QUESTION: I am a 30 year old woman working as a psychology intern at a local hospital. My engagement in the hospice program has me thinking a lot about my own death. Is it possible to reach the end of life and have a peaceful, unmedicated death and, if so, how does one live in a way that supports this? My assumption is that it may require denying medical treatment for disease processes before they get to the point where you are overmedicated to deal with the disease and the pain caused by symptoms of the disease. Of course, when it comes my time, I will probably seriously consider end of life medication, but I'd like to think that I can pass on without the sedatives that put people into a coma before they die.
Response: Interesting questions. I’ll take one at a time.
Is it possible to reach the end of life and have a peaceful, unmedicated death (yes, it is) and, if so, how does one live in a way that supports this?
I’m not sure how you can live your life while planning for how to die. There are too many possibilities for how we die to outline how it will be. We can, however, live our life making each day special, make it count for something so we don’t have too many regrets when death does approach.
I think the most concrete way of planning for how we will die is through having an Advance Directive in place---even at 30 years old. Not every one lives to be a senior citizen.
Your assumption that you need to deny medical treatment in order to maintain control needs some exploring. I am interpreting the words “medical treatment” to refer to medicines such as narcotics, not actual treatment to slow or eliminate the disease progression. So, first, dying itself is not painful. Disease causes pain. If your disease is not causing pain then there is no reason for you to have pain medicine or a narcotic as death approaches. You can maintain control as long as your mind will stay focused.
If you end up having a disease that causes pain I strongly advise that you take whatever pain medicine will affect and reduce the pain. A person who is knowledgable in end of life pain management (operative words here are “knowledgable in end of life”) will know how to manage your pain and keep you alert.
Your final statement needs clarifying. “I'd like to think that I can pass on without the sedatives that put people into a coma before they die”. It isn’t the medications that put people in a “coma before they die” (not to say that they can’t). It is the dying process itself that makes people non responsive as death approaches. Generally, in the days to hours before death, a person is so withdrawn from their physical body that even though they are moving and murmuring they are not really responsive to their environment.
We die the way we have lived. If we have approached the unknown in a fearful manner so will we approach dying. If we have been a take control, be in charge kind of person, so will we take control of our dying process as long as we are able. If we have run away from our challenges in living we will run away from our challenge at end of life.
I asked myself a long time ago what life was about. What was our purpose for being alive? The answer for me is to find joy, peace of mind and fulfillment. I think how we live our life and what answers we bring consciously or unconsciously to those kinds of questions, will determine what we bring to the end of it.
Making an Advanced Directive isn't easy. But the relief, the weight that is lifted when our directive is in place is amazing. Any chance we have to give ourselves more peace of mind we must take. Do it. If you need help, read the chapter called Living Will and Durable Power of Attorney in The Final Act of Living.