Barbara Bush Faces Death With Courage

Update: Barbara Bush has passed away at her home in Houston on Tues., Apr. 17, at age 92.

Barbara Bush’s decision to stop aggressive treatment for lung and heart disease at 92 is a valiant one. Her condition has worsened over the past year, leading to a recent series of hospitalizations. Now she is facing death with fortitude, courage and realism. She should inspire everyone in the medical arena, doctors and patients alike.

Palliative care is often unpopular, especially with diseases not commonly thought of as terminal. I was resistant to the concept the first time I saw a palliative-care team approach someone with severe heart failure. I tried to convince the team that patients could live like this for months or even years. The patient finally convinced me that he no longer wanted or needed to live in a constant state of breathlessness and immobility.

It is far easier to figure out the point of no return for cancer than for heart or lung disease. Recent advances include better transplants, valves that can thread into the heart through catheters, and ever-improving medications to compensate for worsening pathology. But 5% of heart failure remains refractory to medical treatment, and in these patients palliative care has been shown to improve patient satisfaction and decrease costs. For someone severely ill in her 90s, moving toward palliative care is sometimes just the right thing to do.

Patients with chronic obstructive pulmonary disease—from which Mrs. Bush suffers—are even less likely to receive comfort care than those with heart failure. That too can be shortsighted, especially when infections are frequent and the disease has severely and irreversibly damaged the lungs. Sometimes it makes the most sense to help patients maintain their breathing and dignity as long as possible while forgoing the discomfort and ultimate futility of hospitalization.

Mrs. Bush has long been ahead of the curve when it comes to expanding public acceptance for new or controversial ideas. She fought the stagnant literacy rate with a proactive foundation and an important motto, “Let your children see you read.” She was also known for her AIDS activism as first lady—at a time when HIV and AIDS were still steeped in stigma.

Now she is a pioneer of a different kind. She has looked soberly at her life and made her decision. A willingness to face more bright lights and blipping monitors in the emergency room and the intensive-care unit can seem like courage. But it often comes from fear of dying or the urging of a family member or doctor who doesn’t want to let go. It has taken me many years to accept that Mrs. Bush and those like her are the most courageous. I suspect millions of others would agree.

This blog was originally published in the Wall Street Journal.