Question: Why are we so afraid of death?
Ira Byock: Well, I do think it’s partly a human thing, I mean partly anthropologically, frankly biologically there is some hardwiring to avoid death. We fear, we have a fright or flight impulse or response built within us, a hormonally and neurochemically and the like. But I think it has become more exaggerated at least during the later part of the last century, during the last half of the last century, certainly I was born in 1951, and I know my parents talked about how in the 1930s it began to become apparent that there were dramatic miracles happening in medicine that people would comeback from the hospital after an ammonia or a serious urinary infection that should have killed them but with the advent of sulfa and penicillin’s and the like, people were just dramatically rescued and came back well from the hospital.
And then cardiac care got better and people didn’t die quite so quickly from heart attacks, and surgical care got so much better. And so as the power of medicines fueled by scientific advances became frankly dramatic, people culturally began to learn that the best care possible for anyone who you love and is seriously ill is to put them in the hospital. And frankly even better later in the century was to have them in the intensive care unit. And then it was the best hospitals, you don’t just want any hospital, you wanted the best hospital. So the American way of dying has gradually become dying in the hospital maybe in the intensive care unit, maybe even better still at the referral centre hospitals ICU.
Again there has been no ill intension, quite the contrary but it turns out that nowadays 20% of Americans die during a hospitalization that included an ICU admission. Many Americans, that’s a fifth of all American deaths. Many Americans are dying tether to machines, actually having their arms restrained so they don’t pull out their breathing tubes and the like, similarly 50% of people dying in hospitals, and 30% or so in nursing homes. This is not the way anybody really wants it, but we have never had a cultural conversation about what a healthy last chapter of life looks like, what that would actually look like to be taking the best care possible of one another professionally and socially in a way that is not always seeking to prolong life, and it corporates this notion that dying is going to happen at some point.
Recorded on: March 21, 2008