Baby boomers have spent more than half a century revolutionizing the way we live. Now it is time for us to revolutionize the way we die.
We came of age in the post-WWII era of complacency, consumerism, and conformity. Then we grew up seeing our leaders murdered: John Kennedy, Malcolm X, Medgar Evers, Martin Luther King Jr., Robert Kennedy. The U.S. sent troops to Vietnam and war turned out to be more complicated than we had been told. Politicians did not always tell the truth. Around the time we reached voting age, President Nixon was resigning in disgrace.
And so we became the generation that did not trust anyone over 30. We challenged everything the grown-ups gave us from the draft to healthcare to the toxic substances in air, water, and our homes and the products we produced and used. The "Our Bodies Ourselves" movement shifted the focus of medical treatment to give patients better information and wider choices. Was your father in the room when you were born? Did your mother get to decide how she wanted to manage medication for labor pains? You're welcome.
We saw injustice and so we protested and we challenged more. We changed the laws to protect the rights of women, minorities, the disabled, and the LGBT community. We made consumer goods safer, especially cars and toys. We created the modern environmental movement, stopped the damage to the ozone layer, took lead out of gas, and brought our lakes back from near-death.
We understand that there is much more to do, and we have seen some of our most important efforts rolled back or distorted beyond recognition. But we have never given up on our commitment to questioning what is and pushing for what is better.
We understand that some of you who came after us consider us spoiled and selfish. You're welcome for that, too. We did not invent the idea of complaining about the excesses and failures of the previous generation, but we pretty much perfected it.
Here's a secret -- we're delighted when you blame everything on us. First, it means you learned our most important lesson about your obligation to recognize and repair the failures of the past. And second, we know how cycles of history work, which means that your children will think we were just great, while they are carrying on our tradition of rebelling against you.
We can handle whatever you've got. We survived disco, yuppies, Iran-Contra, the Starr report, the dot.com bubble and the sub-prime meltdown. One word of advice, though: No complaining unless you have a constructive solution to propose along with it. Otherwise, it's just whining.
Before we turn it all over to you, though, we've got one last revolution: end-of-life care.
We used to talk to our friends about caring for our children, about teething, homework, and college applications. Now we exchange stories about caring for our parents, about finding caregivers and assisted living facilities, about durable powers of attorney and navigating Medicare, about dementia and rehab after strokes. There is a growing body of literature by baby boomers writing about caring for their parents at the end of life, including Roz Chast's brilliant Can't We Talk About Something More Pleasant?, George Hodgman's touching Bettyville, and Scott Simon's heartrending Unforgettable.
A director of an assisted living facility says that she began her career helping people in their 50s care for parents in their 70s, but now works with people in their 70s caring for parents in their 90s. The advances in treatment for heart disease and cancer have given us more time than any generation in history with our parents, for which we are grateful beyond words. But it has also given us unprecedented health care challenges, with the number of people around the world living with dementia predicted to rise from 44 million today to 135 million by 2050. Our health care system is still too focused on treatment rather than prevention, which means that near-endless expensive treatments are covered, whether they will improve the quality of life or not. But until 2016, there was no coverage for conversations about whether a patient wants those treatments.
The numbers in the studies vary, but all of them conclude that a huge percentage of our health care costs are spent treating people in the last six months of life. Anyone who wants that six months should have it. But because doctors and families are skittish about asking patients what they want, too often the result is needless suffering. Over and over, my friends have told me, "I thought I was doing the right thing by seeking out the best treatment options for my parents and insisting on every possible procedure and medication. But now I realize that it was for me, not for them." Dr. Craig Bowron wrote in the Washington Post about the way that family members, particularly those who have not been caretakers, rush in to insist that "we do everything we can," meaning as many medical procedures and treatments as possible. They often use the vocabulary of battle. "This person may think she is being driven by compassion," he says, but it is more likely to be a reflection of "the guilt and regret of living far away and having not done any of the heavy lifting in caring for her parent." It can reflect the adult child's own fear of death, loss, and lack of control as well. Bowron writes:
When their loved one does die, family members can tell themselves, "We did everything we could for Mom." In my experience, this is a stronger inclination than the equally valid (and perhaps more honest) admission that, "We sure put Dad through the wringer those last few months."
We must do better.
In part 2: Where to start