Moyers on Dying
We're Unprepared for Final Journey,
Say TV Journalist and His Wife
The TV series "On Our Own Terms: Moyers on Dying" is a thoughtful and probing look at the American experience of end-of-life care. Through interviews with a broad spectrum of caregivers, patients, doctors, advocates, experts and others, acclaimed journalists - and spouses - Bill Moyers and Judith Davidson Moyers sensitively explore such vexing issues as how hospitals decide when to terminate treatment, how patients cope with their imminent deaths, palliative care and assisted suicide. Thirteen/WNET New York presented the four-part series - produced by Public Affairs Television, the Moyerses' production company - on PBS in September 2000. Contact your local PBS station for information on rebroadcasts or buying the series on video.
Bill Moyers is one of the leading television journalists working today. Although he spent much of his early broadcast career with CBS News, he has received wide acclaim for his probing public television series, including "Healing and the Mind," "Joseph Campbell and the Power of Myth" and "Genesis: A Living Conversation." Judith Davidson Moyers, president of Public Affairs Television, has served as executive editor of many of the company's PBS series.
In a recent interview, Bill and Judith Davidson Moyers offered the following answers to questions about "On Our Own Terms."
This is a huge, complex subject. What inspired you to tackle it?
Bill: My wife, Judith, and I are journalists, and two or three years ago we began to sense a story in the making. Americans were talking about death and dying as they haven't in a long time. It is a change that is being driven by many factors. Baby boomers are facing the aging of their parents as well as their own mortality. The AIDS epidemic has brought death close and has taught us many lessons about what needs to be done to provide compassionate care for the dying. And, the debate about physician-assisted suicide, framing end-of-life issues in very simplistic terms, has been heavily covered in the media and gotten people engaged in the issue.
What was it that we wanted to know? What changes are needed in our health care institutions? How should doctors, nurses and clergy be trained to prepare for the last stage of life? How should our public policies, like Medicare, and health benefits through insurance plans be changed to provide for different kinds of care? How do we respect different cultural values and expectations about the experience of dying in our pluralistic society?
We produced this series because the movement to change how we die in America is a big story, like the natural childbirth movement that transformed how we enter the world. Now we need a better exit.
What effect do advances in medical technology have on the choices we face, both as individuals and as a society, in dealing with death and dying? What is the impact of the aging of the population?
Judith: We love high-tech medicine. It saved Bill's life a few years ago when he had heart trouble, and it saved our grandchild's life. But advances in medicine have made dying into a process that takes much longer than in the past. This progress has complicated our choices and moved death out of the home and into the hospital. As children growing up in the South, we were present for all the deaths in our family. When our grandparents died, we were there in the room, probably sitting on the bed.
But dying has changed so much over the last century. Back in 1900, the average age of death was 46. In those days, death came quickly. Today the average age is 78 and death tends to come slowly, by chronic and progressive means. The issues are so much more complicated. In 1997, 87 percent of the American people told Gallup that they want to die in their homes rather than in a hospital, yet 80 percent died in health care facilities. An ordinary person understands that you can't avoid death, but it is how we leave that becomes the source of fear for us. None of us want to die a death we deplore in a place we despise.
What was the most important thing you learned doing the series? What touched you the most?
Bill: We need more light on the subject of dying if we are to improve end-of-life care. Not a single resident physician I interviewed for this program had been given a substantial course on end-of-life care in medical school, and most are not trained in the latest techniques in pain management. In our research we learned that insurance companies and government are spending a huge amount of money on end-of-life care but, unfortunately, most of it is spent in the last 30 days. The individual doesn't have a lot of choice about how that money can be spent. Instead of putting you in an ICU for 30 days where you can't speak and your family can't be with you, maybe you would like to stay at home at a much lower cost and have nice meals brought in by a hospice person. These are the kinds of things we need to talk about.
What touched us the most was the generosity of the people in the series who let us into their lives at the most intimate and vulnerable of moments.
Judith: In the series you will meet many very loving and generous caregivers. Some are spouses, some are health care professionals and some are volunteers. So many of them expressed how much the experience of being with someone who is dying enriched their own lives in a profound way.
Have you had your own caregiving experiences? After working on the series, have you changed how you will approach your own deaths?
Bill: Before my mother died at 91, I made many mistakes in trying to ensure that she had good care. I hope that this series will help other people avoid mistakes by bringing more understanding (and) knowledge to the situations they confront. And by being prepared.
You wouldn't take a vacation trip without preparing for it, but because we don't like to talk about dying, we are not preparing for the final journey. The most important thing you can do is to sign an advance directive and assign a health care proxy so someone who cares about you is making these critical decisions if you are not able to. Talk to your family and physician, check your insurance, find out what is available in your community.
What enables people to make their peace with death? What role does spirituality play?
Judith: We found that just as every life is a particular life, every death is a particular death. Several doctors who specialize in palliative care pointed out that you really can't make peace with death if you are in pain. If pain is appropriately managed - and a great deal can be accomplished to reduce pain - then the dying person can deal with the emotional and existential issues of dying, including their spirituality.
Do you think our society's discomfort in talking about death openly is changing?
Bill: After a long period of denial about death in American culture, Judith and I believe that the public is ready to take death out of the closet and talk about the kind of care we offer the dying and their families in this country. What will bring them to the discussion is our individual desire for a gentle closure. We want to die a good death. Each year half the U.S. population is touched by the death of a relative or close friend, so these issues are very important and meaningful for all of us.
It can be hard to think about our own death, but all across the country we have found people are anxious to talk about a loved one's care at the end of life often out of a sense of frustration. It's no secret that we don't die well in America, and almost everyone has a personal story to share about someone who died under difficult circumstances.
Judith: We always hope our programs will be a catalyst for dialogue. We don't have the answers; our job is to raise questions, provide different perspectives that might offer insights and report on innovative models for good end-of-life care. To help our programs have a value beyond the broadcast, we work hard to bring people together in communities and give them tools and the opportunity to talk and work together to find solutions.
The members of these groups are forming coalitions at the local level to set goals, determine community resources and establish an ongoing plan of dialogue and action to address end-of-life care in their community. More than 200 community-based coalitions across the country are planning activities like these in conjunction with the premiere of "On Our Own Terms." We hope the tools we are providing, including a 30-page discussion guide and an extensive website at www.pbs.org/onourownterms, will support their work.