My father did us all a favor. He died suddenly, years before we had expected it, though given the family history it was no surprise.

My mother was another matter.

She had been ill for many years, years that were extended by surgery, treatment, and drug therapy. Paid for by the American taxpayers, because she was on SSD - Social Security Disability. Of course, most health care in the US is paid for to some extent by the American taxpayers. We pay for it through tax subsidies to employers who provide it, through grants, through medicaid and medicare, through subsidies to public and other hospitals. But that’s a story for another day.

As for my mother, there came a time when her body finally made it clear she was breaking down and there would be no treatment that could stop it. The best they could do was prolong the time it took for her to die.

I’ve visited people who are ill before and been to funerals, but I had never been there for the process of dying. I’ve heard that most deaths are excruciatingly painful. My mother fell into that category. Body system after body system failed over a period of days. She was out of it but not so much that she wasn’t screaming in pain every time she was give a shot or they tried to find a vein. Those too were shutting down. She was in pain and mental distress, reliving all sorts of bad things that had happened to her in a very hard life. Thank goodness she was not in her right mind - awful as it was for us to see her that way - because she would have been humiliated to know. She was always so proud of how smart she was - and she was very, very smart, just born poor and lived poor.

A friend recently talked to me about her very ill father. He unfortunately switched to the privatized delivery system of Medicare and is having serious problems getting treatment. Both he and her mother are too ill to make their way through the regulations to figure out how to get the treatment he needs. So it falls to my friend to be constantly traveling to the city where her parents live, shuttling between her home and responsibilities to her parents’ home.

And, to make it worse, her siblings and she do not agree on how to proceed as their father gets closer to dying. He is dying in the sense we all are, but more so. There is no way out of his current circumstance but death. The only question is how painful and humiliating his death will be. My friend is willing to trade days lived for fewer days in less pain. Her siblings are not.

As Martin Luther King said on the eve of his death, “Like anybody, I would like to live a long life. Longevity has its place. But I’m not concerned about that now.”

My siblings and I could have been caught in the trap my friend is in, but, fortunately for us, our mother had written an advance directive that said what she wanted. When there was no hope of a good quality of life, she wanted to be out of pain and not have her life prolonged.

We couldn’t find a copy of that directive for a couple days, but our mother had told us all what she wanted, so there was no division among us on this issue. Good thing too. The hospital was unwilling to go along with what we wanted. It took two days of fighting them to get them to give her enough morphine patches - and stop injecting her with morphine which was so painful - to put her out of pain. After two and a half days, we got help from the local hospice group, and the hospital finally listened.

So, yes, we were her death panel, deciding that she would not receive all that modern medicine had to offer.

We had them stop all drugs (except morphine) and food, but when they asked about water we paused. It seemed cruel to let her be thirsty. But if we let her have water, she would persist for longer - possibly well over a week. And they would have to give it intravenously - but her veins had constricted. So we said no water. Just keep her out of pain. It took two days more, but come dawn she drew her last breath.

There are, of course, no death panels in any of the proposals for health care / insurance reform. There are, or were, provisions that would have required that insurance pay for consultation with health providers on making these end of life decisions.

Now, because of the unthinking, rabid nature of the opponents to health care reform, those payment provisions are out.

If we are lucky and if our parents are lucky, we will live to see them die. That is the natural order of things.

The only question is whether we will be prepared to face the challenges and decisions we will have to make. Whether we will be united and supportive of our siblings as we make these decisions. Whether our parents have as good a death as possible.

It’s now been a few years since both my parents died. I still have horrific memories of my mother’s death. Those memories will never be erased until I am gone.

• death,
• health-care,
• insurance,
• hospitals,
• medicine