Do You Want to Die in an I.C.U.?

Pandemic Makes Question All Too Real

Cheryl Goldman of Valley Stream, N.Y., has emphysema and relies on supplemental oxygen. She told her son that if she contracted Covid-19 and needed a ventilator that she would refuse treatment.

Sobering statistics for older patients sharpen the need to draw up advanced directives for treatment and share them with their families.


Earlier this month, Cheryl Goldman, a retired high school teacher living on Long Island, called her son, Edo Banach, in Maryland. It seemed a routine chat until Ms. Goldman announced that if she became ill with Covid-19, she would decline a ventilator.

“I’m her health care proxy,” said Mr. Banach, who happens to be the president of the National Hospice and Palliative Care Organization. “Her perspective was, what’s the point? In all likelihood it’s not going to help, and she’d be taking a vent away from someone else.”

At 69, Ms. Goldman has emphysema and already relies on supplemental oxygen. She told me that she’d been following the news, including the grim statistics for older adults with chronic illnesses who require ventilators during extended stays in intensive care.

In such cases, “the number who leave the hospital is low, and it’s lower for someone with health problems like me,” she said. She also feared being separated from her family during a hospitalization and wanted, instead, to remain at home with hospice care. “It’s a pragmatic decision.”

Mr. Banach, leading the response of about a thousand hospices nationwide that are facing heightened demand and bracing for worse, appreciated her forthrightness. “It’s the kind of conversation everyone should be having with their loved ones,” he said.

In the best of times, it can be tough to get Americans to discuss and document their end-of-life wishes. Depending on the study, a third to two-thirds of adults haven’t drafted advance directives, the documents that outline which medical treatments they would accept or refuse and designate a decision maker to act on their behalf if they’re incapacitated.

“People think, I’ll deal with it in the future,” Mr. Banach said. But for thousands of older adults, the future may have arrived.

To date, there’s no clear evidence that older people are more apt to contract the new coronavirus, said Dr. Douglas White, a critical care specialist and the director of the Program on Ethics and Decision Making at the University of Pittsburgh School of Medicine.

“What we do know is that older individuals are more likely to experience very severe disease if they do become infected,” he said. “The data are sobering.”

That’s partly because most older adults have chronic conditions — heart or lung disease, diabetes, high blood pressure — known to intensify the virus’s effects. And they have less physiologic reserve — “less ability to rebound from an overwhelming illness,” Dr. White explained.

When seniors and their families engage in what’s called advance-care planning, they often focus on the D.N.R. question — whether patients would want to be resuscitated after cardiac arrest.

But because Covid-19 is a respiratory disease, the more pressing question will likely be whether a hospitalized patient who’s seriously ill will accept intubation and ventilation.

That initially involves a tube inserted down the throat, connected to a ventilator that pushes air into the lungs. When a patient has spent two weeks on a vent, doctors commonly perform a tracheostomy, creating a surgical opening in the windpipe that replaces the swallowed tube.

Long before the virus erupted, among people over 66 who spent 14 days in an I.C.U. on a ventilator, 40 percent died within a year of discharge. Now, “those numbers are too rosy for Covid,” Dr. White said, citing findings from Italy and Britain, where more than half of older patients on prolonged ventilation died.

A just-published JAMA article looked at coronavirus patients admitted to Northwell Health hospitals in and around New York City. Excluding those still hospitalized after the monthlong study, the mortality rate among patients over age 65 exceeded 26 percent, and almost all patients over 65 who needed mechanical ventilation during that period died.

That data can prompt frank exchanges. “If a patient is elderly and has significant medical issues, I’ll explain that a large proportion of people who become ill with Covid-19 and need a ventilator unfortunately will not survive,” said Dr. Kosha Thakore, the director of palliative care at Newton-Wellesley Hospital in Massachusetts.

Moreover, longevity is not the only priority, and sometimes not the primary one, for older people considering medical options. What will life look like if they do survive?

“After elderly people have been on a ventilator, they’ve often already developed physical debilitation, difficulty swallowing, bedsores,” Dr. Thakore explained. They frequently cycle in and out of hospitals with complications. Their deficits can be physical or cognitive or both, and are often permanent.

