about one-third of the Medicare budget goes to the care of people in their final weeks.
The third outcome, and perhaps the worst one, is that so many people miss the opportunity for a fulfilling final chapter of life. If a person’s pain is under control, and he can take a decent breath, he can attend to all kinds of non-medical priorities: getting his financial affairs in order, mending relationships, expressing and receiving love, perhaps even attaining a measure of spiritual calm.
What would Gov. Ed Rendell’s report do about today’s problems? Give patients a greater voice in their care, through advance directives. Require doctors and nurses to know how to treat the dying. Pay medical professionals fairly for their work with terminally ill people, which takes time to do well. Educate Pennsylvanians about resources to them turn a challenging time into a fulfilling one – palliative care, which assures their comfort while in a hospital, and hospice, which enables those who wish to conclude their lives at home among family.
In all the new report has 160 recommendations, nearly all worthwhile. A growing number of states are showing similar initiative. California required doctors to learn how to treat pain. Oregon sanctioned a doctor who ignored patients’ suffering. New Hampshire, which holds the first presidential primary, is now home to a grassroots group that intends to make every candidate describe what ought to be done to make dying peaceful and pain-free. This is all great news, because we will all walk this road someday.
At the end of William Hanley’s memorial service, there were no mournful tolling bells. Instead his son drove William’s car to the front of the church, and let loose a blast from those infernal truck horns. The congregation laughed.
With 128,000 Pennsylvanians dying every year, constructive ideas to improve life’s last chapter likewise deserve to be trumpeted.