(The following post is by guest contributor Asuncion Alvarez, who is a professor of bioethics at the National Autonomous University of Mexico and has written extensively about end-of-life issues. She is also vice president of the World Federation of Right to Die Societies, board member for Morir con Dignidad Mexico, and a member of Final Exit Network. – Kevin Bradley, Editor)
Although we Mexicans have a reputation for having a great familiarity with death, in reality this only happens two days of the year, November 1 and 2, when we celebrate the Day of the Dead. We enjoy the colorful festivities and many people arrange altars to honor their dead. We eat sugar skulls that bear our name and enjoy a delicious sweet bread decorated with the shape of bones. But outside of those days, most Mexicans do not want to think or talk about death, and we maintain an attitude similar to that of the United Sates and many other Western societies that avoid and deny it. Unfortunately, we do speak with some frequency about the deaths reported by the news that have increased exponentially due to the violence of organized crime. Perhaps this has made us more aware that we can die at any time (as the COVID pandemic has also reminded us), but it is not so clear that this awareness is accompanied by reflections and conversations that help us Mexicans know what to do when it is time to accompany and support someone facing the end of life.
It is also true that in Mexico, a country made up of a diversity of communities, there are some that preserve ancestral beliefs and traditions that allow them to know what to do when confronting death. They know how to console themselves with words and rituals that help to alleviate the anguish caused by anticipating the end of life and the pain of separation from loved ones. But for most Mexicans, fear of death prevents them from asking themselves what they would choose when they are near death, which medical and non-medical decisions to make and communicate to their family members and friends. Consequently, many patients and their relatives reach those difficult moments totally unprepared. Physicians are also part of this society that denies death and they do not receive training to help them cope with it; many of them still believe that their duty is to prolong life at whatever cost. Since many patients and family members are not clear about what decisions to make, it is the physicians who decide, leading to many patients having an end of life much more prolonged and painful than necessary.
No doubt we Mexicans need to reflect and accept that one day we are going to die and learn to talk about it. Thus, instead of fighting to achieve the impossible, we will seek to have the best possible end of life, something that depends on making good decisions and plans. We will be prepared only if we have thought about and discussed them in advance. The more awareness we gain, the better quality of the last stage of our life we will achieve. In addition, we will be more willing to demand that we legally have all the necessary options: to be able to suspend treatments, to have the best palliative care and, in the event that this is not enough, to receive help to decide when to die.
I can’t finish this reflection without clarifying that the difficulty in talking about death is not the only obstacle to people receiving better care at the end of life. Due to the inequity in the Mexican health care system, some receive more attention than may really be needed while others do not receive the minimum necessary. The COVID pandemic has shown this sad reality in an alarming way.
Clearly, we Mexicans face the same challenges of achieving a humane and dignified end of life for our people that confront other nations.
Dr. Alvarzez’s comment about the the wisdom about death and dying being preserved by the most traditional communities made me reflect that the same could be said about our own country. Regaining a sense of acceptance of mortality as a natural part of life may be a “back to the future” endeavor.