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Let no one say America is a death-denying society. Our newspapers are full of articles reporting on battles over how we die. The Terri Schiavo controversy was not a blip of newsworthy gruesomeness on the pages of otherwise cheerful publications. Schiavo's story replicated others, on and off the front pages, that have been going on for more than 30 years. Death, once again, is changing in America, and we have been arguing about how to handle these changes since they began decades ago.

One hundred years ago, science made its first serious advances in pushing death later and later in life. Diseases like tuberculosis, pneumonia, cholera, and influenza struck towns and cities regularly until scientists discovered they were caused by germs that spread uninhibited in open sewers, trash heaps, and other unclean city sites. With the help of inoculations and public health initiatives, diseases of old age became the leading causes of death, especially heart disease and cancer.

Once again, death is changing. Stephen P. Kiernan writes in his new book Last Rights that further advances in medicine and public policy have displaced quick killers such as heart attacks, strokes, traffic wrecks, and other accidents. Instead, long-term illnesses have become the nation's leading killers. "In a recent fifteen-year span, deaths from chronic respiratory disease increased 77 percent. Fatalities from Alzheimer's disease have doubled since 1980. … People now succumb to congestive heart failure, lung disease, diabetes that leads to kidney failure, ALS (or Lou Gehrig's disease), Parkinson's, osteoporosis that results in falls, confusion and immobility." Despite massive research, AIDS and cancer, two other gradual killers, are on the rise.

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February 2007

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