A Good Death: How Boomers Will Change the World a Final Time

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Surely the world has heard enough of the Baby Boomers, who have dominated the political, cultural and economic landscape for six decades. But a generation that has refused to go quietly into any life stage will, it seems, be heard from one final time on the biggest issue of them all: how to die.

For eons, folks grew old, endured the symptoms, and died when it was their time—according to God’s will, some would say, even if it involved fighting through lingering illness, pain and suffering, or years of mental or physical incapacitation. A “good” death was about having lived long enough to see grandchildren, put one’s affairs in order, and pass away surrounded by a loving family.

Boomers don’t see it that way. To them, a good death is more about a good life. When they can’t have that any longer, it’s time to pull the plug. This will be the first generation to broadly eschew painful life-extending procedures and make the most of palliative care to live better in fewer days, and then die with dignity.

“The goal post is always moving as people get closer to the end zone,” says Ruth Goldstein, a retired nurse in Baltimore who has worked with the elderly. “But the main point is that each person is in charge of when it is time to call it a game.”

(MORE: With Baby Boomers Retiring, Why Do We Need So Many New Jobs?)

Growing old and dying has never been especially topical with boomers, who brought sexuality, birth control, gender issues, and civil rights out of the shadows. In recent years, boomers have reinvented retirement, recharacterizing this period of life from one of leisure and withdrawal to one of encore careers, giving back, and prolonged engagement.

Many remain at work, youthful and energetic. But as friends have begun to grow ill and pass away and boomers bury their parents, often after long and expensive bouts of physical or mental suffering, the generation that didn’t trust anyone over 30 has turned its thoughts to dying—and how to do it, like everything else, on their own terms.

“Boomers have never been a stoic bunch,” says author and gerontologist Ken Dychtwald, who has studied the generation for four decades. “They’re not going to allow their last chapter in life to be an extended period of loss, fear, pain, and suffering.” He believes more will choose to forego treatments that degrade but extend life, and when confronted with years of illness opt for the quick solution—suicide either with or without the help of a doctor.

As one boomer responding to a story in the Baltimore Sun wrote: “When I reach that stage I want bacon and sausage for breakfast, pizza for lunch and a Whopper for dinner. That menu would not only provide me with great pleasure, but might also speed up the inevitable.”

Medical science has done a remarkable job in keeping people alive longer. Life expectancy has ballooned from 47 to 78 years over the past century. But science has also gotten better at keeping people dying longer. Boomer parents have been the principle battleground for things like Alzheimer’s, Parkinson’s, chronic arthritis, incontinence and diabetes, all of which can make life a struggle for year upon year. It’s not pretty, and boomers are starting to ask how they might avoid this nightmare.

(MORE: Boomers Never Got Their $30 Trillion Inheritance — Will Millennials?)

“They’re saying they’d like to have some degree of humanity and dignity and control over the end of their life,” says Dychtwald. “They don’t want to be a burden to their children and grandchildren; they don’t want to live an extra decade in some hospital or nursing home with tubes up their nose.”

Suffering people have long sought an early end, of course, and many have done so quietly—or not so quietly in the case of patients of euthanasia advocate Dr. Jack Kevorkian. But we are now seeing the beginnings of a broad movement that will change the game for good. “People are starting to think about aid-in-dying as the next civil rights movement,” says Goldstein. “Death with dignity is the final frontier of human rights and freedom of expression.”

So what was once a taboo subject—how to die—is now in open discourse. The death café movement encourages people to meet and discuss the concept of a good death. This dialogue is being fed in part by less rigid adherence to organized religion, which has strong views surrounding death and dying, and advances in medicine and technology that make it easier to feel you can control pain and symptoms and the way you die.

Four states—Vermont, Oregon, Washington and Montana—have passed laws legalizing aid in dying. Six states have active campaigns to promote aid in dying—Connecticut, Hawaii, Massachusetts, Montana, New Jersey and New Mexico. Another half dozen states are moving that direction. You can find out what’s happening in your state here.