Even pre-Covid, after 14 days on a ventilator in an I.C.U., only about one in five older discharged patients went home. “The others end up in nursing homes,” Mr. Banach said. “Some may later go home, and some will die in the nursing home.”

Though older adults with Covid-19 may not require hospitalization or ventilation, the decisions they face if they do highlight the importance of reviewing advance directives.

A new study in JAMA Internal Medicine questioned 180 patients over age 60 with serious illnesses; most said they would trade a year of life if that meant they could avoid dying in an I.C.U. on life support.

But that kind of aggressive care is exactly what they might receive. “If you don’t let the system know your wishes, the system takes over,” Mr. Banach pointed out. Family members can feel lingering trauma if they’re forced to make life-or-death decisions for loved ones who never discussed what they wanted.

“Many older patients we’ve encountered with Covid-19 have opted not to undergo ventilation and an I.C.U.,” Dr. White said. “No one should impose that on a patient, though if there’s true scarcity, that may arise. But patients might choose it for themselves.”

If older people have paperwork stashed in a drawer or safe, now is the time to unearth it and see if their instructions still reflect their values. If so, scan the document and send it to family members and doctors, Mr. Banach advised.

But for those who never got around to drawing up advance directives, appointing a decision maker — and telling that person what’s acceptable and what’s not — is ultimately more crucial. In emergencies, doctors probably won’t flip through documents to learn patients’ wishes; they’ll ask family or friends.

Mr. Banach’s counsel: “Take out your phone and do a video selfie: ‘This is who I am. This is the date. This is what I want.’ Send it to your friends and relatives. That’s enough.”

Many hospitals and health systems have developed workarounds when documents require signatures or witnesses; some are also doing palliative-care visits via telemedicine.

Dr. Gregg VandeKieft, a palliative care specialist with Providence Health on the West Coast, recently spent half an hour on Zoom talking with a patient’s sons about her end-of-life care. Dr. VandeKieft and a nurse were in Olympia, Wash.; one son was in Alaska and two elsewhere in Washington. “It felt not all that different than if we’d been in the same room,” Dr. VandeKieft said.

The coronavirus pandemic may spur more such conversations. In Los Angeles recently, Brie Loskota and her husband contacted close family friends, a couple in their 70s, asking about their well-being, offering to FaceTime, and then inquired: “If you got sick, is there anything we should know?”

The older couple, one of whom has a neurodegenerative disease and has already experienced mechanical ventilation, responded that they both wanted to avoid hospitalization and to die at home.

“It was a relief to be told,” said Ms. Loskota. “It’s not less heartbreaking, but it lets us make a decision with them in mind. It led my husband and me to talk about it for ourselves.” They’re in their 40s and have not yet drafted advance directives.

Complete Article HERE!

How to cope with our collective grief:

Psychologist sister offers counsel

On April 23, Michael Neel, funeral director of All Veterans Funeral and Cremation in Denver, looks at the casket of George Trefren, a 90-year-old Korean War veteran who died of the coronavirus in a nursing home.

by Chris Herlinger

Day to day, things remain at a standstill in much of the world. And out of that standstill comes grief, says Australian Mercy Sr. Maryanne Loughry.

In a recent blog, I discussed Loughry’s webinar about how to deal with anxiety and stress during the COVID-19 pandemic. Loughry, a trained psychologist who teaches part-time at the Boston College School of Social Work, has done double duty with another webinar, providing more insight into some of the challenges the pandemic poses.

This time, in an April 21 webinar, also coordinated by the Rome-based International Union of Superiors General, Loughry’s focus was on grief: specifically, personal and social (or collective) grief as well as “anticipatory grief” — waiting for tragedy to unfold.

As she did in the earlier webinar, Loughry made clear that we must respect others’ different experiences and reactions right now, that everyone is dealing with this unsettled moment in different ways and at different paces.

That affirms an insight that New York Times opinion writer Charlie Warzel recently made: “Tragedy and suffering is unevenly distributed and everyone’s lived experience is unique. It feels a bit like we’re living with one foot in two different worlds, or experiencing every outcome of a projection model at once.”

