Bill Moyers: We are journalists, both of us, and we saw a story that was working its way through the undercurrents of American life. And that story has several layers, as most good stories do. One was a growing movement to improve care at the end of life. Second was an emerging conversation about death and dying after a long period of denial.
Judith Moyers: You know, we like jumping on subjects that are thought to be taboo. So, we felt challenged to take on this taboo as well. Dying is a part of life, a part of the life process. We don't want to skip it.
Bill Moyers: Three years ago, our own, then-37- or 38-year-old son acknowledged that for the first time, he was having to try to imagine a world without his parents. That was a startling confession to hear come from this, our oldest child. So that was a factor. There were so many factors that came together, that converged to cause us to think that this is a subject we wanted to do.
Beliefnet: I understand Bill's mother died while you were making this series. How did that loss affect the way you approached this journalistically?
Bill Moyers: The way it influenced me was that I realized all the mistakes I made in the course of my mother's dying. I was a fairly sophisticated, fairly knowledgeable fellow in his early 60s who nonetheless knew very little about hospice; who didn't understand palliative care, or its importance, or the breakthroughs that have come in America in palliative care. And who just simply didn't know how to respond to my mother's needs for comfort. It was when hospice was called in that I really began to learn a lot about the care of the dying, that I had only thought about abstractly until then.
Beliefnet: If you could have done it differently, what would you have done?
Bill Moyers: I would have explored much more deeply what the last stages of life are. Any of us should know more about the fuller stages of the process, in the last years or months of life, than I did. That's one. I should have, myself, questioned the doctor's judgment more than I did. He would say, "Well, I don't think your mother needs more pain medicine. I think that she needs to be conscious, and we need to change her diet a little bit." I wish I'd said, "Look, let's face it. My mother isn't going to recover. Her agitation can be addressed. I'm not sure consciousness is as valuable at this time as it would have been 6 months, or 12 months, or 2 years ago. So, let's have a more open conversation."
Beliefnet: That's surprising--that the taboos that you found in the medical profession, and in dealing with the medical profession, persist also into the world of religion.
Judith Moyers: Absolutely. While doctors told us that they received no instruction in medical school about dying, about making a patient more comfortable, for example, or about how to deal with family members, clergy also reported back to us that they really did not have that kind of training that would make them feel able to give that kind of counseling, if in fact the subject was raised.
Bill Moyers: One of our stories concerns a couple in Louisiana. He was dying of ALS, Lou Gehrig's disease. He had begun as a Southern Baptist, and was now non-denominational. She remained a deeply committed and worshipping Southern Baptist. But when he began to reach the stages of disability and needed her full-time presence, she just stopped going to church. She says on camera, in my interview with her, that of all the things she misses the most, going to church is one of them. She wasn't getting any help from her church because she didn't want to bother them. And so she didn't inform the church that she wasn't there because her husband was dying. The church didn't ask, didn't explore the matter. I actually wrote the pastor a letter when I got back to New York and called his attention to the issue. And the church then moved in and was a very big source of help. But there's failure of communication in all of these relationships--between doctors and patients, between pastors and members, between the dying and his or her loved ones. We just haven't developed a mature way to converse about death, to face it openly, and deal with it honestly. I think that talking about death is, in fact, the best weapon to cope with our fear of death, and to get help in the process of dying. But it's not done all that often.
Beliefnet: How would you like to die?
Judith Moyers: Well, I'd like to be in control. I would probably do everything in the world there is to do, to continue to live. I would do surgeries, medications, treatments, and all the rest. But I'd like to know that when I say, "Enough is enough," that that would be followed as my wish. I'd like to be conscious, if it's at all possible. When I go, I would like to experience this. I would like to know what's happening. I'd like to be in communication with my loved ones, my children, my spouse. Maybe even my grandchildren. I'd like to be able to be talking to the end, if I possibly could. I think it's obvious that I would like to do that. And I would like to be free from pain. That's a big concern of mine, and it's something I learned in doing this series--that most Americans suffer more pain than is necessary. Many people die in pain, whose pain could have been relieved with the technology that we know now.
