As a longtime resident of Wasilla, Alaska, I wonder if my hometown will ever escape its current association with partisan politics in the minds of people elsewhere. More specifically, will the American public ever be able to engage in an adult conversation about end-of-life medical issues? Too many people, it seems, don’t realize that death is bipartisan. In the recent public town-hall meetings about reforming health care, efforts to provide end-of-life counseling have been described as “death panels,” most notably by one of our prominent Wasilla citizens. Such language is a blatant example of demagoguery.

 In 1974, Ernest Becker won a Pulitzer Prize for The Denial of Death, a book about a formerly taboo subject. It was a prescient work that has become a perennial best seller. Becker agreed with philosophers of the past who have argued that human beings can only stand so much reality and that a total apprehension of the precariousness of our lives would drive us insane. 

 He understood that until we face up to death, maturity is impossible and wrote in detail about the extraordinary effort we make to avoid facing our own mortality. Becker was also very much aware of the irony involved in the conundrum that one of our deepest needs is to be free of apprehension about death and yet we experience this most acutely when we are feeling fully alive. 

 In the decades since Becker’s own death, a new school of psychology known as "terror management theory" has gained momentum, arguing that any and all reminders of death have a negative effect on our judgment. In my forthcoming book, September University: Summoning Passion for an Unfinished Life, I discuss at length how the fear of death, coupled with intolerance for otherness and a lack of curiosity, causes us so much anxiety that it forever detracts from our ability to enjoy life free of the need to blame others for life’s difficulties. The mere mention of a word, metaphor, symbol, or example that reminds us of dying has been shown to negatively influence our decisions. 

 In politics this works magically because psychological studies show that we often respond to fearful reminders about death with an aggressive attempt to defend our political views. So, when a few misguided cheerleaders disparage the need to provide medical counseling in the final stages of life, emotion overrides our ability to reason and everyone loses.

 Nowhere is it more important to set aside partisan politics than when discussing the end of life because we are all going to die—for most of us sooner than we think.  In politics, in particular, we identify with our political party, and when our side loses an election we suffer a loss of stature that bears a conscious or subconscious association with thoughts of death. In other words, we die a little. And if you fear the future and revere the past, here again, as the terror management psychologists frequently demonstrate, change and uncertainty become interchangeable with feelings that the end is near. Fear mongering about end-of-life medical issues can win a political argument by controlling the opposition’s fear, but when this happens, the stakes are such that the terminally ill lose the ability to die with dignity. 

 To show his contempt for the demagoguery of calling medical counseling death panels, editor Jon Meacham, in the September 21, 2009, issue of Newsweek, declared that he had been a teenage death panelist and has in fact served on two such panels, one for his grandfather and one for his father. He says, “One answer to the health-care conundrum is painful but inescapable: we have to become more comfortable with death.” I have served on five such panels with my family, and I know without a shadow of doubt that things worse than death can happen to people. My maternal grandparents went through years of barely conscious but visibly obvious medical torment and excruciating pain. Death in the 1980s was a subject to be avoided, and there was no counseling available for family members or mature guidance for them in realizing that there are experiences more horrific than death.

 The rugged beauty of the Alaska wilderness offers frequent reminders about the harshness of reality. I often wonder what it would be like if our migrating caribou were consciously aware that someday, with a high degree of certainty, each of them individually will come face-to-face with the wolf. I think about this because we humans share a similar fate. But instead of the wolf, we face the nursing home. And, speaking from my own experience, I prefer the beast. 

 In Nasty, Brutish, and Long, psychologist Ira Rosofsky writes with profound seriousness, but also with humor and compassion, about his years of experience in dealing with patients in nursing homes. He tells us that if we reach age 65, we have a 43 percent chance of winding up in a nursing home, and if we reach age 85 our chances for dementia are one in two. Further, the average nursing home resident ingests about 10 drugs per day. In an example that speaks as loud as any about the lack of humanity in our health care system, he characterizes the situation with what he calls the “Rosofsky Law of Inverse Proportionality: The more training you have, the less time you spend with patients.”

 Rosofsky reminds us that the average person aged 65 to 74 has about seven hours per day of leisure time (maybe less with today’s economy), an observation that reminds me of one of my reasons for writing September University.  Those of us with more than a half-century of life experience should have the maturity and, one would hope, the will to see that end-of-life issues are discussed without resorting to petty politics. Those of us with experience visiting friends and family in nursing homes know that in some cases people do better in nursing homes than they would living alone, but that being in a nursing home and being lost in the corridors of your own mind is a dreadful fate. Who among us would prefer that, instead of death with dignity, we be shot full of stupor-inducing chemicals, quietly managed by as few staff as possible, and end up being warehoused in order to keep the Medicare payments going? Of course, if we are drugged into mental oblivion, we would not likely care, except you have to wonder what goes on behind those desperate looks from the many nursing home residents who can’t seem to bring themselves to speak a complete sentence, but who are obviously experiencing what Rosofsky refers to as unfocused rage.

 So the next time you hear someone step up to the podium and try to misrepresent health-care reform by making the public fearful of impending government death panels, please ask the speaker to stop the fear mongering or please be seated and let someone else have a word.

Jack London, the writer that drew me to Alaska and who died young, said he would rather be “ashes than dust.” I, myself, would prefer a death with dignity to what Rosofsky depicts as nasty, brutish, and long.  How about you?