The idea of different “projection models” is a good segue into one of Loughry’s key points. Loughry praised the insights of the late Swiss-American psychiatrist Elisabeth Kübler-Ross, whose seminal 1969 book On Death and Dying laid out the idea of sequential stages of grief: denial, anger, bargaining, depression and, finally, acceptance.

While Kübler-Ross’ insights about grief are still affirmed, the field of psychology has since embraced the idea that the stages are not necessarily always in sequence.

“We grieve differently,” Loughry said. “We move back and forth [between the stages]. We move around the different stages. That’s what emotions are.”

And emotions are very much in flux right now, given that people are experiencing both personal loss and a shared, profound collective loss in communities and societies.

“We’ve lost a lot in this pandemic,” Loughry said. “We’ve not just lost people we’ve known and loved: family, community members, people from our own countries, routines and jobs. But our natural world has been turned upside down. So we’ve lost that sense of what our world is about and what we’re about.”

What people have known and experienced in the past — the basic fiber and texture of life as people experienced it, the pillars “we rested on” — have “now receded,” Loughry said.

“We never thought we wouldn’t be able to bury our dead or visit the sick. But that’s what’s happening right now.”

And in some regions, the situation is exacerbated by already-existing humanitarian and social challenges.

“In some countries, people don’t even get to hospitals,” Loughry said.

But Loughry said at both the collective and personal levels, people have experienced grief before. And that they have, perhaps more than they know, the tools to deal with the situation right now, despite its unprecedented nature.

Noting a string of natural disasters like the 2004 Indian Ocean tsunami and the recent Australian bush fires as well as manmade tragedies like the 1994 Rwandan genocide, Loughry said that, ultimately, people rebuild their lives.

“What we know about collective grief is that we survive. We move on,” Loughry said. “Our world is different, and we know [more] about ourselves and our society.”

That was one affirmation and insight. There were numerous others.

Don’t underestimate collective grief right now.

One of the things many are mourning is “our lack of normalcy.” That’s a shared, collective experience, “a source of grief for us,” Loughry said. But another source of grieving is what we see around us.

“We know our families and the local businesses we deal with are suffering,” she said.

That sadness is accentuated by our day-to-day disconnection from others.

“We’ve also had a profound loss of connection. We can’t physically embrace anybody.” The result? “This can lead us collectively to grieve what we’ve lost.”

Be aware of another kind of grief.

That is “anticipatory grief,” waiting for something to happen. People have “anticipation that this tsunami, or epidemic, is going to overwhelm us.” And that means real worries about mortality, both ours and others’.

“I could be taken by this pandemic. You could be taken by this pandemic. It threatens our very being,” Loughry said. And that results in a feeling of “loss of safety. A lot of us don’t feel safe anymore.”

Now is the time for “naming and claiming” grief.

Specifically, now is the time to share and name what is being lost and what is happening in the world and to ourselves. Loughry noted that people throughout history have established commemorations and memorials for collective tragedies, like the Holocaust. At the root of those is the need for naming.

“To hold it in and not to share it is actually something that can overwhelm us,” Loughry said.

Ask what worked.

At an individual level, this is perhaps the moment to ask what helped us in the past when we grieved.

“We need to go back to that again,” she said. “Who did we reach out to? How did we respond? What was helpful, what wasn’t helpful?”

Be conscious of others’ vulnerabilities right now.

That’s especially important in religious communities, where such vulnerabilities may be more visible right now. Perhaps some have not grieved past losses and are doing so now.

Loughry said leaders of communities need to be aware of “what you can do and what you can’t do,” noting that they need to be aware that they and the members of their leadership team are “also impacted” and “are a part of the collective grief and the anticipatory grief.”

Be aware of another dynamic.

Some people — Loughry was speaking specifically of sisters — will be in denial, constantly saying they are fine. But that is often a barrier. Loughry advises not to raise that concern now. This is the time of affirmation, affirming “that people are moving at different stages,” she said. That is especially true at a moment when “people are in confined spaces.”

Loughry added: “It’s a time at the moment for compassion, not for challenge.”

At the same time, don’t be afraid of emotions.

“It’s OK at the moment to be emotional” and allow raw, unfiltered feelings to rise to the surface, Loughry said. That could mean being “teary, because that’s exactly what your body and your emotions need.”