Beliefnet: Did you get the sense from looking at these cases, journalistically or from your own life, that the dying process is different among people who have a confident belief in the afterlife?
Bill Moyers: Yes. I did notice that people who believe that there is an afterlife face the process with more grace and more gently than people who don't. That they accept death more naturally than people who don't. And they seem not to be afraid of what comes next; of course, none of us knows what is coming next.
I walked into a hospital in Birmingham that you'll see in the final broadcast. Turned left off the elevator, turned right down the corridor, and heard a voice, a man's voice, singing down the hall about Jesus. And my crew and I were told that we could go in to see him. And we walked in, and here was this older man--not as old as I am, but older than most of the others we'd been talking to--and he was singing away. He was dying, he knew he was dying. And I said to him, "Are you afraid?" He said, "Oh, I'm not at all afraid. I know that Jesus is waiting for me." And that man did die very peacefully and very gently, his family later told us.
Beliefnet: What are the most important spiritual steps that one can take as part of this process?
Judith Moyers: Saying I love you to the people that you want to say that to--that is definitely a spiritual issue. Settling the unsettled in your life--the relationship question is a very important spiritual issue, and perhaps the preeminent one. The ability to simply think through your life, to think back on your life, to think through it a little bit, seems to be a very important spiritual issue.
Bill Moyers: I think we give meaning to life in how we love, and how we work, and how we live. And I think the best preparation for death, just to speak as an individual, is to live a life in which you give as much meaning as you can to what happens every day.
I don't think it's healthy to be a morbid society and be obsessed with death. Nor do I think it's healthy or realistic to deny the reality of death, and therefore not to talk about it until it's too late. There has to be some better mix in our society. Dying is almost un-American. We Americans don't like limits, we don't like boundaries. And death is the ultimate limit and the final boundary. We just would prefer not to talk about it. So I'm hoping that as a result of the series, there's a more sustained, serious, and open conversation about death and dying as a natural part of living.
Bill Moyers: There were some beautiful moments.
Bill Moyers: The moment when Kitty Rail, in Oregon, when I said to her, "Well, is this the day?" She had been planning to call in her physician to assist her death, because that's legal in Oregon now, as you know. And I said, "Well, is this the day?" And she said, "No, this is not the day. I have a good book, I'm sitting up. My daughter is coming over with my granddaughter later in the day. No, this is a good day."
Judith Moyers: That statement that Kitty Rail made was really one of my favorite statements in the series. When she said, "It's a good day," I really started examining, what would make a good day for me? Well, for me, it would be many of the things that Kitty Rail spoke about. Having a good book, having my daughter come over, having my grandchild come over to see me, and not being in too much pain. And I'm just wondering if it wouldn't be a wonderful exercise for us all, way before the time comes, to say, what is a really good day for me? What are the components of a really good day?
Beliefnet: Can you take a shot at summarizing what you see are the most important things that individuals can do to prepare?
Bill Moyers: One, take a piece of paper and try to describe the kind of death you want. Write down your wishes for end-of-life care. Then sit down with the people around you, who love you, and whom you love, and talk about them. Examine, do you have an advance directive? Do you have a health care proxy? Does it do exactly what you want it to do? So, discuss that. Take a spiritual inventory. Take a financial inventory. In other words, prepare for the trip you think you're going to take. None of us would take a long and important trip without getting ready for it. We'd consult the travel guide. We'd decide the sites we'd want to see, the clothes we needed to take, and the schedules we wanted to keep. We'd let the people around us know where we're going to be in case of an emergency. We would make sure we had in our suitcases the medicine we need, if we have prescriptions or have needs. We would do everything to make sure that our trip was planned down to the nth degree.
But here's the most important trip one will ever take, the destination of which is not known, and most of us don't prepare adequately for it. So my advice is to think through this trip as you would any other and decide in advance what you have to do to get ready for it.