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The last remaining way to die.

In the November 1989 issue of Chest, researchers at the University of California, San Diego reported progress in understanding how people die in their sleep. A study of sleep patterns in 233 elderly nursing home residents found a high prevalence of periods in which the patients stopped breathing (apnea) or almost stopped breathing. Women who had displayed more respiratory disturbances had a higher death rate over a four-year period; this was not true of the men in the sample, however, apparently because they died from other causes first. The study also found a difference in mortality rate depending on the cause of the apnea-those patients who had upper airway obstruction were more likely to die during sleep than those with failure of the brain to initiate breathing.

So far, so good. However, the researchers conclude by asserting "the task for the future will be to determine how and when the survival of patients with sleep apnea can be prolonged." On this agenda, we may find another way to keep death at bay-the last remaining way to die undisturbed.

But do we really want to know how to keep people from dying in their sleep? While most patients currently treated for sleep apnea are younger, the history of life-extending procedures is that they are used on progressively older patients. Experimental procedures become ordinary and then nearly obligatory. There is no reason to suppose that treatment for sleep apnea will be any different.

Some of us would prefer dying "peacefully" in our sleep to "war" in the ICU. But the theoretical right to be left alone fares poorly when confronted with the compulsion to use available life-prolonging technology. Instead of only looking for new ways to forestall death, perhaps we need to invert the question: Given that we must die, how would we prefer it to be?-Karen S. Ritchie, assistant professor of medicine, University of Texas MD Anderson Cancer Center.
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Title Annotation:progress in understanding how people die in their sleep
Author:Ritchie, Karen S.
Publication:The Hastings Center Report
Date:May 1, 1990
Words:319
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