Commentary: McCain shows us the power of coming to terms with dying

Sen. John McCain has not announced a decision to stop treatment for his brain tumor — but his public actions indicate that he has transitioned from “being sick” and hoping for a cure to “dying” and hoping for the best possible quality of life in the time remaining.

He has completed his final book, “The Restless Wave.” He has planned his funeral and asked people to eulogize him. He is openly gathering friends and colleagues to his ranch to say goodbye, share memories, and pass on wisdoms. When he does die — especially coming so soon after Barbara Bush openly stopping treatment in favor of comfort care — there will be a rare opportunity for us as a society and as individuals to benefit from the experiences of these courageous public figures and further the growing national dialog about how we die.

RELATED: McCain gets visits from friends, family after surgery.

We as a society have not come to terms with dying as a natural part of living. The technological capabilities of medicine have outstripped the moral capacity to distinguish what can be done versus what should be done. This results in end-of-life care that is often aggressive, expensive and not aligned with patient preferences. Far too many of us die in hospitals, in pain and isolated from their friends and families. These statistics make clear the scope of our problem:

• Although 90 percent of those on Medicare say they want end-of-life care at home, only one-third achieve it.

• Twenty-five percent of all Medicare spending is for patients who are in their final year of life. Most of that money is spent in their last couple of months for care, which is often of little apparent benefit.

• The default standard of care is “all necessary care.” This standard of heightened levels of care contributes to the estimated $810 billion in unnecessary, unbeneficial, or wasteful care provided to Medicare beneficiaries who spend most of their Medicare dollars in the last year of life.

PHOTO GALLERY: Sen. John McCain through the years.

• Despite overwhelming conformity, when it comes to what Americans claim is important to them at the end of their life, patients do not always receive the level of care they desire. Among those seniors who have taken the time to spell out for their physicians how they envision their final days, only two percent of respondents requested “all possible care.”

• A study of patients who understood themselves to be terminally ill with advanced cancers found that only 17 percent of respondents expressed interest in “life extending treatment.” Instead, most patients valued quality of life over extending it.

There are institutional changes required to improve end-of-life care, such as restructuring the U.S. payment system and policies to support palliative care provision and updating medical school curriculum to educate clinicians about end-of-life care. These are necessary components of a long term solution but institutions are slow to change.

FOLLOW US ON TWITTER: Viewpoints tweets the latest insights and analyses on politics.

In the meantime, there are personal barriers to dying well, largely fueled by fear and lack of information, which can be addressed now. Failure to plan ahead makes it difficult — if not impossible — to achieve end-of-life goals. There are tools available to help us think through and document what we want at end-of-life. There are excellent books that educate readers about the process of dying, palliative treatments that are available and the many services that hospice provides. Healthcare organizations at all levels should commit to investing as much on campaigns targeted at improving communication about advanced care planning and increasing public information/participation in end-of-life care as they do for campaigns on healthy eating, exercise and screenings.

Without action, many of us will never achieve the closure that McCain is surely working towards — and grieving family members will be left with heart-wrenching tales full of tears, anger, regret and loneliness.

Ducharme Hoben is the author of the memoir “Dying Well: Our Journey of Love and Loss.”

Reader Comments ...

Next Up in Opinion

Facebook comments: Aug. 17, 2018
Facebook comments: Aug. 17, 2018

As reported by the American-Statesman’s Philip Jankowski, the Austin City Council approved the McKalla Place deal Wednesday, paving the way for Columbus Crew SC owner Anthony Precourt to begin financing an estimated $200 million stadium on the 24-acre tract of city-owned land. The vote was 7-4, with Council Members Leslie Pool, Alison Alter,...
Opinion: America’s lengthening enemies list

On Friday, deep into the 17th year of America’s longest war, Taliban forces overran Ghazni, a provincial capital that sits on the highway from Kabul to Kandahar. The ferocity of the Taliban offensive brought U.S. advisers along with U.S. air power, including a B-1 bomber, into the battle. “As the casualty toll in Ghazni appeared to soar...
Opinion: Republicans are playing with fire in the states

WASHINGTON — The backlash to President Trump and the steady rightward journey of the Republican Party could sharply shift the distribution of political power in state capitols across the nation in this fall’s elections. And because reapportionment is coming, this could change the contours of American politics for more than a decade. Strengthening...
Phillips: Last hurrah for Confederate groups in Veterans Day parade
Phillips: Last hurrah for Confederate groups in Veterans Day parade

During his 22 years in the Air Force, Lt. Col. Daarel Burnette observed Veterans Day events around the world, from Izmir, Turkey, to Colorado Springs, from military bases to the Pentagon. In all those places, during all those years, the emphasis was on sacrifice of U.S. veterans, said Burnette, who retired in 2001. It was about honoring soldiers who...
Herman: After months of kicking it around, Austin goes major league
Herman: After months of kicking it around, Austin goes major league

Great news! We’re getting a big-league football team. Less great news for some: It’s the other football, the one in which you actually use your feet for something other than running. Me? I’m good with the Austin City Council’s 7-4 vote Wednesday that should clear the way for the Columbus Crew to relocate to Austin and eventually...
More Stories