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.”
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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.
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“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.”