As mentioned in the first takeaway, modern scientific capability has completely altered the course of human life. People now live longer and better than at any point in history. For all but the past couple hundred years, the average human lifespan was 30 years or less. It didn’t matter if you were 5 or 50 — death lurked around every corner, and every day was a roll of the dice. 

That’s simply not the case today. Although death can still come at any time, medical innovations like antibiotics, vaccines, chemotherapy, anesthesia, blood pressure and cholesterol meds, heart surgery procedures, kidney transplants, and so many other advancements in public health and sanitation have contributed to a massive reduction in mortality rates for nearly all diseases and ailments we face. We can even use medicine to slow down terminal illnesses a bit. 

These advancements in medicine have been matched by the huge improvements in the institutions we interact with in old age. Before the Hill-Burton Act of 1946 was passed to create a boom in hospital construction across the country, people were mostly on their own to deal with disease and illness at home. If you got seriously sick before modern hospitals became commonplace, you were kind of screwed. Eventually, hospitals became so crowded with elderly patients dealing with chronic and end-of-life illnesses that nursing homes expanded as a way to care for many of those individuals.

But most elderly folks have come to dread nursing homes because living in one usually involves sharing a room and losing much of your control over your daily schedule. Your independence is zapped; most of the control lies in the hands of the nurses and staff operating the facility. Assisted Living complexes were introduced in the 1980s as an alternative to nursing homes; a middle ground between the total freedom of independent living and the far more restrictive environment of a nursing home. Assisted Living facilities provide old people with their own private room complete with their own door lock, thermostat, kitchen, bathroom, carpeting, furniture, and more. Residents have far more freedom to organize their schedule as they wish while also receiving round the clock care from on-site nurses and support staff. It’s like an apartment for elderly people.

There’s a point here, and it’s this: While all of these developments in medicine and elderly living institutions have been highly beneficial, they have also turned the process of aging and dying into medical experiences. There will almost ALWAYS be something we can try from a medical perspective to help extend the life of someone dying of old age or of a severe terminal illness, whether it’s more combination chemo, another invasive surgery, or some kind of experimental treatment. But there comes a point in many of these cases where medicine becomes more harmful than helpful — where yet another surgery or another round of complicated drugs actually worsens or shortens the time we have left. Today’s medical technology can sustain our organs until we are well past the point of awareness and coherence. That’s really not what we want, though.

Whether it’s with our own life or the life of somebody we love, there can come a time when we realize there isn’t much to be gained by continuing to medicate and treat; to keep fiddling and fixing in an effort to prolong life at all costs. In other words, there comes a time to wave the white flag; to stop the suffering and struggle and instead spend what time is left by making peace with God, saying our goodbyes, and being with the people we love most. Relentless medication and treatment can create suffering that robs us of those opportunities. When there is no cure and the chances of returning to even a relatively decent life are 0, it becomes harmful to use medicine to keep someone alive.

The hard part is realizing when it’s time to wave that flag, and the even harder part is accepting it. But the last thing anyone wants is to become so diminished that they aren’t remotely close to their true self and can’t do any of those crucial end-of-life tasks in their final days because they’re strapped to a ventilator or are mentally incoherent. That’s tragic. Again, for most of human history the ability to needlessly prolong life wasn’t even an option because medicine was nowhere near as advanced as it is now. Death was usually swift. Now, many deaths only come after long medical struggle. This is reflected in the fact that roughly 25% of Medicare spending goes to the 5% of patients in the last stages of life. 

The author sums it up well: “At least two kinds of courage are required in aging and sickness. The first is the courage to confront the reality of mortality – the courage to seek out the truth of what is to be feared and what is to be hoped . . . But even more daunting is the second kind of courage – the courage to act on the truth we find.”