Where Do You Want to Die?

---NUMBERS---

According to End of Life Issues edited by Brian de Vries:

In 1949, the norm was still to die at home.

In 1990, 60% of deaths took place in institutional settings and only 17% occurred at home.

Home deaths are more common in the UK, Japan and Australia than either the US or Scandinavian countries.

In a 1993 study of adults in Australia and Italy, there was a 3 to 1 preference for dying at home verses in the hospital.

In a 1976 study in Los Angeles, African Americans preferred home verses hospital by 2 to 1. Mexican-Americans by 5 to 3.

In a small 1999 study of 25 women with stage 4 breast cancer, 38% wished to die at home; 24% preferred to die in a hospital or other institution; 24% had no preference for location; and 14% were undecided.

In studies conducted from 1984 - 1995, when the hospital was the only alternative, 54% - 74% of dying people wanted to die at home. When hospice was the only alternative, 53 - 58% of dying cancer patients and 32% of dying AIDS patients preferred to die at home.

Looking at the first sentence in the paragraph above, that means that 26% - 46% of dying people wanted to die in the hospital. Why not die in the home?


---ADVANTAGES---

HOME
-increased social interaction with family
-avoid potential for insensitive paid caregivers
-patient is more comfortable in familiar surroundings
-less expensive
-family has higher level of involvement in care and as a result the dying experience may be more meaningful


HOSPITAL / INSTITUTIONAL SETTING
-24 hour professional mental health and spiritual support easily available
-pain control adjustments made more easily and quickly
-patient prefers to be less of a "burden" on family
-family does not feel they could cope with caring for the dying loved one at home
-able to manage more difficult symptoms such as dyspnea (difficulty breathing) or intractable pain


As I hope you can see, where you want to die can be a very difficult decision. Where do *you* want to die? Ultimately at that time, you (the individual) will hopefully be the one to make this decision. However, this decision is frequently complicated by a number of factors including circumstances related to the illness and conflicting family needs.

I hope and wish for each of us to have the death that would be most meaningful for us and hopefully our deaths will occur in a place that makes us feel safe, loved, and cared for whether we choose to die in a specific setting or are given no alternative where our death will occur. Regardless, may we all find peace at the end of our lives.