Preparing for death: Have a plan to face your mortality

ONCE upon a time, in a more naive world, we accepted there were two certainties: Death and taxes. 

To our cost, we know now that only one of those stands. That contemporary alchemy — “aggressive tax planning” — has made one of fate’s twins optional. Death, however, retains its bite.

Science has, nevertheless, deferred death in an unprecedented way. We live longer. A boy born this week can expect to reach something around 76 years of age; a girl can hope to live five years longer. Those are the official figures but gerontologist Aubrey de Grey believes “a decisive level of medical control” over the travails of ageing makes it possible that someone alive today will live to be 150 — double the official expectation. Not only are we living longer but the proportion of old people is rising dramatically and will grow even faster in decades to come. There are 540,000 or so people aged over 65 in Ireland, 12% of the population. This figure will hit 1.4m — 22% — by 2041. The changes predicted for the cohort 80 and over are more dramatic. The number of people in that bracket is expected to rise from 130,600 to 458,000 — an increase of 250%. An ageing population of this scale is unprecedented and our social, cultural, and psychological mindsets seem unprepared. Set against the looming pension crisis maybe that should be rephrased as “dangerously unprepared”.

Behind that grand statistical picture, there are, and will be even more, people dealing with the minor discomforts of early old age and eventually, for many of us, a dramatically altered course of life made possible, though not inevitable, by scientific capability. At a moment when people live longer and better than at any time in history, scientific advances have turned the choreography of ageing and dying into purely medical experiences. Death has been, culturally at least, sanitised by being moved from the home to hospitals or nursing homes. It is as if life’s last inevitability has been removed to a far, distant, unfamiliar place.

Many of us will have seen a loved one, a parent or even a child, struggle with mortality and an encroaching death. Many of us will have seen a dear friend broken by the illness that will quickly end their life fight an unequal battle in the pursuit of a delusion — that something that has been lost might be recovered through the ministrations of science. A death that might have been an enriching experience, one full of love and comfort, is turned into a bloody, 11th hour brawl with an indomitable enemy. Sometimes, though not always, the waning days of life are surrendered to medical last-throws-of-the-dice that push us into a twilight life with little or no real chance of any meaningful benefit. It’s as if an interim state has been created because we hope against hope.

Those who choose to fight to the last are perfectly entitled to do so but would it not be more humane, more loving, to recognise when the race is run and turn to the kind of care that embraces our mortality and offers the comforts needed to accept that? The very least we should do is have a conversation with those who will have to make the decisive decisions when our time comes. Not to seems delusional, unfair, cowardly, and certain to leave a legacy of pain and regret.