Third of three parts; (click here to read part 2)

"She wouldn't be saying she wants to commit suicide if she had Rockefeller's resources. She's saying she wants to commit suicide because we have made long-term care the step-child of medical care. We've never properly funded long-term care, and we see to it that old people have to be impoverished very near their death." Many elderly people literally face a choice between a friendless and penniless future—a terrifying thought—or death. And they often face this choice in isolation.

It is this elderly, "invisible" patient that concerns Lynn. "For every 60-year-old dying of breast cancer, there's a hundred dying at 85 of uncertain causes. These are the people who should be in the limelight, not the 25-year-old men dying of AIDS."

As a geriatrician, the debate toward PAS in the midst of a broken system puts Lynn in a serious dilemma. "Am I supposed to be willing to be your Nazi doctor treating you as a useless eater, or am I supposed to stand by as society's tormentor and see that these inadequate resources are all you have to live on and that you have to keep living it out?"

According to Lynn, this is the real debate—how we treat or fail to treat the bulk of her elderly, once middle-class patients. Legalized PAS is just one possible solution, one that she believes won't really be the best option for those most likely to be affected by it. "Who will show up when 5 percent of deaths are done this way?" she asks. "It's not going to be the occasional Janet Adkins who can't face the prospect of possibly losing her mind, or the 60-year-old who has just found out he has cancer. It's going to be old people. A 60-year-old still has families, insurance, and people who care. We have an awful lot of 85-year-olds who literally have no one who still cares."

Lynn believes that politicians by and large simply aren't addressing the larger issues. "We're talking about cutting Medicare and our social obligation to take care of the disabled, and at the same time we're also talking about physician-assisted suicide, and no one's noticing that they might come together in a very difficult way. Our society has to learn to debate the issues around these situations. What kind of people are we when we say to the elderly who run into adversity, 'You should just be dead?' "

For solutions, Lynn recommends developing measures that examine the quality of end-of-life care and demanding that certain, agreed-upon standards be met. Popular reports on hospitals—such as U.S. News and World Report's annual issue—don't even mention end-of-life care.

Article continues below

Lynn also views developing a sensible financing system as one of the top priorities. "Right now I can get elegant, $20,000 surgery for a patient at the drop of a hat, but I can't get her lunch. If we were building a system around the fears of 85-year-old women, surely we would make sure they could have lunch!"

The proper treatment of pain is another need that concerns Lynn. She points out emphatically that "no one near death needs to be in pain. People find it hard to believe, but almost all patients can be kept conscious and out of pain. The rest can be kept sedated and out of pain."

Pain goes beyond physical suffering, however, to include emotional isolation. So often, elderly people want to go on living, not just existing. One chaplain told Lynn the story of an elderly, bedridden woman who was dying. Her overly anxious sister attended to her every physical need and persisted to ask the patient if she wanted anything—orange juice, tea, sherbet, ice? Finally, the dying patient took her sister's arm and brought her near so she could hear her speak. "What I really need," the patient told her, "is a tender morsel of juicy gossip."

One of Lynn's nursing-home residents once claimed to find no meaning in life, but gradually grew more at peace. Lynn noticed that she always had her bed cranked up to the same position, so Lynn lay in such a way that she could survey the patient's view, and there she saw a group of large, flowering weeds. That evening, Lynn went out to the yard and brought some of the flowers in and placed them near the patient's dinner tray. Sometimes, a sick patient doesn't really need death, she just needs to be reminded that the outside world still has flowers.

Since, according to Lynn, three-quarters of all people die in federal programs, most medical costs are managed by a bureaucracy. One consequence is that end-of-life care is not cost-effective for most doctors. "If you develop a reputation to be the best in town at providing good end-of-life care, you'll go out of business within a year!" Lynn laughs. "We have to make it possible to have excellence. It has to be possible to be really good at end-of-life care and still be able to make a living. Now, we've perversely set it up so you just can't do it."

Apart from the immorality of PAS, Lynn believes an assisted-suicide law simply is not necessary. Patients already possess the legal authority to give up eating, or to refuse antibiotics or insulin. The only thing a patient now lacks is control over the exact hour of his or her death, making the patient unable to gather family, say good-bye, and then immediately die.

Article continues below

Unless someone is willing to underwrite end-of-life care, Lynn suggests that we need to develop an "ethics and a culture" that can deal with these issues—and that means religious bodies need to take a much more active role. "Religious bodies are acting as if the big thing is to comment on physician-assisted suicide. I don't care what they say about physician-assisted suicide. What I want them to do is to say, 'This is what the end of life should look like.' Given our new demographics, how does the church address the old and dying? If a patient can live a little longer with a drug that costs $10,000 a month, should we say yes or should we say no? Do you realize how many people die alone in Washington, D.C.? What does that mean for the church down the block?

"My experience with churches has been fairly grim. If I call up the minister of a church a person attended for 30-40 years in the prime of her life but she's now disabled, and I ask 'Is there anything you can do to help this person's burden?' I'd say I'm no better than 50-50 to get a favorable response—and that's when the doctor is calling!

"Old people getting sick can't count on the church. There is no one to validate the patient's importance. Paid care givers can only go so far.

"If what one faces when one reaches the end of life is being thrown on the dung heap of humanity, then a lot of people are going to choose to be killed—and not foolishly. And then what I am supposed to do?"

Lynn wishes the Christian community would simply become more "thoughtful." "It's not enough to send flowers to shut-ins," she says. Many older people tell Lynn that the only time they ever get touched is during a physical exam. "Why can't we develop hug networks?" she laughs.

"We need to look to find ways to validate the humanity of people who are getting near the end of their lives. Take the last 20 members who have died in your congregation and ask their families how the church responded. I've had patients who were furious when they received cards telling them people were praying for them. 'Well, why don't they come and meet me?' they ask. 'Why won't they pray with me in person while holding my hand?' "

Gary Thomas is a writer from Manassas, Virginia.

Have something to add about this? See something we missed? Share your feedback here.

Our digital archives are a work in progress. Let us know if corrections need to be made.