We’ve taught sex education,
but there's been no instruction
for death and dying.
revisited depending on someone's state of health and
what's going on in their lives. If at 55 you pull out a
living will and you designate a healthcare proxy and
state your wishes, you need to review from time to
time and make sure that it's still consistent for you.
For some people it’s enough to breathe without
having any way to communicate or to take
in nutrition via mouth or even move their
body. That’s enough for them and that's okay. I'm
not insisting that what's suffering for me has to be
suffering for you. I'm not here to place a judgment
on someone's decision, but I do my very best to
explain to people what that life might look like, as
much as one can. Most of the time, people don't
want that. With a realistic understanding, they
opt out of it.
To tell you the honest truth, I have mixed feelings
about California’s End of Life Option. People will
often get a prescription for the drug that would end
their lives, but they don't use it. Maybe just having
it gives them a sense of control and a sense of calm
that is powerful within itself.
My friends and I in the world of palliative care are
torn. On one hand it makes sense for people to have
this autonomy, but on the other hand it's like we've
skipped the progress we’ve made in making sure that
every single human being has access to good quality
care with an emphasis on easing suffering. We are
making great advances in alleviating the reason why
people are wanting to end their life. It's tricky.
For younger people, I think the distance from what
they see as the likely end of their life actually can
be powerful. You're not as fearful of death because
you see it as far away. To normalize death as a part
of life early on is the right thing to do. There are
some fantastic groups creating death education
programs in middle school and high school.
We’ve taught sex education, but there's been no
instruction for death and dying. I am fascinated
that here are many young people interested in this
topic outside of healthcare. This is not something
that I would have come to if it weren't for my
personal experience of taking care of patients.
I’m thrilled to see millennials and younger people
thinking about death and innovating this field.
We're just at the beginning of a social movement,
a groundswell. The real shift in understanding and
practice is going to come from the consumer; from
the patient and the caregiver, not necessarily from
the healthcare facility. That will make the biggest
change within the system.
UNGERLEIDER is an internist
practicing hospital medicine at California Pacific
Medical Center in San Francisco. She received
her medical degree from Oregon Health &
Science University in Portland, OR and completed
residency at California Pacific Medical Center
where she is now on the teaching faculty and
serves on the Foundation Board of Trustees.
In her spare time, Shoshana enjoys traveling,
exercising and eating great food. She lives with
her husband in San Francisco.
VOLUME II | 15