The emerging template for a good death isn’t all about choosing your moment, though that is the biggest part of what is changing. And much of what makes a good death today has long been the case. Here are the key aspects of a good death:

  • Control of the process You want to make decisions around all aspects of your illness and be certain that your wishes will be followed even if you are unable to see to it yourself. “People want more control in the months and days leading up to dying,” says Megory Anderson, founder and director of Sacred Dying Foundation. “They have clear ideas of where they want to die, who is with them, and what medical intervention is used.”
  • Open Communication You can’t be in control if you aren’t getting an honest and coordinated discussion among doctors, patient, and family. This should include frank talk about chances of recovery and burdens of treatment on the patient and family.
  • Broad support You want to know the medical staff will stay to the end; that your family is on board, finances are not the deciding factor, and that professionals will help you prepare emotionally. In The Good Death: The New American Search to Reshape the End of Life, author Marilyn Webb writes: “There is recognition of the need for family strength, an understanding that the good or bad legacy this death creates will endure in family lore.”
  • Spirituality Many look to their religious traditions during the dying process. But spirituality encompasses much more than faith and traditions. It’s about creating a peaceful and comforting environment that may incorporate prayer, meditation, music, and candles. This is highly personalized and may provide the kind of signature departure that many boomers demand.
  • Minimal suffering Today’s powerful medications make it possible to relieve physical pain while remaining lucid longer. But mental suffering can be acute too, and one way to relieve it is by placing limitations on treatments early in the process and clearly delineating what measures are to be taken to keep you alive. “More end-of-life-care clinicians are coming to the understanding that aggressive treatment doesn’t universally deliver better quality or quantity of life, and isn’t always in the best interest or reflect the wishes of patients,” says Colleen Wadden, director of external communication for Providence Health & Services.
  • Meaning Boomers have always sought a better way. They want to feel their dying experience is just right for them. This is what drives the hospice care movement, where terminally ill people get the care they need to live long enough and with minimal pain to go out on their own terms. “Death is seldom good, desired or welcome,” says Dr. John Shuster, chief medical officer at Alive Hospice in Nashville, Tenn. “The task is to help patients and families bear what may seem unbearable, to work toward relief of as much physical, emotional, and spiritual distress as possible, and to enable patients to live well during this precious and important time with as much meaning and dignity as possible.”
  • Closure Unsettled affairs make death more difficult. You want to use your final days to make sure loved ones are cared for as best you can, mend fences, and leave memories. “Baby boomers build and preserve meaning through narrative, and the telling and sharing of important stories,” says Shuster. “This is healing for all ages. Celebrating and focusing on important relationships adds meaning to life, especially in the setting of a life-limiting illness. An advanced illness can be the stimulus to heal important broken relationships.”
42 comments
mattpetelicky
mattpetelicky

Instead of complacently being herded into nursing facilities, they are preparing for old age and potential for limited mobility by installing equipment and devices that will allow them to safely age in place.  In some cases, they are even designing their home with aging and limited mobility in mind. http://pariuribonus-online.com/unibet/

rrifraf9@aol.com
rrifraf9@aol.com

hello everyone,

   lots of interesting comments. i am a hospice nurse after spending 35 years in critical care. this conversation must be had. boomers or any other. i also facilitate at a death cafe we founded in indian river co, fl. the response has been tremendous. people wanna talk about this. we all should want a say in our end of life choices. nobody gets the privledge of not facing this at some time.

teblen1
teblen1

If it is fiscally expedient for the State to support policies that shorten the lives of elderly/disabled whose shorter life expectancies render them a target for managing the budget,  you can bet that the "good death"  will be pushed as sexy and desirable ---with and without the informed consent of the targeted group.   Passive euthanasia for fiscal expediency has been going on for years in our public hospitals.   

