“Dying is not a failure.” Why—and how—to prepare for death.

Story by Jessica Hall – MarketWatch

After several decades of working in the healthcare industry, Michael Doring Connelly saw how the insurance industry and the medical industry are often at odds with the realities of life and death.

Connelly served as chief executive of Mercy Health, one of the nation’s largest health systems, from 1994 to 2017 and previously served as an executive with the Daughters of Charity National Health System (now the Ascension Health System) and has experience with healthcare systems in Germany, the United Kingdom, Denmark, Sweden, and Spain.

Connelly spent five years writing “The Journey’s End: An Investigation into Death and Dying in Modern America,” published by Rowman & Littlefield, to discuss ways to reform healthcare in America, educate and empower consumers to advocate for better care around dying and explain how more care doesn’t equal better care.

MarketWatch: Why did you write this book?

Michael Doring Connelly: I spent a lifetime in healthcare trying to reform things and didn’t have much success. With the book, I tried to target what to improve, and the care of the elderly is the biggest problem in healthcare.

MW: What’s the biggest mistake our society makes around death and dying

Connelly: It’s a confluence of forces. Everyone is afraid to die. The healthcare systems see dying as a failure. But if you’re in old age, dying is not a failure. It’s a natural progression. People will say “Do everything possible to save Mom” and it’s a terrible thing—it puts the patient through hell. Healthcare providers feel compelled to do this. The payment system encourages it. To do everything possible today can be a disservice.

MW: If you had the power to control the circumstance of your death, how would you want to die?

Connelly: I would like to die at home with my family. Today, the majority of people die in institutions and horrifically, in ICUs (intensive care units). If they’re dying, they shouldn’t be in the ICU. It’s really abusing the patient. But people cry “Do everything possible” because they don’t want to lose their mother. I don’t want that.

MW: In the book, you urge older adults to develop a ‘death literacy.’ What does that mean?

Connelly: The Lancet published a project on death and dying. The research, conducted by a worldwide commission of experts, suggested that we need to regain our appreciation for the value of death. Death literacy—it’s knowing what to expect in old age. It’s the knowledge and skills that old people need to navigate aging and dying. People don’t like to accept that they can’t physically and mentally do what you did before. Healthcare does a poor job at dying at home and the public is misinformed about hospice. If you get a terminal diagnosis, get an evaluation from a palliative healthcare provider who looks at the whole picture. Hospice—by not treating you—actually results in you living longer and more comfortably than active treatment would. It’s a better option. It’s accepting trade off, accepting that you won’t live forever. Physicians are the lowest users of healthcare at the end of life because they understand—they don’t try to have everything done to them.

Connelly: Clinicians generally aren’t interested in recommending palliative care or hospice. But during COVID, they more often made those referrals because the system was overloaded, and palliative care and hospice made sense. During COVID, there was so much death that there was a temporary awareness. But generally, there’s a fear of death—everyone wants a legacy, wants to be remembered for something. In the book, I talk about it being more important to understand your life than extend it.

MW: Is there a balancing act that allows you to strive to stay healthy as people live longer while also accepting the reality of a natural death?

Connelly: Try to stay active as possible for as long as possible. And then, education becomes a very powerful tool in this area. There was a study that showed patients videos of the procedures they were requesting. They weren’t understanding what they were really asking for. Once they saw what the procedures entailed, their views on what they wanted changed. Under the healthcare payment system, doctors aren’t paid to patients, help them prepare for what’s the come and educate them. That requires a lot of time and care and multiple conversations. It doesn’t really happen. There’s an obsession with coding in healthcare payment systems and talking and educating isn’t a payment code. That’s why concierge medicine is becoming so popular. Patients gain greater access and doctors have more time.

MW: What do you want to stay with readers after they’ve read your book?

Connelly: Prepare for dying. Make an informed choice. Educate yourself. People have false assumptions of what works. It’s your life and you need to prepare for the end of it. We all do a lot of stuff to prepare for a newborn: we buy all sorts of things, redo the house, read a lot of books, and talk to everyone for advice. Dying is a similar experience. We have to prepare for it. The healthcare system isn’t helping you learn about dying. You, as the patient, need to ask for palliative care. If you’re referred to the ICU, or for a transplant, or a feeding tube—ask for a consult with a palliative care doctor first.

MW: What reform do you think we need in healthcare?

Connelly: An economic tsunami is coming at us. There’s a significant shift in the demographics of the U.S. We have will 78 million people on Medicare by 2030. I can’t believe we’re in denial about this economic force. We could stop spending unnecessary money on end of life procedures because they aren’t working. We’re dumping this burden on future generations in the form of debt financing. I spoke about 12 things to change healthcare. There’s the issue of hospice. A doctor needs to certify that you’ll die within six months. No doctor wants to say that and tell a patient that. So, doctors don’t bring up hospice until the last seven to 12 days. We also need to expand home care days for hospice. There’s a limit on that and that makes no sense. Congress is too overwhelmed with all that’s facing mankind and getting re-elected to make changes. The insurance world is obsessed with proof. It’s difficult to prove that hospice will cost less. So, we need and want consumers to make these changes. It’s not going to come out of Congress or the healthcare system. We need a cultural change. Do you care about your kids and grandkids? Don’t burden them with the cost and complexities of dying.

This interview was edited for length and style.

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