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The Final Exit

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Much if not most of my commentary addresses issues of national security because I spent my career in military communications and that is where my professional expertise lies. But at the age of 86 I am acquiring yet another area of interest and expertise - the various traumas and anxieties that attend the end of life.

We all know our lives will come to an end eventually, but most of us prefer not to think about it, even those of us with confidence in a better life to come. That is a mistake. We end up going through the stages detailed by Elizabeth Kubler-Ross: denial, anger, bargaining, depression and acceptance. That's a lot of wasted time and anxiety that could be better spent savoring your final days and hours, reaching out to loved ones and getting your affairs in order.

We must all die and for most of us, death will not come quickly or painlessly. For too long, the medical profession has turned a blind eye to the rituals of death, preferring to focus on extreme measures to prolong life even when the measures are painful and expensive and the chances of success are small. But today at long last we are seeing a more enlightened approach in providing palliative care to those near the end.

Palliative care involves many things. Part of it is the simple act of relieving pain, but that can be overdone. Too much reliance on drug therapy leaves the patient comatose and unable to interact with other people. The true challenge of palliative care is to help seriously ill people, usually elderly people, interact with others, presumably family and friends, and get the most out of the time they have left.

Palliative care is not the same as hospice care which is a specific type of palliative care for patients whose life expectancy is probably six months or less. More general palliative care is people suffering at any stage of life and in some cases is offered along with curative treatments with high likelihood of success. The number of hospitals providing palliative care services, according to the Center to Advance Palliative Care, as reported by Dr. Sonya Christianson in The San Diego Union-Tribune, grew from 658 in 2000 to 1,734 in 2012. That is a hopeful sign.

Often elderly people with serious disease, especially cancer, must make a difficult decision whether to undergo painful treatments that might give them an added year or so of life or choose a more comfortable time at home with family and friends for maybe six months. Often people who choose the latter live a lot longer than the doctors predict. I have seen many people die simply because they gave up. But if you have people close to you who you can communicate with, you fare much better and usually live longer.

I know in some states people in desperate straits can legally arrange their own deaths. I find that troublesome morally and ethically. Palliative care is the best alternative and it should be a basic therapy offered by the medical profession. We all have to die; we cannot control that. But we can control how we die, and the medical profession can make that possible.

Lt. Gen. Clarence E. "Mac" McKnight, Jr., (USA-Ret) is the author of "From Pigeons to Tweets: A General Who Led Dramatic Change in Military Communications," published by The History Publishing Company.