How baby boomers will change end of life care

The baby boomers, the largest generation in American history, are now almost all in the last third of their lives (if average life expectancy is 78). They have spent the previous, early and middle thirds of their lives transforming cultural ideas, expectations and practices (e.g with the civil rights movement, environmental movement and women’s movement, etc).

The question now is, “Will the baby boomers also transform our cultural ideas, expectations, and practices regarding the end-of-life?”

I say yes! Here are my predictions and recommendations for this generation of “revolutionaries”:

1. Baby boomers expect to live longer and will seek out technologies to do so. We continue to see life expectancies extended (although the obesity problem may soon change that) and the boomers will focus on ways to further extend their years on the planet. I strongly recommend however that they seek technologies that will extend quality life rather than quantity alone. For example, but do not choose medical interventions that will prolong your days if those days are going to consist of lying in a bed, unable to poop or pee without assistance. Choose technology that creates quality alone, quality plus quantity, but never quantity only, at the expense of suffering.

2. Baby boomers will author and create the “natural death” movement. The natural birth movement was predominately a product of the baby boomer consciousness. Taking root in the 1960s, a movement occurred to “de-medicalize childbirth” with varying degrees of penetration into general culture. The outcomes ranged from the growth of midwives and the home birth movement, to changes in the architecture of labor and delivery rooms — to make the birthing experience more intimate and family centered, as it had been for all of human history before modern medicine.

Similarly, I expect this boomer idea to cross-fertilize end-of-life movements:

  • Death will become “de-medicalized” and will again be viewed as a natural event that can be managed in natural settings such as the home. The hospice industry will see phenomenal growth to accommodate this shift in desiring to manage dying at home. (90 percent of Americans already say they want to die at home but nearly 80 percent of us presently die in medical institutions.)
  • For those who must experience dying in medical institutions, more efforts will be made to humanize the experience and to make it more intimate. Dedicated hospice units and rooms will be built with a design emphasis on comfortable, home-like surroundings encouraging family gathering and final intimacies.

3. Boomers like to be in charge and will seek more control over the dying process. One present expression of this is the right to die movement. While I am opposed to physician assisted suicide and euthanasia, I understand and support the impulse to gain control over the dying process and to minimize suffering. I personally feel that this can be accomplished without choosing to ingest a life-ending substance, however. At the right time (for you), choosing comfort-focused medicine over cure-focused medicine will allow you to gain control over the dying process: physical suffering can be controlled with appropriate medications, allowing time for quality emotional, social and spiritual closure and reconciliation to be obtained between you and others. Additionally, choosing comfort-focused care more often enables you to die, expectantly, where you desire to be the most (usually at home).

Thus, I expect boomers to gradually increase the dialogue about assisted suicide and other novel pathways for obtaining control over the dying process.

4. Expect more non-traditional, cost-conscious funeral preparations. A great example of this is my husband, Kris, who is one of the trailing baby boomers, born in ’61. He wrote a great treatise on this topic entitled, “Final Resting Places and Dealing With the Funeral Industry Monopoly” (Chapter 22 of It’s OK to Die). In this chapter he argues compellingly that the funeral industry hangs us out to dry if we haven’t made plans in advance. We don’t “shop around” in the midst of our grief and just pay for whatever is easiest (but not most economical), while wiping our tears.

Kris gives unusual tips for saving thousands of dollars on funeral costs and tells a story about how we drove his deceased father, in a full–sized casket, across multiple states in an SUV to save on flight costs for the casket and the whole family. It was a very “thinking out of the box” experience (slight pun intended), which turned into a trip that gave final closure to the whole family, saved thousands of dollars, and felt like an adventure. Sounds like something every baby boomer should look into.

Monica Williams-Murphy is an emergency physician and author of It’s OK to Die.

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  • Lucy Hornstein

    Hear, hear!

  • James deMaine

    I hope you’re right. Though I still see boomers like Steve Jobs seeking “holistic therapies”, then shifting to every big gun that technology has to offer – what I call “blind faith-in-science”.

    My physician father at 94 passed in a home-like environment very peacefully without tubes, bells and whistles. It felt very spiritual and natural, well outside the realm of the way death is often medicalized. Perhaps boomers can reach a few generations back and face death like he did.

