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I want to share a second TedTalk I came across today, Let’s Talk about Dying, presented by Dr. Peter Saul. (Disclosure: this and the previous Ted Talk I posted were part of a bibliography of grief resources from Grief: A New Normal put together by the Chaplaincy Innovation Lab.) Dr. Saul describes his experiences as an ICU doctor and how they have informed his ideas regarding advanced planning. To highlight a few points from his talk:

So we have had tremendous success, and we kind of got caught up in our own success quite a bit, and we started using expressions like “lifesaving.” I really apologize to everybody for doing that, because obviously, we don’t. What we do is prolong people’s lives, and delay death, and redirect death, but we can’t, strictly speaking, save lives on any sort of permanent basis. 

This point is important and fundamental to how we view intensive care units. By changing the language from lifesaving to life prolonging, we are able to better understand the value of ICU as well as the limitations. Through this, there can be a better sense of how to make decisions about prolonging vs. refocusing care to symptom management.

What we know is that obviously we are all going to die, but how we die is actually really important, obviously not just to us, but also to how that features in the lives of all the people who live on afterwards. How we die lives on in the minds of everybody who survives us, and the stress created in families by dying is enormous, and in fact you get seven times as much stress by dying in intensive care as by dying just about anywhere else, so dying in intensive care is not your top option if you’ve got a choice. 

I like his observation about how discussing our wishes can decrease the stress placed on our loved ones who will be living on. In my work, we can often see the differences between knowing and not knowing in how family’s grieve and mourn a loved one.

Dr. Saul goes on to advocate for a national movement to encourage people to have these conversations. Sure, this isn’t unique as there are many groups that encourage advanced planning. Yet, what intrigued me about this talk is his last point:

… I like “Peace, Love, Natural Death” as an option. I do think we have to get political and start to reclaim this process from the medicalized model in which it’s going. 

Now, listen, that sounds like a pitch for euthanasia. I want to make it absolutely crystal clear to you all, I hate euthanasia. I think it’s a sideshow. I don’t think euthanasia matters. I actually think that, in places like Oregon, where you can have physician-assisted suicide, you take a poisonous dose of stuff, only half a percent of people ever do that. I’m more interested in what happens to the 99.5 percent of people who don’t want to do that. I think most people don’t want to be dead, but I do think most people want to have some control over how their dying process proceeds. So I’m an opponent of euthanasia, but I do think we have to give people back some control. It deprives euthanasia of its oxygen supply. I think we should be looking at stopping the want for euthanasia, not for making it illegal or legal or worrying about it at all. 

This is a quote from Dame Cicely Saunders, whom I met when I was a medical student. She founded the hospice movement. And she said, “You matter because you are, and you matter to the last moment of your life.” And I firmly believe that that’s the message that we have to carry forward. Thank you.

He frames the conversation about how people make choices into one about trying to grasp onto a sense of control when control seems to be lost. Hospice as a modality is about refocusing care on symptom management, which is already putting the control back into the dying person’s hands. This reframing of the choices conversation is powerful and poignant. Listen and reflect on this valuable talk.

As an aside, the next Ted Talk is also interesting to listen to: Am I dying, the honest answer, a reflection from a NY EMT about whether to answer the question of “Am I Dying?”