LOS ANGELES--Last June, terminal brain- cancer patient Brittany Maynard, age 29, ended her life after moving from California to Portland, Ore., to take advantage of that state’s “death with dignity” law allowing for physician-assisted suicide in restricted cases.
Given six months to live, Maynard announced her wish to end her life in a YouTube video that placed her in the national spotlight. In Oregon, after terminally ill patients have their assisted suicide request approved by two physicians, they can choose to take a fatal prescription provided by a doctor.
Unlike Maynard, most people face the end of their lives in old age. Although very few people at any age wish for doctor-assisted suicide, everyone hopes to
Asians Live Long,
But Aren’t Dying Well
Although the average life expectancy of Koreans and other Asian groups living in California is 86.1 years —far higher than whites (79.3 years), Hispanics (83.1 years), African Americans (73.3 years)—Asian patients at the end of their lives seldom benefit from hospice or palliative care.
According to the California Health Care Foundation (CHCF) only two percent of Asians in the United States access hospice care, compared with 82.8 percent of whites.
CHCF’s 2011 multicultural survey of Californians’ preferences at life’s end confirms that all groups overwhelmingly want to die at home, rather than in a hospital or a nursing home. Two-thirds of the 1,669 respondents said they wanted to have a natural death at home.
Two-in-three of all those surveyed revealed that their first worry was not wanting their medical costs to financially burden their families. Their second greatest concern was being having reduced pain until their death.
“James,” who asked not to be identified, recently spoke to a group of reporters at the at the Cedars Sinai Medical Center’s Supportive-Care Medicine Program in West Los Angeles. The program provides palliative and hospice care to very sick or terminally ill patients.
The program helped James to spend his time with his wife, a terminal cancer patient, and prepare for her death, especially during her last 10 days. He recalled, “My wife used to say often that she wanted to pass away peacefully. Now I am satisfied that she did so, having spent the remaining time with her loving ones like family, friends and relatives.”
When his wife’s breast cancer spread to her brain, she chose to enter the hospital’s hospice program, rather than begin painful and difficult chemotherapy, which offered little help in her case.
Shedding a tear, James said, “All my wife got was just medication to reduce her pain, and she had a peaceful period before death.”
Koreans Choosing Hospice Increasing
Koreans who choose the hospice services are increasing gradually. John Kim, who was given three-to-six months to live due to stomach cancer, also chose hospice services instead of chemotherapy. Hospice staff visited his apartment every other day to control his pain and nutritional status.
Kim said, “At first, to live even a little bit longer, I considered medical treatment, but then I realized that I do not want to waste my time getting chemotherapy that would not make me live longer.” Instead of being weakened by the chemotherapy, he said, “I would like to finish what I have to do before death, being with my children and friends.”
Kim’s oldest daughter, 44-year-old “Karen,” (not her real name) said, “ I didn’t agree with my father’s decision, but now I get comfort when I see his relaxed face.”
Karl Steinberg, MD, Chief Medical Officer, Shea Family Health in San Diego, explained, “People tend to regard hospice as a place you visit before you die, but actually, you can get the hospice care either at home or a hospital.”
Steinberg continued, “While in hospitals, doctors put a priority on getting rid of cancer and then pain; hospice staffs do the opposite. Experts prescribe differently according to the person and his symptom to abbreviate the pain. They help patients keep their dignity until the last moment before facing death.”
The Somang (Hope) Society
Koreans in Los Angeles are changing perceptions of hospice care partly because of the “well-dying” campaign of the Somang (Hope) Society, which was founded in 2007. The nonprofit’s president, Boonja Yoo, started the “well-being” movement to inform older adults how to live well, and the campaign evolved into the “well-aging,” to help people better prepare for life after retirement. Eventually, the group also launched the “well-dying” campaign inform older people how to prepare for death.
“Personally,” Yoo revealed, “as my husband and brothers passed away, I realized the more you prepared for death, the more beautifully you can finish your life.”
Yoo, who been awarded the South Korean government’s National Magnolia Medal for her international efforts in drilling water wells in remote areas and early childhood education, decided to develop the well-dying campaign based on her 20-year career as a nurse. She saw many patients at the end of their lives, as well as their family members, while she worked at a hospital, caring for burn patients, and at a nursing home.
She explained that the well-dying program is assisting Korean seniors to develop living wills, in which people can make legacy statements about their life lessons and values; their funeral preferences; possible organ donation; and advance health care directives, instructing other about their treatment near death, in case a coma, dementia or other problem prevents them from stating their wishes.
Advance-care planning is not only for patients, but also for their family. The number of living-will testaments and advance directives written so far is about 9,300. Also, 750 people have volunteered to be organ donors when they die. And 28 who died actually had their organs save the lives of others.
Unfortunately, Yoo said, Koreans are deterred from planning by their “taboo culture of death.” For example, she went on, “There are many people who die too painfully at the hospital because they didn’t really know much about the hospice service that can helps die without pain.”
Yoo explained, “People should not prepare for death by themselves, but plan with their family, as well.” Even though death is never an easy subject, she said, “I still expect that more Korean people could finish their life beautifully, as if they prepared for trip.
Nicole Chang wrote this article for The Korea Daily with support from a New America Media fellowship, funded by the California Health Care Foundation. NAM's Nayoon Jin assisted with the English translation.