The dignity of active living and active dying
by Sandra Hartley, Ed.D.
Medical assistance in dying is now available, but it has not resolved the case for and against dying with dignity. We don’t like to talk about it, but with so much focus on dying better than we currently do, the topic has arrived.
The discussion is not so much about the meaning of death–that is, a life ended. It is about the demeaning nature and lack of quality in the last days of life.
There are many different interpretations of key judgemental words like “dignity,” “palliative care”, and “suffering.”
Perhaps we need better definitions of when dying starts and living ends. Without definitions, we have to refer to heart-wrenching stories about people and their suffering in their final days, weeks, months, even years.
With this article, I hope to start a discussion about the role of active living in the meaning of dignity. I would like to place the notion of “dignity” back in the realm of the living. Surely the active “fight” is for a worthy and dignified life. And when someone sees no point in that fight, they might want to take action to stop living. How is it that active living is promoted, but not active dying?
The dignity of aging
Evidence abounds that people are living longer and stronger and enjoying life more. But even Baby Boomers, who became “zoomers” through sport participation, must be finally realizing their mortality is real.
In terms of biological aging, exercise physiologists tell us we reach our prime by age 25. Women start to lose strength in middle age, and reach chronic frailty earlier and faster than men do. Men, on the other hand, tend to encounter more acute health situations and live slightly shorter lives.
But no matter what our gender, age, or and lifestyle, we all die sooner or later, and apparently some of us die better than others. A life well lived and long lived is the goal, and yet we rarely see a happy ending.
The indignity of not dying
Most families have witnessed unhappy, suffering elders near the end of life. We cannot even name or blame precise diseases sometimes. A downward spiral of aging in very late life often leads to a multitude of demoralizing and debilitating conditions. Yet none of the conditions are bad enough to lead to a peaceful end.
How long is this downward spiral? Can one be dying for days? Weeks? Years?
The issue of dignity is often linked to the medicalization of advanced age–pain management, surgery, and other treatments. At first we are thrilled that loved ones can be made more comfortable for a time. Eventually though, medicine is reluctant to let us die in a timely manner. Strangely, medical practice will assist in pain management for as long as it takes, and even tolerate starvation.
An elderly person with a “Do Not Resuscitate” order can be brought back to life in an ambulance when there is no time to check the paperwork. Repeatedly being brought back to life takes a toll on the individual such that they lose all interest in living, and withdraw. My own graceful and gracious mother, after five resuscitations, was alive and conscious by many measures, and was dead by other measures. She did not eat. She did not open her eyes. She did not respond to questions. She did not move when you hugged her. My mother died six times. What she was left with was disgraceful, her worst nightmare–the indignity of not dying.
The dignity of active living
Some say life is terminal from the day we are born. But that is life, and while we are alive we are interested in pursuing aging the best we can, enhanced with the activities that keep us healthy and fit. Striving for fitness and promoting one’s health at every age is the height of dignified living.
Dignified living is uniquely experienced. As people enter late life, they tend to accept some slowing and declines, some health issues, some disabilities, and some pain as simply a fact of getting older. While only a minority of us live into our late 90’s, some in this age group are running marathons and Ironman races. There is plenty of research evidence that age is no barrier active living.
One does not have to be an athlete. Walking, stretching and moderate fitness regimes cut in half, on average, the decline between age 30 and 80. No medication can cut age declines in half like a basic exercise prescription!
Dignified living is very much enhanced by a positive personality, happy opportunities, education and resources, a supportive social network, lots of luck, and of course a reason to live. But we can age better and enjoy a higher quality of life with a physical engagement. Whether maintaining nimble fingers at the piano, or dancing up a storm, or kayaking on a lake, or walking a dog in the park, what we do physically describes our dignity.
Dignity comes in all shapes and sizes
As a gerontologist who has met hundreds of seniors over the years, I can tell you that there ARE some grumpy old men (and women), and there are saintly, wise folks who are kind and humble despite their tenure and misfortunes. But it is dangerous to stereotype and judge.
For example there are “little old ladies,” but there are obese ones too–thousands of them playing bingo. They get up and can’t wait to get going because they are widowed, love the game, and they have some fun. To play in winter, they dress up in warm and heavy coats, walk, drive or take a bus, meet up with friends, and make an effort to enjoy the afternoon or evening. It is not exercise the way we think of it, but it is physically effortful, and draws on their energy. Not many elderly women “go out” for the day, but bingo players do. I suggest that this is their way to live with dignity.
I propose that advocates of Active Living examine the important role that daily activity, even if minimal physically, has in maintaining dignity and quality of life. Active living is very much about living with zest, making the best of winter days, going to the trouble of getting out and about, and better yet, choosing physical activity over sedentary living.
If perhaps someday a researcher decides that people over age 70 are actually all biologically dying, then dying with dignity will have to come back for a new discussion. But until then, let’s promote active living to enhance dignity and enjoy our activities in whatever ways we can.
About the Author:
Sandra J. Hartley, MPE, EdD is a Professor Emeritus, University of Alberta, living in White Rock/South Surrey, B.C.
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