Dying To Die Well

April 28, 2012

Death, Dying

I was in my late 40’s before I saw someone die for the first time.  I subsequently learnt that this is not unusual.  In the first half of the last century most people died at home surrounded by family members.  Now, most of our adult life passes without personal contact with someone who is dying.  Most people now die in hospitals and often in intensive care units, isolated from family members by screens, IV stands, tubes, wires and a bewildering variety of life support machines. The result is that we, as non-professionals, have lost our knowledge of the physical, psychological and spiritual aspects of death and dying.  Set this situation against the background of diverse and often conflicting political, medical, financial, and cultural issues and it is not surprising that we have a sub-optimal situation, to say the least.

Technology has transformed many formerly acute conditions into chronic conditions, where patients die very slowly.  It is this relative success that has changed the medical profession’s view of death from something that is natural, and a part of life, to something that has to be fought, and if possible, vanquished.  The generalist concerned with the needs of the whole patient has been replaced by the specialist, whose duty is to cure the patient, if necessary, one organ at a time.  This is more than just semantics.  A heart attack at 65 is different from a heart attack at 85.  The former represents an illness that surgery may be able to cure or at least provide some additional years of quality life.  The latter represents the body’s way of saying that life has reached its natural limit.  In the former case aggressive surgery may be justified, in the latter case it is hard to see how it can be justified. 

A close family member of mine was diagnosed with an advanced stage cancer.  Without sufficient discussion about what aggressive treatment would mean for someone who was already weak and had only a small chance of surviving, the physician recommended chemotherapy.  Instead of dying peacefully in her own home, surrounded by friends and family, she died scared and alone in a hospital, suffering the effects of chemotherapy poisoning.  More importantly, she was denied the opportunity to take care of her business of dying – tying up loose ends, saying things that needed saying and bringing closure to her life while surrounded by her loved ones.

There is some hope for change, as a natural dying movement is gaining ground.  However, the basic dilemma remains.  How do we, as a society, find a way to get physicians just as concerned with the patient’s quality of life as they are with finding new technologies and therapies to extend the patient’s life?  Doctors don’t always listen to patients’ and families’ wishes.  End-of-life policies are implemented differently state by state, hospital by hospital, doctor by doctor and person by person.  Furthermore, laws and cultural mores have not kept up with the way dying has changed in such a short time.  There is no consensus about when treatment makes sense, when it harms the well-being of both patient and family and when treatment should stop.

“Where is the life we have lost in living?  Where is the wisdom we have lost in knowledge?  Where is the knowledge we have lost in information?’  T.S. Eliot


About Malcolm Greenhill

Malcolm Greenhill is President of Sterling Futures, a fee-based financial advisory firm, based in San Francisco. I write about wealth related issues in the broadest sense of the word. When I am not writing, reading, working and spending time with family, I try to spend as much time as possible backpacking in the wilderness.

View all posts by Malcolm Greenhill


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9 Comments on “Dying To Die Well”

  1. Michael Denny Says:

    Malcolm….This was a powerful message for readers to consider…in the end more interesting and important than technical charts and economic news if you ask me. Thanks for that. Michael D


  2. Raunak Says:

    Malcolm, a beautiful, touching and thought provoking post indeed.
    Quality of death is as important as quality of life.


  3. Hanne T. Fisker Says:

    Malcolm, such extremely essential theme. It would be beautiful if we could begin (again) to look upon death as liberation and a celebration of the immense wonder of actually having lived, allowing and supporting us to leave with honest dignity.
    It reminds me of the movie ‘The Sea Inside’ based on the life of Spaniard Ramon Sampedro. It took self-less love to set him free…


    • Malcolm Greenhill Says:

      Thank you Hanne. I appreciate you taking the time to go back and read these old posts of mine. I had never heard of The Sea Inside but I just read a review and see that I have to watch it. I don’t understand these people who are against the right to suicide. In the U.S. the state claims the right to kill its own citizens with drones etc but denies citizens the right to take their own life. Go figure.


      • Hanne T. Fisker Says:

        I love your writing, it’s a treat to go and read through your posts, perspectives with depth and insight. .The Sea Inside is one of those movies that leaves a strong and beautiful impact on the viewer, at least this viewer. And the characters; such incredible acting showing how they are all emotionally effected differently due to their relationship to Ramon. Such honesty and integrity.

        You got a great point and I couldn’t agree more!


    • Malcolm Greenhill Says:

      It would be beautiful if we could begin (again) to look upon death as liberation and a celebration of the immense wonder of actually having lived

      Hanne, that’s an interesting perspective. Is it yours or does it originate with a particular faith/religion/culture?


      • Hanne T. Fisker Says:

        It is a perspective I’ve grown into from living and experiencing life and death from an early age and understanding they are one and the same in a paradoxical way. A perspective from a life focused on love and freedom within; to love in such a way that the loved ones and myself are set free to be…

        It might be close to certain faiths, religions and cultures but I don’t follow anything, what comes closest is these words of Edison: there are no rules around here, we are trying to accomplish something I do my utmost to live life full on, taking it all in. To do this, I see it as allowing energy to be released and there by set free by not holding on to anything out of fear of loosing it, nothing is really mine to own anyway, only to live it and experience it. This is to me true love and freedom within.


      • Hanne T. Fisker Says:

        And, much credit is to go to people from all walks in life I have been fortunate to meet along the way from whom I have learned much through listening and observing what they have spoken and lived which gave resonance within. That’s the beauty of life, everyone is in a way a teacher whether they are aware of it or not and I remain in many ways a curious student… 🙂


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