“Everybody dies, and nearly every person wonders, however privately, what form that death will take.”
It just might be the juxtaposition to Halloween, the Day of the Dead, but I have just recently received separate messages on how to live longer and how to die happier.
Dr. Roger Landry, a Tufts medical school graduate with a MPH from Harvard, after more than twenty years as a flight surgeon in the USAF wrote a book in 2014, Live Long, Die Short: A Guide to Authentic Health and Successful Aging. None of his “essential tips” are surprising, but he has established a whole company of multi-disciplined professionals based on those tips to provide consultations to communities wishing to ward off dementia: 1. Exercise regularly, 2. Challenge your brain, 3. Reduce stress, 4. “Unplug” regularly, and 5. Eat a balanced diet (“Mediterranean”, of course).
Since 2014 Dr. Landry has expanded on his original list (followed here by brief editorial comments):
- Use it or lose it. [“Motion is lotion” is the physical therapist’s mantra].
- Keep moving. [A recent ten year study of 2000 people indicated that you only really need to take 7000 steps a day (about 30 minutes of exercise a day) to reduce your risk of early death. Risks were lowered a bit more at 9000 steps, but stayed level at 10,000 steps or more. If you are a regular reader of this blog you already know that the 10,000 step “threshold for health” is completely arbitrary. The Japanese figure for 10,000 looks like a running person, so the Japanese manufacturer put that figure on its fitness devices.]
- Challenge your brain. [Unfortunately several studies have been unable to confirm the current conventional wisdom that cognitive decline may be delayed by challenging your brain with crossword puzzles, word jumbles, or Sudoku. “A new commercial field of ‘brain fitness’ has been launched to bring to the market training exercises and games that maintain and strengthen cognitive abilities in adulthood. However, the majority of brain fitness methods and products now marketed and sold to consumers have scant scientific evidence to support their effectiveness.” ]
- Stay connected. [Yes, this is particularly true for elderly married couples; they live longer than singles. But, when you retire remember your marriage vows. You married “for better or for worse”, and NOT for lunch; get out of the house during the day. Excessive social media connections may not be beneficial. Remember “unplug periodically”.
- Lower your risks. [Meditation, painting, reading, naps even, or just gazing off into space for some time will lower your stress level, as long as you don’t sit and gaze into space for so long that friends and family think you may be approaching the bend.]
- Never act your age. [Pediatricians hardly ever do.]
- Wherever you are be there. [ This a variation of Jon Kabat-Zinn’s famous slogan from his 1994 book on mindfulness, “Wherever You Go, There You Are”.]
- Find your purpose. [When you retire, and you don’t have a hobby, get one.]
- Have children in your life.[ The benefits of non-family intergenerational relationships are well documented.
- Laugh…a lot. [It clears out your lungs, raises your oxygen blood level, and releases endorphins which make you feel great.
Dr. Landry implies that if you follow his tips and live longer you will then have a better chance of “dying short”, but I won’t go into his details because he was trumped by a mailing from Compassion & Choices, a non-profit organization advocating for “choice, dignity, access, and autonomy at life’s end” by seeking state legislation to allow “medical aid-in-dying” services.
Medical aid-in-dying (previously called physician-assisted death) is currently legal in eleven jurisdictions: California, Colorado, District of Columbia, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington. Similar legislative efforts are ongoing in other states, including Massachusetts.
The 60’s, 70’ and 80’s was a turmoil of ethical and legal debates about a person’s “right to die”. For instance, after years of legal squabbling with doctors and hospitals Karen Quinlan’s parents were given legal permission in 1976 by the court to remove her from the respirator that was keeping her alive in a vegetative state. During this same period Ethics Committees sprang up in most hospitals to help physicians, nurses, patients, and families work together addressing the vexing question of “how best to die” for an individual patient. Critics of Obamacare quickly dubbed these well-intentioned groups as “death committees”. Advance directives, living wills, and even more specific patient orders to their physician (TreatmentMedical Orders for Life Sustaining – MOLST, aka Comfort Care) are now widespread and and reflect the common wisdom that we do have a “right to die”, and that we have some choices as to how and when. But remember, when the courts determined that Karen Quinlan had the right to die and her parents stopped her respirator support expecting her to stop breathing, Karen actually continued to live without a respirator in a vegetative state for eight more years!
The current controversy is centered on the ethics of patients asking for active medical help in achieving a “good death”. The old term “euthanasia” with its nasty implications of a slippery slope of unbridled expansion of “physician-assisted suicides” is obsolete. Much of the change in terminology is due to the positive experience and public support in Oregon since implementation of their Death with Dignity Act in 1997. It took ten years for the next state to pass a similar law, but since 2017 there has been a flurry of such laws. California passed their End of Life Options Act in 2015 with a sunset provision in case the worst case scenarios predicted by critics actually developed. That 2015 law was recently renewed until 2035 after California voters rejected its scheduled repeal by 60%.
Medical aid-in-dying laws differ among states in terms of eligible diagnoses, waiting periods, extent of screening and documentation of patient choice, type and/or numbers of medical providers able to provide the service, etc. Many state courts and the U.S. Supreme Court have upheld the medical profession’s right to choose the method of aiding the patient that is compatible with the patient’s request. About ten other countries have passed similar laws, often fashioned on Oregon’s model. The country with the most documented experience (mostly very positive) since 2002 is the Netherlands.
Our country’s discussions of medical aid-in-dying will continue and hopefully the data will continue to reveal that “abuses” are few, that more states will adopt these internationally-accepted laws, and that more patients will be able to have, as my late Irish-ancestry mother-in-law used to wish for, “a good death.”