Archive for » October, 2014 «

Die rich or die poor?

How we die is no big deal, really. The last weeks or months of ‘terminal illness’ that most people experience are miniscule when compared to the length of time they’ve lived. But that is not to say that people should die any old way, rather than in the best possible way. It is good to improve dying, if we easily can.

How indeed do most of us die?

Rich people have no choice but to end their lives in a high-tech hospital, cared for by teams of specialized staff who make sure death will be postponed as long as they can afford to keep the technology running. The super rich have part of their home transformed to a plush hospital, for the final phase, so that they can die without suffering the indignity of departing this world from premises that they do not personally own. And poor people – oh well, does it really matter anyway? They don’t spend a long time dying anyway, do they?

It is true that poor people, especially from remote areas did not linger, dying. But things have changed of late. Now they too have access to life saving technology. As the state services in remote areas have improved, dying there too has been transformed. Two recent stories brought this home to me.

A 70 year old man living in a village far from the capital was admitted to the nearest government hospital, after taking seriously ill quite rapidly. The doctors told the family that his kidneys had stopped working and asked them to discharge him from their hospital and transport him without delay to the General Hospital of that province. Thanks to the high quality of services available there, he survived until his kidneys began to work again. The family too managed to survive the costs of transport, various tests and the like by resorting to small loans, while his sons were able to take turns to be at his bedside 24 hours a day.

Soon after apparent recovery and discharge, the man was readmitted to the local hospital with various symptoms and again the family was asked to take him back to the General Hospital in their province. Three days later the family was told that he needed to have his ‘blood exchanged’ or ‘cleaned’ and that they had to take him to an even bigger hospital, far from home. But the man refused the move.

The family decided they would take him anyway because they wanted to do everything possible for him, (‘After all he is our father’). He was kept against his wishes at the bigger hospital until the family eventually heeded his pleas and took him home against medical advice. The long journey back in a three-wheeler did not kill him. The man and his wife and the families of his two married sons and daughter were by now in desperate financial trouble.

Somehow, he began to look better and happier at home and it was a week before he showed symptoms again and this time he refused to go even to the local hospital. The dutiful family overruled him – with some encouragement from well-meaning neighbours and relations. The local hospital now says he cannot be managed at a small hospital and has asked them to take him again to a bigger hospital. The family has not done this yet, as the father now refuses adamantly to go to the far-away place. The hospital has said they will transfer him by ambulance if the family does not take him. The man concerned wants them to take him home. The local doctors say he will die within two or three days unless he is taken to the bigger place. Right now the family is in the process of mortgaging their small house and property to raise money to keep father alive. Neighbours are busy locating the money lender who will offer the highest price.


The second story was of a man who had been persuaded by the kind tobacco trade (so essential for the ‘development’ of our country, some of the ministers and high officials in the finance sector will assure us) to smoke his way to cancer. His story is similar, with ‘life-saving’ technology available near at hand every time he deteriorates. He does not want to be taken to hospital any longer but he is, and sometimes transferred to the bigger place, and returned home with a new lease of life. These last a week or two. This man too was quite agreeable to going to hospital at the start but then decided it was enough. With life-saving technology now accessible, the family will not heed his wishes.


What do we learn from these accounts?

The big lesson is that these two people have not yet learnt that life must at all cost be extended. So they resist. Had they been wealthier, they would have been more eager than their families to have the best possible technology unleashed, to extend life.

Dying at home, with all its attendant discomforts and physical suffering, may be what these two men want. They may (inexplicably?) prefer this to the privileged deaths that are being forced upon them: the kind of deaths that the rich can no longer escape.

High-tech medicine has suddenly reached people who did not have access to it previously. Five years from now, the poorest people in the remotest villages too will have been educated into wanting everything possible done to keep them alive for even a few more minutes. And when this happens, families will not have to overrule the ill person in order to have death postponed for as long as possible.

In the meantime though, the poor should not be forced to die like the rich, unless they explicitly opt for it. Our health services are forcing modern forms of dying on some people for whom it is still quite alien, and unwelcome.

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‘Hooray’, I say – for this site is repaired – and appears alright again.

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(And thank you those who inquired, concerned, about my silence these last months)