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End-of-life issues need more debate

“The cradle rocksabove an abyss.”— Vladimir Nabokov

The great writer manages to summarize human existence in six words. An abyss does await us. White lights notwithstanding, none of us knows what comes next.

Even more terrifying, we don’t know if there is any next.

Fear of death and love of life. They are sweeping topics. And they burble and gurgle just beneath a more prosaic discussion the nation is conducting right now — the so-called national health care debate.

We have heard about insurers and pharmaceuticals, public options and Medicare gaps.

What we haven’t heard about is our cultural attitude toward death.

Here is another transcendent writer, the poet Dylan Thomas:

“Do not go gentle into that good nightOld age should burnand rave at close of day;Rage, rage against the dying of the light.”

We do rage, don’t we?

We fight the end ferociously, individually and as a society.

In this country, that combat takes on a uniquely American, “you ain’ta-gonna take me without a fight” aspect.

The struggle over whether and how an individual makes his or her exit has consequences for all of us, including those who are nowhere near the end.

To put it bluntly, we as a nation spend a lot of money to prolong lives that probably should not be extended.

Is going into “that good night” really a worse choice than spending two years hooked up to a tube, bringing very little to those around you?

I don’t mean to make light of any individual’s final months or days. I have clearly not been there yet, and I don’t think any of us know how we will react until we lie there facing the choice.

Nor am I suggesting that we activate the dishonestly named “death panels.” Whether, when, and how to die are individual choices, not the government’s, not even the doctor’s.

But I do think the end-of- life discussion needs to take place.

We are facing a paradox — we spend enormous sums of money on whiz-bang, state-of-the-art technology that keeps people barely alive while simultaneously short-changing other people who could benefit if that money were spent on health care for them.

We can trace that contradiction directly to our cultural attitudes. Unlike us, many cultures see death as part of life, or even a good thing, not something that should be prolonged for the sake of putting up a good fight.

Not every American feels pugnacious toward death. We are hearing more and more about “death with dignity,” and the hospices that provide that option are growing in number. That is a healthy (pardon the pun) trend.

Cultural attitudes take time to change — decades, generations, sometimes centuries.

Our feelings about death and how to handle it are in transition.

While this inexorable process moves slowly forward, the Grim Reaper waits and watches. He has a notch on his scythe for each of us.

Perhaps if we didn’t fear him or ache to duke it out with him, life would be better for those we leave behind.

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