Already!  there is an epidemic of covert and overt (default) DNR code status being extrapolated into the hospital charts of elderly Medicare/Medicaid patients who have exceeded Diagnosis Related Group Caps and/or are the victims of mistakes/errors and the complications thereof that inappropriately (and illegally) shortens the lives of elderly patients by limiting further treatments that the hospitals/physicians KNOW will NOT BE REIMBURSED.   

Pretty ugly stuff going on under the radar of public scrutiny that BOTH political parties hide from because it is a subject that is too politically dangerous for the politicians who will do anything to protect their jobs ---even at the expense of their constituency.    

MellowtheMoonlight
MellowtheMoonlight

For many years I had been hearing, that abortion would lead to euthanasia.  I couldn't connect the dots  - though I had read the "slippery slope" hypothesis. Now it is clear. There are not enough people in the workplace to support the retired. There won't be enough hospital and clinic beds for aging Boomers. There will not be enough physicians and paramedical personnel. We are going to cost a lot though we paid, for decades, into Social Security and Medicare, money that should have been invested for us but was used for other purposes - war, probably. 

The Nazis, disseminated ideas, that began in the scientific community, to eliminate certain segments of society, through the media and universities. The same dynamic is operating in this and other first world societies. The Boomers are on this. Giving suicide a sexy image, does not promote your cause with most of us.

anonbody
anonbody

This is a depressing article, not because of its subject of death, but because of the obviously price people are putting on their lives in terms of utility. If people no longer feel useful, in deciding to take their own lives, they are leaving the world in mental pain, much in the same way that a 15-year-old would leave the world with thoughts of "everyone is better off without me anyway."  In truth, even the elderly and the dying have much to teach us about life.  This article fails to acknowledge that, and I fear that with this new wave, those "choosing" not to undergo assisted suicide may be branded by others as selfish, leading to even more confusion and depressive thoughts.  In order to prevent this, it's necessary to love and show we value the elderly in our lives. No one wants to be unwanted.

Kcpaul
Kcpaul

Visit www.begintheconversation.org - This website focuses on providing the documents as well as encouraging individuals to have the conversation about how individuals want to face End of Life. 

ModernSeniors
ModernSeniors

Any addition to changing the way people die, boomers are also changing the way people age.  Not only are they taking more control over when and how they choose to go, they are also reshaping aging all together.  Instead of complacently being herded into nursing facilities, they are preparing for old age and potential for limited mobility by installing equipment and devices that will allow them to safely age in place.  In some cases, they are even designing their home with aging and limited mobility in mind, ie wider doorways, no thresholds, easy access tubs, etc.

BerneeG
BerneeG

Great article, but why not continue the conversation to what to do after death?

Spend a lot of money on funeral arrangements, bury, cremate, donate your body to LifeLegacy Foundation?

So many options..........

teblen1
teblen1

All advanced directives,  including the POLST form (physicians' orders for life-sustaining treatment)  are about preserving the autonomy of the patient AND, also, saving $$$$$ and preserving profits for government Medicare and its private for-profit partners   by reducing end- of- life costs of dying for the growing elderly population who will freely  ELECT to shorten their lives to shorten their suffering as an intelligent response to the "neutral"  facts/prognosis of their terminal diseases.  It has been the public policy vision of Congress and CMS that elderly patients would NO LONGER die in expensive ICUs and CCUs at great cost to Medicare/Medicaid and the private insurance giants.    They would die in their OWN homes or in residential nursing homes or long-care facilities with the help of hospice and palliative care at much less expense to the government and the private insurers.   Over treatment of the elderly for profit would be greatly stemmed.        

The federal 1991 Patient Self Determination Act which has not been implemented fairly or intelligently  by the States gives patients the legal right to shorten their lives to shorten their suffering EVEN if the refused procedure or medical treatment is NOT deemed to be medically futile ---  and prohibits discrimination of hospitals against patients who do NOT prepare advanced directives.    Patients,  therefore,  are presumed to be full code status when they are admitted to hospitals unless the hospital/physician deems that they are NOT under some due process procedure developed under State Law.   

