Remember the "death panel" hysteria? For months before passage of the Affordable Care Act it raged, raising the specter of nameless bureaucrats deciding who was worthy of which procedure, who would live and who would die.
We're a considerable distance from such a dystopia, but medical and fiscal experts -- those who are honest and brave, anyway -- say that some form of rationing is inevitable.
The greater the percentage of the population that's frail and dependent on Medicare, and the more the government serves (ridiculously) as middleman for our health care consumption, the less there will be to go around.
The rationing may be passive, rather than aggressive -- resulting from limits on doctor reimbursements that quickly squelch availability, rather than from outright refusals for requested care, say, after a certain age -- but such rationing does loom.
We contemplate the situation with anything from rage to resignation, but now and always, no matter what system we end up with, the greatest power we have is to decide for ourselves how we'd like the final years of our lives to unfold.
As a friend put it to me recently, "I've realized I don't need just a retirement plan -- I need an expirement plan."
He experienced this epiphany as he struggled with the failing health of his mother. A lot of the family burden -- the logistics of her care and housing -- fell on him, which added to the weight of the loss he knew was coming.
When it came -- more quickly than he'd seemed to anticipate --he radiated a peacefulness and acceptance, perhaps because as a family, they'd done things well. Another, older friend at virtually the same time was bidding farewell to a beloved family member who chose to die at home with nothing but hospice care -- with only what was needed to mute the pain of passing from this life to ... whatever comes next.
What both men were witnessing and participating in is what we all, ideally, should address as individuals and families. Without any encouragement or pressure from a distant bureaucracy, we should form our own "death panels" -- or end-of-life support systems.
We should ask, to paraphrase Scripture: How shall we then die?
In my experience, people are turning away from what they view as excessive use of technology -- innovations that postpone the inevitable without delivering any appreciable improvement in one's final days and weeks -- in favor of simple acceptance of death and merciful alleviation of pain.
My own in-laws chose this route. It felt more loving than I can begin to express.
Bill went first. He had declined further treatment for lymphoma since he was in his mid-80s and the cure might be worse than the disease. A year or so later, hospice care at home eased his passage, and loved ones surrounded him as he departed this life.
His wife, Renie, died 14 months later. She missed Bill so much, and when X-rays of an arm broken in a fall also revealed aggressive cancer, she decided she was done. She left us within weeks.
Both of them led very rich lives, full of friends and faith. They had -- they gave us -- very good deaths.
We are blessed, of course, that they still had their wits about them to consciously choose their own paths, but all of us cogent enough to be reading a newspaper right now have the same option.
What has astonished me as I've delved into this subject is that scientific research shows tendencies exactly the opposite of what I've experienced.
Although most of the people I've mentioned were committed Christians, studies in Israel and in various American states show that the more religiously devoted the patient, the family and/or the doctor, the more likely they are to choose aggressive technologies that do little more than postpone death.
The difference is not in sect or denomination; it's in intensity of religious devotion.
On the one hand, I understand the compulsion to choose life -- even to the point of pain and cost. When our culture celebrates pink-sneaker-clad legislators or stylish lobbyists who support abortion of viable late-term fetuses and mock these babies' defenders, then we truly live in a "culture of death." Pushing back against such smug evil is understandable.
But could it nonetheless be misguided? Whatever happened to "For to me to live is Christ, to die is gain?" Or to the first lesson of the Book of Job, which is that both Satan and God hold power over our deaths?
I'm blessed that the very religious people I've loved are also very reasonable and sweet. My politics tell me that in guiding their own deaths, they chose liberty. My faith tells me that in embracing death, they chose life.
Ruth Ann Dailey: firstname.lastname@example.org.