That may be uncomfortable, particularly in a community setting, because it shows your vulnerabilities. But there is no reason to hide such emotions because “it’s not something that can be easily covered up.”

Advice for communities.

When asked how communities should deal with discussing grief and experiences, Loughry said that “each community is different.”

She did suggest that discussion about grief might be better done in small groups “rather than a big setting, where they might be asked to say something they are nervous about saying.”

Another idea is to allow people to write down thoughts and place them in a communal bowl without people being named.

Whatever is decided, it is important to affirm people’s comfort, as “we don’t know how much longer we’ll be in lockdown and you don’t want to increase their vulnerability.”

Loughry also affirmed the need some will feel to remain silent and not to share.

Faith is important.

Sisters’ religious faith is “a real resource” right now, Loughry said. First, there are the biblical and historical anchors: Church forebears experienced drought, famine and other calamities and got through them.

Sisters, who are fortunate “to have an identity, security, and we have supports,” are in a position to offer compassion to those seeking it. And that can help sisters at this difficult moment with their own grief.

“We feel good when we minister to someone.”

A sense of hope.

Loughry noted the pandemic has unfolded during Lent and Easter, with the attendant echoes of death and resurrection.

“We do know that we are going to get out of this, and that there is another side,” she said. “We know this time will pass. We don’t know when, but we know it will.”

Complete Article HERE!

Coronavirus is showing us how we’ve failed to manage the logistics of death

Madrid’s City of Justice building has been converted into a morgue for coronavirus victims.


This is different from saying we need to talk about death and dying (which we also need to do). I mean instead that we should focus our minds on what the human corpse means in this new pandemic reality.

Consider the number of dead bodies in the world before coronavirus. Based on global mortality statistics, approximately 56,842,500 humans died over the course of 2019. That’s roughly 155,732 people a day.

In the US, approximately 2,898,060 people died that year, which means about 7,939 a day. In the UK, the death rate for 2019 was 620,268, averaging 1,700 people a day.

It is easy to gloss over these statistics, since most of us never really think about millions of dead bodies. But what these numbers illustrate is that dead bodies are an everyday constant, we just don’t pay attention to them unless our job directly involves the dead.

So dead bodies are completely normal -– until suddenly they’re not. Until a novel virus sweeps the globe and produces a dead body count with life altering repercussions.

In order to manage and cope with the millions of dead bodies produced every year, different countries create what I call a “national death infrastructure” or NDI. The various parts of this infrastructure range from the local (a neighbourhood cemetery) to the global (systems in place for international repatriation). But crucially, the National Death Infrastructure is largely invisible to most of our lives.

Now COVID-19 is making NDIs visible. Indeed, the coronavirus pandemic is relentlessly demonstrating what happens when NDIs are not prepared for an unplanned spike in human mortality. We have seen thousands of coffins unattended in Italy, temporary emergency morgues in New York, and Spanish officials storing dead bodies at an ice rink.

Disturbing as many people find these news stories, everything happening to manage COVID-19 corpses is from various “mass fatality” and “disaster victim identification” playbooks. I know this because, as director of the Centre for Death and Society at the University of Bath, I’ve participated in consultations on governmental postmortem preparedness.

What’s different, of course, is that most people already oblivious to the NDI are wholly unprepared to see dead bodies rapidly produced in multiple countries, at the same time, and reported hourly on the news.

Imagine though, if details were broadcast for a year on how every one of the around 56 million people across the planet died – how they died and in what circumstances. Seeing this kind of detail in death might help people realise how important the infrastructure dealing with dead bodies really is, and why it needs to be financially supported by national governments.

Because right now, huge numbers of families cannot mourn their dead in the ways they expect to. We have seen this situation before with AIDS-related deaths, where next-of-kin were told a funeral was unsafe because HIV caused the death.

As I explain in my new book, Technologies of the Human Corpse, none of this was correct but that didn’t stop it from being said. And now COVID-19 flips the situation on its head. Funerals are currently not safe because living family members could spread COVID-19 by interacting with fellow mourners. The human corpse, this time, isn’t the viral issue. So the kind of funerals many of us are used to will have to wait.