Hopefully!   The baby boomers,  because of their independence,  will see the importance of preventing unilateral passive euthanasia of patients because of their age and shortened life span  as a means of controlling the Medicare budget to protect the profits of the Insurance Giants and the for-profit suppliers of Medicare/Medicaid.   When hospitals are not fully reimbursed by CMS and the private insurers for the treatment of the elderly/disabled,  they have incentive to believe that the elderly patient is better off dead. , Of course,  unilateral covert and overt (default) DNR code status is hardly ever discovered because there  are NO procedural protections in place for the elderly  patients that  prevent influence to shorten life and/or  that confirm the autonomy of the CHOICE of the elderly patient to shorten life,  such as the patient's witnessed signature  -----except in Missouri.      However,  in Missouri,  there has been NO case law made since 1991 that addresses covert/overt/default DNR code status.   

A first step for the baby boomers  would be to push for some kind of federal mandate to the incorporated physicians and for-profit clinics and private hospitals to SEEK informed consent for patients in the OUTPATIENT and the INPATIENT setting for either Curative Care or Palliative Care/Hospice,   the two different legal standards of care NOW reimbursed by Medicare.    Several states have already passed new laws to try to stop the growing trend of shortening the lives of the elderly Medicare/Medicare patients because of fiscal realities but most have not.   Physicians,  especially the specialists,  will not talk about end-of-life choices because they have no legal obligation to do so under most of the existing State laws.   

All of the recent NOISE about palliative care is a means of confusing the issue and straightening out the MESS without admitting that passive euthanasia of the elderly is now common.      There are NOW two different standards of care created and reimbursed by Medicare.   These are (1)  Curative Care where everything is done to try to defeat the disease  or (2)  Hospice/Palliative Care where curative care is abandoned but comfort care,  including some curative care such as setting broken bones or prescribing antibiotics for pneumonia,  etc..,   is paid for under the Hospice entitlement ----but the primary fiscal goal of Hospice is to keep patients out of expensive hospital settings like ICU and CCU.    Patients cannot be on Medicare and Hospice at the same time and the six-months-to- death  certification of death by a physician has been unrealistic and unworkable.        .        

ShineOnBrightly
ShineOnBrightly

These topic is touched more frequently as more of us babyboomers experience the loss of parents, friends, and even our own end of life. Having had 3 profound losses during the last 4 years (husband, sister-in-law, mother), I will say that each end was completely unique. I agree that the medical community could use some improvement with being on board with the dying process. In each of the 3 cases above, the medical community seemed to turn away when all treatment failed, leaving the family to figure out how to help the patient with his/her death. In 2 of the cases, we turned to hospice, which carried the patient and family through the process in a beautiful way. In the third, the patient was left to die in the hospital room, surrounded by family, yet with little support from the doctors/nurses. 

As we look at death, it's important also to make known our wishes about final disposition and memorials. Let loved ones know about the preference of burial or cremation, type of memorial service, final resting place, etc. It's amazing how many people shy from those discussions due to the perceived discomfort around the topic. 

And lastly, remember and honor your loved ones with respect. Websites like www.shineonbrightly.com provide amazing resources to help with that. 

stevecimelli
stevecimelli

Not a word in this article about terminal sedation, sometimes called palliative sedation.    This is not suicide, but sedating the patient as if for surgery and withdrawing food and water.     Patients  quickly die.    This isn't causing death, but opening the door for death.    It is legal in every state and approved by most major religions.       I heard about this over 20 years ago, but almost never see it in the press.    There is no need for legalizing assisted suicide, although I think individuals should be free to take that path.   This removes suffering of patients and loved ones.   How about an article on terminal sedation Time?