  • Deep Ramachandran

    Thank you for this article. I hope you’re right, but if there is any evidence that this is going to happen, as a critical care physician I have yet to see it. The boomers are already seeking out better technologies to extend their lives, there is no reason to think that they will suddenly realize that their life is over and give them up. Most boomers are using up tens of thousands of dollars at the end of life, to extend their lives by a matter of weeks, we already see them doing this for their elderly parents and they are beginning to do it for themselves too.
    Technology makes it easier to extend life (though not necessarily quality) and harder to let go. For most people “taking control” means taking control of the living process by trying to avoid death, rather than taking control of the dying process. In my experience, it is the rare extraordinary individual who has the fortitude to take control of their dying process and that is unfortunate.

  • leslie fay

    As a “leading edge” boomer and a respiratory therapist of almost 40 years I’d like to think you are right, but my experience leads me to believe you’re not. Americans continue to think that death is optional. They have not grasped the quality v quantity issue. I feel this is at least partially due to education or lack thereof. People think that dying is like it appears on television and nowhere is anyone educating people as to what “do you want us to do everything?” actually entails. Perhaps we could blend the two and have a program called “Beyond Scared to Death”? A reality program that would show the pain and suffering that goes on when a patient has become terminal but no one wants to admit it. Teaching physicians to present the situation in a way that will help the patient and the family to make an educated decision would be really great. Instead of “Do you want us to do everything?” how about ” You’re father is dying from..insert disease(s)..anything else we do will be futile and extend his life briefly but inflict great pain and suffering. We can make him as comfortable to make his passing as easy as possible”. I have seen soooo many doctors who give false hope and contribute to the pain and suffering.

  • Bart Windrum

    As a lay person who’s been at and in deep EOL thought since my parents’ crummy hospitalized demises in 04/05 I believe I have identified various aspects that interfere with dying in peace and hence dying at peace (they are myriad, as we all here know).

    I like this article because it provides a cogent birdseye view of a range of possible directions a generational cohort may take.

    Whatever one’s specific or predominant experience of the cohort thus far, I think that it’s quite early in the Boomer response to dying. At almost 60 I’m near the leading edge of the cohort, and we’re only beginning to see a nascent national conversation, evidenced by sporadic articles about our parents’ demises (among the latest, and certainly most prominent, Joe Klein’s Time “How To Die”). As a reader of those, and as an observer of various 1-2 hour EOL panel presentations (the typical public face of the EOL conversation) it’s clear to me that they all fail to cover the most salient aspects. They basically just state the problem and promise that palliative/hospice will rescue in a timely manner. It takes several hours to get through this, and typically questions about self-directed dying are deflected (because even our best friends, palliative/hospice docs, are loathe to go in either direction, they being to acquiesce or to push back). Nothing at all is mentioned or offered about those myriad aspects of dying in peace—basically a rundown of twenty first century mechanized dying realities and the medical and social milieu around it all.

    Don’t discount the natural dying and alternative funeral movements. They’re real; I’ve presented at conferences held by both.

    One study that’d be interesting to see would try to assess the Boomer generation in terms of wealth, politics, and orientation around dying. I wonder if there’s any correlation between, say, high wealth and desire for longevity at the risk of machine dying…

  • SamBlaine

    As a boomer with no medical training, it is important to remember that some illnesses, unlike advanced terminal cancer, can cause life-threatening episodes that if treated can result in recovery and several more years of life. Most of us want that– especially if the doctor is not sure if we are dying.

  • deetelecare

    Dying at home can be difficult and painful too, and shattering for the family, unless support is brought into the home. Caregivers often don’t realize when a person is declining and going to pass, even when you have medical training. My brother and I can speak from this experience–it is so hard to give up and to detect that time is short, particularly with dementia which is a long, slow slide. Support at home requires a system, funding, administration of pain meds and accommodation of caregiving in the workplace–and with a crumbling economy that is going to be difficult to find (we need only look to the the idealistic view of deinstitutionalization of psychiatric patients as a morally right cureall–we fail to provide the part 2, which is community support, because states and cities don’t want to fund or cannot.)

    There are groups such as HealthCare Chaplaincy in NYC which provide trained chaplains and do research in the area of addressing spiritual needs not only at the end of life, but in life threatening and chronically ill situations, supporting both the patient and family. Their chaplains work in hospitals and LTC through palliative care and spiritual care, and they train chaplains throughout the US. We need to get past ‘hospice’ and think of these aspects as well.

  • katerinahurd

    Do you think that demedicalization of the dying process is due to the recognition of futile medical interventions. What is the medical profile of diseases that is most commonly diagnosed in the baby boomer generation? Was a survey done with respect to how much prevenative care baby boomers recieved?

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