BY JOHN STAMPER, KNIGHT RIDDER NEWSPAPERS.
Jessie Eaton died slowly.
She suffered a heart attack in 1985. A stroke in 1988 left her homebound withblurry vision. She moved into a nursing home in 1993.On Oct. 5, 1997, more than a decade after her health began spiraling downward and her skin started decaying from bedsores, this 93-year-old woman, whose weight dwindled to less than 100 pounds, died in her sleep.
More and more Americans are living into their 90s and 100s. Those extra years are full of life for some, but there is mounting evidence these gains achieved through advances in science and medicine have a dark side: the end is hard and long for many.
Living longer has radically changed how Americans die, experts say. The infectious diseases that ravaged this country 75 years ago no longer sicken many (of course, this picture is now changing rapidly for the worse- KB).Instead, degenerative diseases such as cancer, stroke and heart disease sap our energy and spirit for a decade or more before we die.
"Fifty years ago, people didn't die this way," said Joann Lynn, co-founder of Americans for Better Care of the Dying, a national activist group.
"A major triumph of this age is that we grow to live old, but that means we will probably die of a degenerative disease."
The World Health Organization warns that this increase in degenerative diseases will result in "a huge increase in human suffering and disability."
In the United States, about 27 percent of people are stricken by a heart attack during their lifetime, 32 percent have cancer and more than 20 percent suffer from a stroke. Managing the consequences of this change is a challenge for growing numbers of older Americans, for their families and for a medical system equipped to fight disease but ill-prepared to manage death. We know how to make death easier, but we aren't doing it, activists complain.
As the first baby boomers pass 50, the system is changing, but slowly. The cost of our struggle with death became apparent in a national study on death produced by the National Center for Health Statistics recently. About half of those who died had a functional limitation during the last year of life. Fifty-nine percent couldn't walk a quarter of a mile. Twenty-four percent couldn't use the telephone, a 1993 survey shows.
Christine Cassel, head of the Department of Geriatrics and Adult Development at Mount Sinai Medical Center in New York, said that giving up control over everyday routines such as eating and bathing can be devastating to patients and their families. "It's a real blow to the sense of self-respect and ego for many people to say 'I can't go to the bathroom by myself,' " Cassel said. The mortality study found that 43.5 percent had trouble using the toilet alone during the last year of life. Often, depression and loneliness followed the physical disabilities, as it did with Eaton. She became a recluse during the last years of her life, convinced someone was out to get her.
In fact, Sid Eaton said his mother insisted on leaving her first nursing home,considered one of the finest in the Portland, Ore., area, because she felt the nurses were trying to poison her. "She was really pretty alone the last few years, but it wasn't something she talked about much," he said.
Where we die also has changed during the past 50 years.
More than three-fourths of all deaths occur in a medical institution -- 56 percent in a hospital or clinic and 19 percent in a nursing home, the mortality survey found. In 1937, 37 percent of people died in a medical institution.
Money, or the lack of it, is also an issue.
Of the more than 2.2 million people who died in 1993, 63,000 couldn't afford the health care they needed. Lynn, also director of the Center for Improved Care of the Dying at George Washington University, said this number was probably an underestimate, since most families didn't know what treatments were available and what treatments their loved ones should have received. Nearly half the families said Medicare covered most of their expenses, but 10 percent of those who died used their own money or their family's to pay for health care.
When people get sick, their family gathers to offer comfort and aid. But what happens when people stay sick? Often, children live hundreds of miles away from ailing parents, and they usually have jobs and children to care for. These factors, combined with the changing causes of death, force families to choose among caring for their parents, going to work or caring for their children.
"Many people can alter their lives to give care for a short period of time, but when it becomes long term, people have to either dig deep into their finances or significantly alter their lives," said Sarah Goodlin, a geriatrician and assistant professor of medicine at Dartmouth Medical School.
The mortality survey found that a spouse helped care for the dying 58 percent of the time, a daughter 46 percent and a son 22 percent. Sid Eaton began spending most Sundays with his mother after her heart attack. He would go shopping for her, gathering groceries and home remedies for aches and pains that he said often bordered on kooky.
"At least one day a week was given to her," he said. "That sort of got factored into my life." But Sid Eaton, an only son, is not the average caregiver. Most are female. Daughters and daughters-in-law are often called upon to accept the task of providing care, even as they continue to work and hold their families together. In fact, three-fourths of all caregivers are women, 80 percent of whom provide care an average of four hours a day, seven days a week, Goodlin said.
"Even if you have a son, it's the daughter-in-law who often ends up doing a lot of the care," Cassel said. "If we really expect women to be in the work force, adding the responsibility to care for an elderly dying person is a lot to ask."
In addition, the mission of American medicine and health care has always been to save lives. A worthy goal, but one that is sought for many patients who have little hope of recovery, critics say. Doctors should be focused on giving quality end-of-life care to the 80 percent of Americans who die from chronic diseases, Goodlin said. "This is not an area health care professionals have focused on," she said. "Generally, medicine is focused on preventing death and not managing it."
Many patients suffer painful deaths because their doctors aren't trained to ease their suffering, critics say.Things like depression, nausea and a variety of pains easily can be treated but often aren't, making death an excruciating experience for the patient and family, Lynn said.
A 1997 study conducted in five university hospitals and co-written by Lynn found that more than one-third of conscious patients experienced severe pain during the last three days of life. The study also found that most family members believed the patients preferred treatment focused on comfort, but instead received life-sustaining treatment. In this survey, four out of 10 patients had a feeding tube before death, one-fourth were placed on a ventilator and about one in 10 had a resuscitation attempt.
"People don't get expert care at the end of life by and large, mostly because we don't know how to do it in the U.S.," Cassel said. "None of us were trained very well in this area."
This study done by the National Center for Health Statistics shows that people, if they do not die early in life of heart attacks, cancer, strokes, AIDS etc., etc, ad nauseam, find themselves slowly becoming crippled mentally and physically as they slowly die of these same degenerative diseases. Of course, it is a fiction that modern medicine has anything to do with the fact that people are living longer; this is due to better hygiene and more comfortable material circumstances than we had 100 years ago.
It is clear that modern medical science has not been of any benefit to humanity and can never be of any benefit. I realise I am saying this in the midst of a culture which is in a state of complete idolatry when it come to people's attitude toward modern scientific medicine. The reason modern scientific medicine cannot ever be of any help in overcoming the problem of disease is because modern medicine has no understanding of the human being, it has no understanding of disease and no understanding of health.
(to be continued..)
In addition to "Theosophy" the titles of Rudolf Steiner which are the basic books necessary to understand any of his other writings and lectures available, are as follows:
An Outline of Occult Science.
Knowledge of Higher Worlds and Its Attainment.
The Philosophy of Spiritual Activity.
Christianity as A Mystical Fact.