Body count

And even for the kind of services that are now taking place, funeral directors in the US and the UK are running out of personal protective equipment (PPE) and body bags.

Refrigeration trucks in New York serve as an expanded morgue.

This is a bigger issue in cities like London and New York, but it will quickly affect small places too. Funeral industry workers are the essential frontline staff that both the living and the dead critically need right now, and like their colleagues in medicine and pathology, they are putting their lives at risk to ensure the national death infrastructure operates.

The current situation is not sustainable and governments will need to move quickly to manage the ever increasing numbers of dead bodies and make sure the funeral industry front line has the supplies it needs. They will also need to be prepared for a public backlash if they fail to do so.

Right now we all seem to be suffering from what I call “virological determinism” – we are blaming everything on a virus, when in fact blame lies with human failure to adequately follow existing public health pandemic response and preparedness planning. Failure which has created a situation where for weeks and months to come we will be confronted by mounting mortality statistics and dead bodies. More dead bodies than most national death infrastructures can manage.

So we need to talk about dead bodies and we need to do it now. And we should never forget that the COVID-19 dead bodies are mounting up because humans failed to effectively anticipate what new viruses almost always do – create human corpses.

Complete Article HERE!

Why Grief Will Help Us Survive Coronavirus

“Anxiety is something that’s talked a lot about, but I don’t think that grief is talked a lot.”

by Cait Bladt and Neda Toloui-Semnani

Right now, the world is trying to make sense of a tragedy that makes no sense: A microscopic particle has traveled across borders and oceans to tank economies, push millions out of work and school, and kill tens of thousands.

When a loved one dies, people know to grieve. But it’s just as important to grieve a loss of normalcy, according to Dr. Patrice A. Harris, a psychiatrist and the president of the American Medical Association.

“Anxiety is something that’s talked a lot about, but I don’t think that grief is talked a lot,” she told VICE News.

“There is a lot of disruption in routine,” Harris added. “I’ve heard from talking with parents that their teenagers are grieving prom and the inability to go to prom. Their teenagers are grieving graduation, high school graduation. And we know that college students are grieving.”

Routine often gives people a sense of self and purpose. And without that, they may be experiencing profound grief as they try to redefine themselves without jobs, or feel farther from their schools, religious communities, and relationships.

To get through that grief, Harris emphasized the importance of connection. She prefers the term “physical distancing” to the more frequently used “social distancing,” because social connections are more important now than ever before.

And then, of course, there’s the more familiar grieving process, which has also become even more difficult due to the pandemic. In many places, funerals have been banned due to fears of spreading the virus.

“We can develop new rituals and new routines. Family members can get together and decide, ‘OK, we are not going to be able to have a funeral or service or a memorial. But here’s what we can do.’ And fortunately, we can be connected through technology,” Harris said.

With so much uncontrollable and unknowable factors in the current situation, people need to give themselves time and space to experience grief.

“We each have to recognize how we grieve, respect how we grieve. Give ourselves permission to grieve in a way that gets us through to the next phase, which is remembering, appreciating what we had, and then deciding what we can do each individual way to move forward in the next phase.”

Complete Article HERE!

How to Grieve and Support Others During a Pandemic

What can you do for a friend when you can’t give them a hug? We talked to some experts to find out.

By Adrienne So

On April 8, author Nicole Chung learned that her beloved grandmother had died. Chung lives across the country from both her grandmother and mother, so she got on the phone to make arrangements as best she could.

“No viewing. No service at the funeral home or graveside,” she tweeted. “I can’t even figure out how to get flowers to the gravesite. Ordinarily the funeral home would handle, but they keep saying all they can do is ‘drop the body at the cemetery’ (their words) that morning.”

Of all the social rituals that social distancing and travel restrictions have disrupted, mourning is one of the hardest.

“We were supposed to be visiting my mom this week,” Chung told me on the phone. “I just keep thinking about how if that had gone ahead as planned, if we hadn’t had to cancel because of the pandemic, we’d be there with my mom. It would’ve been some comfort to her. Grandkids would cheer her up.”

