Opinion

With John McCain’s death, end-of-life decisions are now out in the open

Sen. John McCain dies at 81 after cancer battle

After stopping medical treatment for his brain cancer, John McCain, six-term Arizona senator and 2008 Republican presidential nominee, died {in his home} at age 81. The senator and former Navy pilot would have turned 82 next week.
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After stopping medical treatment for his brain cancer, John McCain, six-term Arizona senator and 2008 Republican presidential nominee, died {in his home} at age 81. The senator and former Navy pilot would have turned 82 next week.

Americans are often a disputatious sort, earnestly quarreling over virtually anything from abortion to what body posture is patriotic.

So, it’s a valuable reminder and encouraging as a nation now and then to take note when we do succeed in quietly working out serious issues together without searing political struggles.

Progress may be erratic. And it may take some time to sort out our ethics and what’s right to forge a lasting social consensus. But in the end, it’s worth it and our society is better and stronger for it.

Such is the case now with what used to be called the right to die. We saw dramatic evidence in recent days when 81-year-old John McCain’s family announced that after more than a year of battling an aggressive brain cancer, he was stopping treatment and letting nature take its course. He died the next day.

“The progress of disease and the inexorable advance of age,” the family said, “render their verdict. With his usual strength of will, (John) has now chosen to discontinue medical treatment.”

Back in April, former first lady Barbara Bush also discontinued medical treatment for chronic obstructive pulmonary disease. She died soon after at 92. In June, columnist Charles Krauthammer announced he had only a few weeks to live. Left out was the part that he’d discontinued treatment.

There is sympathy and sadness, of course, for anyone enduring such painful situations. But did you notice, no controversies? No one launched a legal fight against them signing their own death warrants.

No politicians demanded legislation, crying out that only God can end a life. It’s McCain’s life and his death. Same for Mrs. Bush and Krauthammer.

Such was not the case 30 years ago when I first began writing on this subject. With few famous exceptions, end-of-life decisions were kept strictly private, largely a response to fear and ignorance.

The advance of medical technology and chemistry had been so rapid that it had surpassed our understanding and social compact. For millennia, death was death. No choices. No appeals.

Suddenly, medical teams had amazing life-sustaining, even life-restarting capabilities. Electric shocks awakened dormant hearts. Pumps flushed orange chemical slurries in to nourish stomachs, regardless of brain function.

Machines take over a patient’s breathing. Nurses even program occasional extra-large breaths to mimic sighs.

But all these marvelous advances and medicines now required decisions. When to stop doing all that we can do?

Few families discussed end-of-life decisions. If at dinner one night grandpa said, “When I die…” he was instantly hushed by a family chorus, “Oh, you’re going to live forever, Gramps.”

Then, he’s comatose in the hospital. Doctors likely know it’s hopeless. Adult children argue over what dad would want.

I witnessed numerous such family discussions. The doctor would lay out the medical facts, what all the team could do, with no guaranteed outcomes, and what an unlikely recovery prognosis could be.

Then perhaps the doctor would add, gently, “You might consider all that as prolonging the dying, not the life.”

Sometimes it took days or weeks for a family consensus to emerge. In the late 1980s, experts estimated that 80 percent of hospital deaths were somehow negotiated, although the obituaries inevitably listed medical causes such as pneumonia or heart failure.

I participated in one of those painful family decisions. I had asked my mother what kind of care she wanted in a serious illness. She replied, “I don’t want to stay past my time.”

I was so relieved to get an answer and end the awkward discussion, I dropped the issue altogether. So, when she was lying comatose before me, it occurred to me: What the hell does “past my time” mean these days?

In one case I witnessed, an elderly man came into the hospital complaining of back pain. Tests revealed it was actually advanced bone cancer.

It was too far along for treatment beyond heavy pain management that would ultimately render him unconscious.

The doctor also noted the cancer was dissolving the man’s bones, producing rising calcium levels toxic to the heart. They could stop treating that and let nature take its course. He left the couple alone to discuss.

Four days later, at home surrounded by family, the man passed away. The death certificate listed the cause as “cardiac arrest.” In those days 30 years ago, only a few people could know it was actually the man’s own decision to discontinue medical treatment.

Malcolm is an author and veteran national and foreign correspondent covering politics since the 1960s. Follow him @AHMalcolm.
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