How to die better

Jane Brody's mother was 49 when she died. This was 30 years ago, when ovarian cancer was an ordeal of experimental chemotherapy and long hospital stays. Twice, she tried to take control of her own life -- or death -- first by slitting her wrists, and later by drinking rubbing alcohol.

"Twice, to my 16-year-old thinking, her life was saved," Brody said. "But when I grew up, I asked myself, saved for what? More misery? An increasingly bleak future with no hope for recovery? If I were in a similar position, would I want to be rescued?"

Brody, whose journalism career began at the Minneapolis Tribune, has written eight books about health and is the New York Times' personal-health columnist. Her latest book, "Jane Brody's Guide to the Great Beyond" (Random House, $26), pulls together what we need to know about end-of-life issues as we approach the universal condition for which there is no cure: mortality. Here are excerpts from a conversation with Brody.

Q Why do we need to be thinking about how our lives will end?

A Because people can't let go. So much money is spent futilely on end-of-life care. We just can't give up these last-minute interventions, but it's more painful, and not just for the person who is dying, but for the survivors who witness it. Even though Americans are living longer and living better, most people are not dying better. They're dying worse.

Q How do you distinguish between accepting and surrendering to death?

A Surrendering is when you have a medical option, but you decide you don't want to do it. Acceptance is when there really isn't an option anymore. You're fighting City Hall, a battle you can't possibly win. And instead of fighting, you say, "Let me be as comfortable as I can be. Let me say my goodbyes. Let me make my wishes known about my worldly goods." When you're hooked up to all those machines, this doesn't happen.

A It's critical to have a health-care proxy who acts as you when you can't communicate any longer. The living will is not enough; you have to have that person who will enforce your living will. In the eyes of the law, they can override any objection from any family member and the doctor does not have to be afraid of a lawsuit because he is following the patient's wishes, and that is the only thing that counts.

Q Will right-to-die laws become more common as baby boomers, known for wanting things on their own terms, grow older?

A In Oregon, where [the Death With Dignity Act] has been legal for more than 10 years, only 1 percent of patients have asked their doctors for prescriptions that could hasten their death. Yet there's something very comforting to people to know that the option is there. The alternative is hospice and palliative care. When intolerable symptoms are taken care of -- pain, particularly -- the less people wish to speed their demise. The thing I hear over and over is, the doctor didn't want to give him morphine because he could become addicted. This person is dying! What difference does it make if he becomes addicted? This is called palliative sedation. It's symptom management and it's perfectly legal.

Q What about ill or aging people who avoid any talk about end-of-life issues?

A We can't bring everybody to the same point, but here's a very good thing to say to people in that situation: "Let's hope for the best and prepare for the worst. Just in case things don't go as we want them to go, let's get your affairs in order."

A Our medical education system has to do a lot better. Doctors are trained to assist living and they're not trained to assist dying, and that's a mistake because dying is a part of living. It's the continuum. Doctors have the idea that if something can be done, it should be done and it will be done. And that's a very big mistake in many cases.

Q How do you regard your own progress toward the great beyond?

A When my 8-year-old grandson asked me if I'll be still alive when he gets married, I said, "Well, you'd better marry young." I'm 67, and I sincerely hope I will be 88 and dance at his wedding, but I want to be there altogether. I'm thinking of ... donat[ing] my body to a medical school, then my remains will be cremated and scattered over the St. Croix River, where I spent so many lovely summers.