The Tibetan teacher Sogyal Rinpoche once said. "To die is extremely simple. You breathe out, and you don't breathe in." This is perhaps the best way to explain the transition into death. Or we should say... how the transition into death is supposed to be. But this is not the experience most people in the modern world have with death. Instead, for most the transition into death is a difficult one, filled with fear and filled with pain. Most people do not like to think about death.
Death has become a subject that we avoid looking at while it chases us down. It is the great inevitability of life, an inevitability that we spend billions of dollars trying to avoid every year. Some of us even make the very purpose of our lives a quest for physical immortality that places us in a quandary, a quandary where we resist death to such a degree that we inhibit ourselves from really living.
Many of us do not actually sit with death and try to understand it until it has caught up with us and there is no way to turn. Most of us never ask who it is that lives and dies. As a result, we have forgotten how to die well without suffering. We have also forgotten how to aid people with the transition into death.
On average, Medicare pays $50 billion per year just for doctor and hospital bills during the last two months of patients' lives, which is more than the entire budget of the Department of Homeland Security or the Department of Education. And it has been estimated that 20 to 30 percent of these medical expenditures may have had no meaningful impact. It costs up to $10,000 a day to maintain someone in an average intensive care unit, which is where many people end up for the days or months leading up to death.
Modern medicine has become so good at keeping people alive by treating the complications of underlying disease that the inevitable process of dying has become much harder and is often prolonged unnecessarily. The process of dying naturally is not only something we resist out of fear, it is also something we resist because it is very profitable business. A business that, though profitable for some, could end up bankrupting the nation.
Currently, 75 percent of all people die in a hospital or a nursing home. This is a problem when the current societal protocol for keeping people alive at all costs leads hospitals and nursing homes to enact highly invasive preventative measures that leave most people sedated and in pain, in an environment that is unfamiliar and in isolation for most of the day. This is in fact how the majority of people end up spending the remainder of their days.
The overwhelming issue staring us in the face is that there is a very fine line between preserving people’s chances at a happy life by using advanced medical technology and being prevented (often agonizingly) from dying a natural death. Our current health care system is in the business of resisting death as if it is an unnatural process. Even in the best of circumstances, its laws and practices leave people suffering unreasonably and unnecessarily at the end of life. Because of the fear of death, most people and their families want to cling to life, and hope for a medical miracle rather than to discuss how they want to die.
End of life care is one of the most important issues of our time. With the baby boom population approaching old age, the medical care market is about to be flooded. It is time for us to really ask ourselves the question… How do we want ourselves and our loved ones to make the transition out of this life? The time has come within our society to approach death differently. The time has come to question the ethics and efficacy of the extraordinary and often hazardous medical interventions that plague the dying process.
It is time to radically re-design the environments in which we spend our old age and most especially, our final days. The time has come for a new kind of end of life care to be provided to the general public that is not just a luxury of the rich, a kind of end of life care approach that recognizes that death is a natural process that we can walk into pain free and fear free, surrounded by the people we love, in environments that reflect wellness and comfort, and supported by professionals who are highly passionate and trained at facilitating the process of death for individuals and their loved ones so that it is a step taken with dignity, and with ease.
And perhaps most especially, it is time to become acquainted with death as a teacher and not as an enemy so that we can stop living our lives in the space of resistance and instead allow ourselves to really live while we are here.