RTYD
RTYD

This is so very true... we don't plan on hanging around longer than we should.  We've decided to build a community called the RockTilYouDrop (www.rtyd.org) where we will fully enjoy our retirement and if that means having 5 great retirement years instead of 20 mundane or painfull years... well, that's the way it'll be.  No burdon on our children... no burdon on society.

nervicited
nervicited

Dying has been way too much of a hassle for way too long. More sanity, coherence and self-determination in the matter of death needs to find its way into law, society, culture and religion. That is not going to be easy, nor has it ever been.

If Baby Boomers are truly the ones who must accomplish the difficult goal of making death more pleasant and meaningful, it may not realistically come to pass in their lifetimes, but at least the music will be epic.

This is the way the world ends: Not with a bang but a boom.

Lettuce prey.

kwtalk
kwtalk

“The goal post is always moving as people get closer to the end zone,” says Ruth Goldstein, a retired nurse in Baltimore who has worked with the elderly. “But the main point is that each person is in charge of when it is time to call it a game.” -- If only that main point were true.

dswood
dswood

Absolutely, boomers need to get this change done.  The United States cannot afford to keep life to its very last often undignified moments if that is not the desire of the dying. Kavorkian was on the right track and bravely faced prosecution for getting the idea launched on a national scale for conversations.  Doctors and hospice have been able to afford a "dignified passing" with the administering of morphine shots to the hearts of failing heart and lunch patients (to keep them from drowning, a very painful death) and so on a national scale, in a rational manner, we do need to get this done.  The boomers want the paperwork available to complete so their wishes are known.  Let's get this done.  Among those that hope to have this passed are very faithful, spiritual people, they also probably know the most about diginity and how that is lived.  Now they want to be able to die that way.  Thanks for the article, this is important.

Whatanotion
Whatanotion

I'm Catholic.  We must believe that suffering is a gift.  So if my final illness breaks my family financially and sees me to suffer in a dying bed for 8 years.  My priest is OK with that.  I am so screwed.  Oh the church runs the hospital where I live.  So. Texas

UleNotknow
UleNotknow

So Dr. Jack was right after all.

oknowwhat3
oknowwhat3

It's good to know that we are starting to accept the conversation of how we want to die.  It's not about how long to live, rather the quality of life for however long.

buffalo.barnes102
buffalo.barnes102

Why is this a "boomer" issue? Stop putting labels on something that will affect everyone when their time comes. 

MichaelCharlesAppleton
MichaelCharlesAppleton

Good article

I am a retired hospice physician, teaching end of life care to physicians in training.

I am also a volunteer host of a "Death Cafe" in Clearwater Florida-- SEE DEATH CAFE ON INTERNET TO LEARN MORE

Michael Appleton MD

michaelbrown
michaelbrown

I fully believe a person who has lived out their healthy life and is constantly in pain or sick should be allowed to just die in peace. I've seen the elderly and the pain and suffering they go through. It also opened my eyes in adulthood as to why so many are not happy anymore. I think the overall topic though should be at what point do we say what is acceptable and what is not acceptable as far as ending one's life? Also, if legalized suicide is to exist, at what point do we draw a line on how to do it or who is eligible to "legally die"? If people can just throw away their parents in some nursing home to live miserably, maybe the person should be allowed to just say enough is enough?

ParisDakar
ParisDakar

Please boomers, you've changed the world enough.

ChelseaGumucio
ChelseaGumucio

Hi Dan-

Great article about the how the preferences of Baby Boomers are so different from the other older generations. I have also seen in my practice with hospice, elder care, and cancer patients that the older generations are less likely to want to discuss advance directives- as if they will die sooner if the subject gets brought up. The Baby Boomers are often much more open to the conversation and it usually begins by talking about how their loved one ended up dying a painful, long, death in the nursing home or ICU. I can easily talk to these patients about how Advance Directives can help them exert as much control as possible even if they are unable to make their wishes known. 