Is there anything you can do when you can’t sit shiva, follow a second line, or show up at a rowdy wake? I called Chris Robinson, a board member at the National Funeral Director’s Association, and Lizzie Post, the great-great-granddaughter of famed etiquette authority Emily Post and the co-president of the Emily Post Institute to get some (hopefully) helpful advice.

For a grieving person, nothing takes the place of your physical presence. But you can still show that you care.

What a Family Can Expect

In response to pandemic concerns, Robinson strongly recommends families hold private, immediate-family services, like the ones he currently holds at his own funeral home, Robinson Funeral Home in Easley, South Carolina. Robinson has upgraded the equipment in all three of his funeral home locations so the family can more easily livestream it for remote participants, something that was becoming more commonplace even before the pandemic.

“It’s hard to lose a loved one under normal circumstances,” Robinson says. “This is probably the hardest thing that some people will have to face.”

But these kinds of funeral home regulations will vary from home to home and state to state. For example, Holman’s Funeral and Cremation Services in Portland, Oregon, has recently limited its services to only outdoor graveside services, with fewer than 10 attendees standing 6 feet apart. Visitations are limited to one or two attendees in the room at a time.

“It’s been difficult for families,” says Cameron Holmes, Holman’s funeral director and general manager. “Funeral directors have to accommodate them as best we can, while following the rules.” Holmes also noted that since they don’t have livestream equipment for graveside services, many families are also choosing to stream or record services via Zoom or Facebook Live.

If you’ve been invited to online services, be sure to sign the online guest book. “You can also write a personal message,” Robinson said. “It means a lot to families to be able to view that.”

What You Can Do

“More direct outreach is thoughtful and considerate right now,” says Lizzie Post, author of Higher Etiquette. “Not that the Facebook message that says ‘thinking of you’ isn’t, but it’s good to utilize everything you have.”

Services like Postable and Felt can—for now, at least—mail handwritten cards for you. You can even write a handwritten condolence message with your finger (or stylus) on the Felt app. If you can’t get to the post office, Post also says that you can take a picture of a handwritten card and send it, or record a video message.

Ways to Reach Out and Help

– Restaurant gift cards

– Nonprofit donations

If you haven’t heard back from someone in a few days, remember that the family is dealing with an unprecedented situation that may have a lot of delays, especially if the funeral home is overwhelmed. Adding a “no acknowledgment necessary” to the end of your card or letter will take the burden off the family to respond in a timely manner.

Sending flowers or gifts isn’t a substitute for human companionship, but it is a way to show that you care, even if you can’t be there in person. “We’re lucky that there’s a lot of things you can send people who are grieving,” Chung says. “I’m sending stuff to my mom. That’s all I can do, is send her things.”

No matter what you decide to send, Post says it’s important to clear it with the family first. Are they comfortable with homemade food, and if you bring it over, will you find it hard to resist leaning in for a hug? Would they feel more comfortable with gift cards or delivery? It’s more helpful to offer something specific that they can accept or decline.

“You’re not making them work to come up with something,” says Post. This advice also applies if someone you know has recently contracted Covid-19. “If I called them, I would say explicitly that you don’t expect to hear back from them and you want to let them know you’re wishing them well right now,” Post says.

Alone, Together

Robinson and Holmes noted that many families are opting to wait to hold a memorial service until the family can be together.

“The biggest thing is just companionship,” Chung says. “That’s just not feasible right now. It feels like we’re in this holding pattern.”

But in one respect, people may have never been more open to the idea of reaching out. We may be all separated, but right now, we can all deeply relate to loss.

“That’s been really strange,” Chung says. “I remember when my father died, the world just kept going on. And in this case, we’re having this giant collective moment of crisis. It doesn’t make me feel better at all, but I do have a keen sense of not being the only one.”

Complete Article HERE!

COVID-19 Answers

A Two Part Interview with Dr. Diane Meier

Everyone is worrying about what to expect and how to prepare for COVID-19. After all, we know so little and there is still no treatment. In two interviews with Dr. Diane Meier, director of CAPC (the Center to Advance Palliative Care), ARCHANGELS Co-Founder and CEO, Alexandra Drane, gets at the core of what’s waking us up at night, including how do we make decisions and how do we actually feel human instead of just medical specimens. Diane makes us feel more in control and feel better about our COVID19 worries… she clears up confusion, addresses the fears many of us have, recommends three things we can all do right now to be prepared–and she makes it not scary. We can all feel good about telling a friend to watch these videos.

