Daniel Akst is a member of Newsday's editorial board.
How do you want to die?
Think about it. If you're the average reader of this newspaper, you've only got 25 years or so left. It'll go by in a flash.
Would you prefer to expire among strangers, in the icy technological grasp of the medical-industrial complex? Would you like decisions about your fate to be made by bewildered family members and practitioners of defensive medicine whom you've only just met?
The issue of how we die is in the news lately because, thanks largely to scaremongering, the government has backed away from plans to have Medicare pay for end-of-life discussions with a physician. These plans succumbed to the bizarre "death panel" hysteria that arose during the debate over President Barack Obama's health care overhaul.
Of course, preventing doctors from talking to patients about the end is perfectly sensible, since if we ignore death, we can make it go away. Right?
Since all of us would prefer to change this particular subject whenever it comes up, let me take a moment here to state what is perhaps too painfully obvious: Whatever your age, faith or fitness level, no matter how virtuous or vain, regardless of whether you plan for it or not, death will come. To insist otherwise would be, as Samuel Johnson said of second marriages, the triumph of hope over experience.
So wouldn't it be better to make sure that, when death reaches out for us, we've done everything we can to meet it on our own terms? One would think so. Yet only about a quarter of us have a living will to guide family and physicians on medical options when the time comes.
Sticking our heads in the sand on this whole subject is one of the worst things we do to ourselves. Not only does it lead to a painful and dehumanizing death for too many Americans, but it encourages us to spend ourselves into the poorhouse to pay for such terrible outcomes.
Runaway health care spending is perhaps the leading threat to the republic just now; this fiscal year Uncle Sam will spend something like $150 billion of our money on Medicare patients during their last year of life. A huge proportion of that spending is for useless treatments and hospital stays. And that money isn't just wasted. It's often counterproductive.
There is evidence that freely chosen hospice care, for example, is not only much cheaper and more comforting, but leads to longer lives - the very thing the technological alternative is supposed to deliver.
Since I think people ought be informed about their options, I'd prefer for Medicare to pay for end-of-life talks. But even if it won't pay, it certainly can't stop us. If you're getting on in years, you ought to have such a discussion - not just with your doctor (pay for it yourself if necessary), but with your kids, your friends and a clergy person you trust.
If your parents are getting old, broach the topic with them. Death won't come any later just because we swaddle it in silence and ignorance.
I'll go further. It's always possible I'll be felled by a heart attack or lightning strike. But if I get old and sick, as so many of us are destined to do, I'd like to be able to decide not just how I go, but when. Under certain circumstances, in other words, I might prefer to die with the help of a willing physician.
Why should such a thing be against the law? People would consider it inhumane to subject a dying cat to needless misery. Yet a dying person is expected to withstand much worse, even at death's door, despite every expressed wish to the contrary.
If we weren't so afraid to talk about death - with or without Medicare - maybe our policies toward it would become just a little more humane.