When Alzheimer's disease or another longer disease gets brought up- many want to be "put out of their misery" before they suffer years and years slowly slipping away. I have also seen a shift in the conversation that is more focused on control in choosing "the right time" to die. As more states allow physician-assisted suicide, I can see it quickly spreading across the country- with those in the baby boomer age spear-heading the movement. I also see a better understanding (still slowly) of utilizing palliative and hospice services to help make people more comfortable at the end of life.

Thanks for the great article!

Chelsea Gumucio, LISW

eFuneral.com Liaison Social Worker

Hermione
Hermione

We need to get the government out of the "death business".  It should not be up to the government to decide how a person should die with dignity.  Seriously, don't we have enough government oversight into our personal lives?  Why does Uncle Sam need to have such a huge role in our end-of-life decisions?

carlyt
carlyt

As Dr. Andrew Weil has indicated many times the aim should be to extend the healthy life curve for as long as possible and then reach the end very quickly;  I think this is a very good description of what boomers and anyone else should set as a goal. Stay healthy with physical exercise , mental stimulation, and good nutrition to extend that curve without major medical problems. I just read several posts and pages about health/exercise/nutrition on the site Retirement And Good Living. That site provides some great information on a variety of retirement related topics.

rrifraf9@aol.com
rrifraf9@aol.com

@teblen1  have you any knowledge of  end of life activities? have you ever seen anyone die in an intensive care unit?

Kcpaul
Kcpaul

Visit begintheconversation.org - Let me know what you think.

barbara1
barbara1

@BerneeG

Agreed.  And when we open the important conversation about how we wish to die, the conversation about what happens next is more naturally begun.  Discussion about our spiritual beliefs in after-life come forth.  Openness emerges among family about how we would like to be remembered when we are gone - a conversation that can bring peace to one who is at end of life. It's why I have offered a printable planning sheet for recording essential information and preferences, http://www.cremation-urns-legacy.com/Funeral-Planning-101-s/1857.htm , in the hope that this is helpful.

scpal22
scpal22

I believe you are confusing "passive euthanasia" with a natural death. All of us are going to die and the majority of  Americans say that they would choose to die in their own home...that is not a choice that "the government"  and private insurers are making for them.  The results of CPR done on a frail, sick person only does more harm and does not return the patient to health, just a brief time on a vent before death. I have worked for a non profit hospice for 20 years and can assure you that our goal is patient choice and comfort, period!

grampa72
grampa72

@ParisDakar Seriously ? You think improving end-of-life is too much change ?

I regret we haven't changed the world nearly as much as we wanted, but I recall my parents' generation (the "greatest" - they were not to be blamed for that sobriquet) as so fearful compared to us. Well, we need to do our part to make this change.

michaelbrown
michaelbrown

@Hermione I seriously doubt you even read the article if that is what you have to say.

Charlotte
Charlotte

Did you even read the article? Or do you just rant about the government no matter what the topic?

This was about INDIVIDUALS making decisions about how they want their end of life to be; and that they want more control.

Maybe you should stop watching FOX news so much, it's preventing you from learning anything.

SLA
SLA

@dakinsky How about the man in shattering pain with untreatable brain tumors that are actually forcing his eyeballs out of their sockets? Shouldn't he have options other than getting increasingly "whimsical"?

teblen1
teblen1

@scpal22 Oh Come On, scpal22,   you know that most of the patients on Hospice die from dehydration that is caused by their terminal  disease/cancer and that the one of the goals of Hospice and all advanced directives is to give the opportunity to dying patients to OPT to shorten their lives to shorten their suffering.   As patients are dying,  they lose their desire to eat and drink and ALL hospices advise the caretakers not to force or push food and drink that is not wanted.   

I'm not criticizing Hospice.    It is a gift from government.   I am old enough to remember when most elderly patients who didn't die in the hospital always died at home with NO HELP from the government.   

Whatanotion
Whatanotion

@redbull Nothing wrong with my religion.  It's the Priest with an apparent Conflict of Interest that ought to consider just who's side he's on.