In a new blog post for The New York Times Timothy Egan explores the medical-industrial complex’s resistance to end-of-life palliative care. According to the article, close to a third of the money spent by Medicare goes towards the last two years of a person’s life desperately trying to stave off the end. Egan sites as an example Annabel Kitzhaber,¹ a terminally ill patient for whom Medicare “would pay hundreds of thousands of dollars for endless hospital procedures and tests, but would not pay $18 an hour for a non-hospice care giver to come into her home and help her through her final days.”

We treat death as a pathology in this country, as something that needs to be kept away, battled, banished. So too do we disavow the aging process as we dye, peel, inject, lift, and bleach ourselves into eternal youth. As a woman in her thirties who is being introduced to the gradual loosening and graying of things, I look around for models of healthy aging to help me transition gracefully into midlife. But what I have found is that there aren’t any. As I look at our public figures, I see 50-year-old women without a line on their faces, dating twenty-year-old boys, running around as if to say “Seventy is the new fifteen!”

How are we to embrace the end if we cannot even face what the middle looks like?

We have been programmed to intervene in the aging and dying processes at every stage. If a gray hair sprouts up, pluck it out. If a crows foot appears, inject it away. If systems begin to fail, even at the end of a long meaningful life, do everything you can to ward off the inevitable. Nevermind that the quality of his or her life is diminished. I don’t believe, though, that this reflects our deepest desires as human beings. I think that most people want to die peacefully at home with as little intervention as possible. So where are we getting lost?

One such place is in the corridors of the medical-industrial complex. As the spouse of an emergency physician I have an interesting perspective on the matter, because I am able to see through the eyes of someone trained to save people’s lives without question. What I have learned is that because of Medicare’s willingness to pay for heroic life saving measures even when palliative care is indicated, much of the responsibility to navigate these hard decisions is shouldered by the health care provider. The hair in the soup though is that most health care providers do not want the responsibility. Far easier for them to say that they did everything they could to save a person’s life than it is it to sit down with that person’s family and talk about what it would mean to discontinue treatment, how it would feel to prepare themselves for the death of their loved one.

No one expects doctors to function as social workers or counselors, but we need to train our physicians that their job is not always to extend life. Months ago I asked my husband how his day went, in the way that I often do. “Save any lives today?” I said. “Nope,” he replied. “But I helped a family let someone go. And that felt just as good.”

In a post I wrote a few weeks ago about mercy, I commended the Scottish government for granting compassionate release to the Lockerbie Bomber, Abdel Baset al-Megrahi, who is terminally ill. By doing so, they have allowed him to die at home in Libya with his family. After publishing the post, I got a note from a friend who always lets me know in a very kind and respectful way whenever he disagrees with my position. This is what he wrote in reference to the fact that al-Megrahi was essentially given a parade when he got back to Libya:

“You touch on cultural differences [of mercy], but omitted an obvious one…the Libyans. If you look at events in the Middle East over the last 60 years, you will see that power trumps compassion or discussion every time…
The reception of Megrahi orchestrated by the government and his meeting with Qaddafi only reinforces this notion. It may have been noble for the Scots to let him go, but it was a mistake. The reaction on the Arab street will be one of victory over the 270 innocents lost that day.”

His comment got me thinking about whether or not the Libyans’ behavior should matter when we decide if al-Megrahi’s compassionate release was the right thing to do. Should an action’s merit be judged by the way in which the action is received? I understand that it does not sit well for anyone that a convicted terrorist would be given a hero’s welcome upon his return to his homeland. I can see how anyone would take that as a slap in the face, as further evidence that this person is not worthy of our compassion. But if we draw this scenario out to another example, the answer seems clear to me: Imagine if you give someone a letter opener for his birthday and he turns around and stabs someone with it. Does his terrible behavior diminish the kindness of your gift? Does it make your gift a mistake? I believe that your responsibility ends when your friend takes possession of your gift. At that point, whatever he does with it becomes his responsibility. And I believe it is so with al-Megrahi and the Libyans.

It is a frightening position to take. I try to think about how I would feel if al-Megrahi committed another act of violence after his compassionate release. It would be devastating. But as hard as it would be to separate ourselves from it, I believe that such an action would be on al-Megrahi’s head, not ours. I feel strongly that we can only lead in this world by example. The only way to prove to others that compassion should trump power in their lives is by practicing it in ours.

My husband is a mountaineer, a rock climber, a backcountry skier, and a doctor, which makes him equal parts adventure junkie and safety nerd. When we met he was doing a lot of mountain search and rescue, orienteering, and other boy scouty things. We would often go for day hikes in the woods and I would invent epic scenarios, which he would then have to talk us out of, stuff like:

      What would you do if I fell down that ravine and broke my arm?
      I would climb down to get you and then take you to the hospital.
      What if I broke my arm and my ankle?
      I would climb down to get you and then hop with you to the hospital.
      What if I broke my arm and both of my legs and I weighed three hundred pounds and we were ten miles in and I was all mangled and bloody and couldn’t walk or hop and I was losing lots of blood from one of my arteries?
      I would climb down to get you and make sure you were breathing. Then I would fashion a tournequet out of my shirt and a stick…

This became our thing. Whenever we were out in the middle of the woods I would make him explain all the different ways in which he could get us out of danger in the event of some horrific accident. It made me feel safer somehow.

One day we were walking on one of our favorite trails and I tripped over a log and turned my ankle. It wasn’t so bad that I couldn’t walk on it but I wondered aloud what would’ve happened if it had been worse. We were many miles from the trail head. Josh said he would’ve rigged some crutch-like device for me or made me a little shelter and then run back for help.

Something terrifying occurred to me then, something I had never thought of before. “What if I’d been alone? What if you weren’t here and there was no one else around to help me?”
Joshua turned to me and, without a trace of sarcasm in his voice, said, “I guess you’d just have to rescue yourself.”

Fred McFeely Rogers testified in front of the U.S. Senate on May 1, 1969 in an attempt to secure 20 million dollars of funding for public broadcasting, which the government was threatening to cut in half. If you have seven minutes to spare today, you can witness for yourself the power of kindness and authenticity to melt even the toughest of hearts. Enjoy.