Death as a Fact of Life

A recent story out of Bakersfield got a fair amount of press here in So. Cal. and elsewhere. A “nursing home” staff member saw an 87-year-old resident in apparent cardiac arrest and called 911. Despite the desperate pleas of the call center operator—"This woman's not breathing enough. She's gonna die if we don't get this started. ... Is there anybody there that's willing to help this lady and not let her die?"—per corporate policy the staff member (a nurse) refused to do CPR and the resident did in fact die.

Outrage followed, of course. Juicy story for the media. Sells air time. Some called it a “tragic death” and pointed fingers at the staff member and the facility. The problem is: the incident didn’t happen in a nursing home. It happened in the dining hall of Glenwood Gardens, the place where Lorraine Bayless rented an apartment. This retirement community does have a separate skilled nursing wing, but Ms. Bayless wasn’t a recipient of nursing home services.

′Nother problem is: she didn’t have a heart attack. She had a stroke, as confirmed by the autopsy report, so CPR very likely would not have saved her.

Third problem: contrary to what is portrayed on TV, CPR is an ugly, traumatic procedure that in many cases will not prove beneficial. Deciding not to perform it on a frail, elderly person is often the kindest and most appropriate response. And according to the resident's family Ms. Bayless would not have wanted medical intervention. She had expressed a desire to die naturally, without aggressive measures taken. The family are comfortable with the decision not to start CPR.

In a thoughtful commentary, ethicist Christopher Meyers of the Kegley Institute of Ethics at CSU Bakersfield asked, “Is all of this moral outrage warranted?” My answer, and his, is a firm NO! 

When I read Meyers’ article, related stories by various journalists, and the description of CPR by Jennifer Black, MD (“What you think you know about CPR is probably wrong)" I came away with these thoughts:

1. This was not a “tragic death.” Tragedy involves a disastrous event, especially one involving distressing loss or injury to life. The Titanic was a tragedy. The Hindenberg was a tragedy. The attack on 9/11 was a tragedy. This was the sudden but natural death of an 87-year old woman who suffered a stroke and who had expressed a wish not to have life-prolonging interventions. The tragedy, if any there be, is the emotional trauma caused to all parties by the execrable media attention the case received.

2. As Dr. Black wrote, the controversy over the incident “has generated more heat than light, and … it is extremely unlikely that [Ms. Bayless] would have survived earlier CPR, and if she had, even less likely she would ever have left the ICU alive.”

3. Most importantly, the incident and the media fury surrounding it (here in Southern California, at least) point out the need for all of us to (a) have advance directives and durable powers of attorney for healthcare, (b) discuss these matters with our family, friends, and physicians, and (c) when appropriate ask our physician to put our wishes into effect through a written order (known in some states as a “POLST” or “MOLST” form).

Taking my own advice, I recently sent to my three offspring a durable power of attorney for healthcare, a separate one for financial matters, and a letter explaining that—like Ms. Bayless and many others—I do not want heroic measures in the event that an end-of-life decision needs to be taken in my case. In part of that letter I wrote the following:

If all the world’s a stage and each of us merely players, our scene must come to an end at some point. When it’s time for the curtain to fall, I don’t want to hang around. Let me get off stage quickly, with as little fanfare as possible. All of which is to say that I want no “extraordinary measures” taken to prolong the dying process. If it comes to the point that a proposed treatment, including even the artificial provision of nutrition and hydration, would not be therapeutic and/or the burdens would outweigh the benefit to me, I do not want such treatment used. In fact, were it legal and were I competent to decide, I would opt for euthanasia under those conditions.

You can read in the Glenwood Gardens story, in the “consent” chapter of my textbook, and occasionally in the general media the horror stories of families faced with end-of-life issues. They often drag on for ages and can cause unnecessary grief for all concerned. I do not want you to have to endure anything like what the families of Nancy Cruzan, Karen Quinlan, Terry Schiavo, and numerous others have had to suffer.

Frankly, my attitude is: I didn’t audition for this role; it was just given me. And when the last scene of all ends my strange, eventful history I won’t regret shuffling off this mortal coil. Mind you, I don’t want to do so any time soon, but at some point I hope you will say, as did the Earl of Kent over Lear’s body: 

Vex not his ghost. O, let him pass; he hates him

That would upon the rack of this tough world

Stretch him out longer.

I post this not to be morbid but in the hope that you will do something similar for your loved ones. Write it out. Have a conversation with them. You owe it to them, and to yourself.

Death is just a fact of life. It’s what makes life special.  

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