To learn more from about palliative care resources, go to and

To learn more about ARCHANGELS, go to and

Death, one day, is inevitable. Suffering should not be.

A temporary hospital at the Javits Center in New York on March 27.

By Sebastian Mallaby

About a month before the coronavirus pandemic engulfed us, my mother understood that she was dying. She had cancer. She had struggled to swallow food and maintain her weight. She was so light that I could lift her like a 12-year-old. On her firm instructions, the ambulance we children had arranged to take her to the oncologist was rerouted to a hospice. There, she received tender and expert end-of-life care. After four days, she died: peacefully, without pain, and with her family around her.

Today, this memory feels weirdly distant. In Italy and Spain — and soon in other countries — patients are dying in opposite conditions to the ones my mother experienced. They go to hospitals hoping for treatment. But, for lack of ventilators, some of them die gradually, alone. Visits from loved ones are often prohibited.

The flood of commentary on the pandemic focuses, correctly, on how to reduce fatalities. But we should also consider how to ease the loneliness and pain of those deaths that are inevitable. No one wants to die slowly in a medical hangar, cut off from family and friends. Rather, most want something as close as possible to what my mother had. They want to choose their own balance between prolonged life and prolonged pain. They hope to have the right to reconsider their choices.

Of course, in the current crisis, the hospices cannot serve everybody, and infectious disease presents risks to caregivers that cancer does not. The imperative is, therefore, to give people the tools to manage death at home, as humanely and safely as possible. Yet this component of our response to the pandemic is missing. We have not grappled with the need to distribute morphine to those who are suffering, even if this is a risky course, as the opioid crisis makes obvious; once we have finally supplied our medical professionals with the masks and other protective gear they need, we need to do the same for family caregivers. But we do not discuss these things, because we are determined to resist death, not dwell on the question of how we might go about dying.

My mother’s last lesson to her children was that this obstinacy is mistaken. While I was vainly learning all I could about her treatment options, she was coming to terms with the reality she could feel around her liver. “No more abracadabra,” she told me fiercely, when I protested that it was too early to give up. She knew she would soon die, and she wanted a good death.

A good death requires lucidity, not magical thinking. Today, this means confronting the reality of overloaded hospitals, and being honest about their inability to help all those who are stricken. In Italy, doctors have had to perform a kind of triage normally seen in wartime: They allocate life-saving ventilators based on age and health status. The same has happened in Madrid, where hundreds queue to be admitted to emergency rooms. Countries such as the United States and Britain will be lucky to escape this fate. New York’s governor, Andrew M. Cuomo, has repeatedly sounded the alarm about the shortage of ventilators. “You’re going to be thousands short. Thousands,” he said on March 15.

Hospitals don’t like to talk about the terms of the triage. Like the rest of us, they prefer to focus on preventing death; they recoil from being explicit about when death might have to be accepted. As a recent article in the New England Journal of Medicine noted, the absence of clear guidelines burdens front-line clinicians, who are forced to make heart-rending choices — doctors in Italy have wept under the pressure. But the absence of clear guidelines also leaves citizens adrift. If you or I fall seriously ill, will we have access to a ventilator?

Last week, two medically connected relatives called me. Being well informed and 70, they both know they fall on the wrong side of any triage. They have therefore resolved that, if their lungs begin to fail, they will avoid going to the hospital. At 70 — even in their 80s — patients still have a good chance of surviving covid-19 at home. But if they do not, my relatives’ definition of a good death is to be together at the end, even at the risk that one will infect the other. All that they ask is access to the palliative drugs that will control the suffering.

Society should think about the millions of people who are not medical insiders, and who should be helped to understand the choices that may potentially confront them. No doubt if governments and hospitals made public their criteria for triage, people would be horrified. But at least they could decide whether to seek help at a hospital or remain in their own beds. And the medical authorities, having leveled with the citizens, could be more forthcoming about the help available at home. To anyone who has witnessed death, it would be a huge relief to know that at least the pain can be managed. Death will be inevitable for each of us, one day. Terrible suffering should not be.

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