“A human being is part of a whole, called by us the Universe, a part limited in time and space. He experiences himself, his thoughts and feelings, as separated from the rest, a kind of optical delusion of his consciousness. This delusion is a kind of prison for us restricting us to our personal desires and to affection for a few persons nearest us. Our task must be to free ourselves from this prison by widening our circles of compassion to embrace all living creatures and the whole of nature in its beauty.” — Albert Einstein, 1921

How will you handle life’s final journey? No matter your spiritual outlook, sage Mark Twain reminded us of the certainty of two things in life, “death and taxes.” As we close out this month’s theme on spirituality, it is timely to address the issues of death and dying.

If you have thought of death at all, it may seem like a lonely, scary or even welcoming place. This is reinforced by many belief systems emphasizing eternal punishment, eternal bliss or returning to earth in a reincarnation cycle over and over again until we somehow get it right. For some, there is just the void and the memories of those left behind.

Medicine, both ancient and modern, has long sought to delay this inevitable human experience. We have yet to solve the 100 percent mortality found in human life.

However, competent, compassionate medical care can guide us all to what has been called the “good death.” Former the University of Texas Medical Branch Professor Harold Vanderpool recently published an excellent book on this topic, “Palliative Care: The 400-Year Quest for a Good Death.”

He describes the troubling dynamics that have slowed progress to “a good death.” Doctors, charged with doing all they can to keep their patients alive, may be reluctant to withdraw futile care or resuscitate dying organs and people. Perhaps one more treatment, procedure, drug or tomorrow’s scientific discovery can help the dying patient hold on. This is even done at times in opposition to a patient’s and family’s desires or because of fear of litigation. Families, out of love, religious beliefs or lack of knowledge, may also try to prolong the inevitable.

High tech and ultimately ineffective attempts to prolong life create enormous human suffering and financial costs. In the last year, life-sustaining treatments for 5 percent of patients utilized 25 to 30 percent of the Medicare budget, costing $150 billion. These are resources that could have been better directed to prevention and improved care of chronic disease.
We can cure sometimes but must comfort always. Improved understanding of treatments available to relieve pain, as well as of supportive hospice services, can help us navigate these tricky waters.

Be sure to discuss with your doctor and loved ones your desires for end-of-life care. Execute an Advanced Directive and Medical Power of Attorney well before reaching a critical stage when you may no longer be competent to make your own decisions. You can bring peace of mind to loved ones and help make your final journey a good death.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.