Bill Moyers' new series aims to help viewers break through the taboos and emotions that make it so difficult for us to deal with a dying loved one.
Always the meticulous journalist, PBS docu-king Bill Moyers thought he was well-prepared before production started on his latest report, On Our Own Terms: Moyers on Dying.
Then his mother, Ruby, began a physical decline that ended with her death on his first day of filming. And everything changed.
"She started dying at (age) 89, and it took three years," Moyers said in an interview last month.
"I was in my early 60s, a worldly wise man. . . . I'd traveled, been in government, newspapers, politics and television. I should know about these things, right? But I didn't really know what hospice was. She had been in a nursing home, and I had been struggling with the doctor" over her care.
Eventually, Moyers turned to one of On Our Own Terms' early subjects, pediatric oncologist and medical ethicist Bill Bartholome, who was dying from cancer of the esophagus.
"Get yourself a doctor who will help your mother die, not a doctor who wants to prolong her life," counseled Bartholome, who vetoed excessive treatments for himself so he could make the most of the time he had left.
"I had to fire my doctor in order . . . to get my mother's end of life comfortable," said Moyers. "It made me quietly determined that the mistakes I had made in her dying wouldn't happen to someone else if I could help it."
The result is On Our Own Terms, a six-hour, four-part effort to break through taboos, denial, legalisms and ignorance to improve the process of dying in America.
It's an intimidating, involving event that unearths new information even as it tugs at heartstrings and asks uncomfortable questions.
But you won't see talking heads indulging in a plastic, politicized debate.
Moyers instead focuses on those at the front lines: doctors, caregivers, relatives and patients, all struggling to live with dying.
He raises a potent question: What happens when, despite all our advanced technology, death becomes inevitable?
How and when do doctors, patients, family members and caregivers turn from fighting to save a life to helping it end humanely and peacefully?
"Our deaths are as different as our fingerprints . . . and you have to weigh these issues according to your own values, your own religion and your own financial situation," said Moyers, who converses vividly and precisely, just as he writes scripts.
"A doctor's role is to save life, as long as that life has a chance," he said. "But when significant life is over, when there's no prospect for a rescue, then the doctor needs to help the patient exercise as much choice and control over the circumstances as possible. And often, they're not trained to do that."
Dr. Diane Meier, director of palliative care at Mount Sinai School of Medicine in New York, backs up Moyers' perspective.
As she tells the camera during one segment, she had nine years of medical training after college and never once took a course on pain management.
Now she pioneers methods of relieving suffering for seriously ill patients, a goal that sometimes conflicts with the desire to extend life.
"Death (is seen as) a failure of medicine," said Meier, who hands everyone she meets at Mount Sinai, including Moyers and his crew, a copy of Leo Tolstoy's cautionary novel on the tragedy of silence during a loved one's demise, The Death of Ivan Ilyich.
"There has been this infatuation and love affair with the ability of modern medicine to cure sometimes and prolong life. We got so caught up in the excitement of that, we forgot our core values as a healing profession."
The statistics Moyers cites are sobering: A hundred years ago, life expectancy barely topped age 46. Today, people live to a median age of 78, with an average four years of disability before death.
Though 90 percent of respondents in one poll said they would like to die at home, 80 percent of us will die in the hospital or some other institution. And though half of us are counting on loved ones to carry out our wishes at the end of our lives, most haven't discussed our preferences with them.
"In the last 50 years, as we've become a more mobile society, baby boomers . . . haven't had the experience of caring for someone who is dying," Moyers said. "They're suddenly realizing . . . their parents' death . . . creates a moral, financial and personal challenge. I hope the wrestling that's going on with baby boomers regarding their own parents will bring them to this series."
In the first episode, "Living With Dying," we meet Bartholome, who decides to marry his fiancee despite a prognosis that gave him just six months to live. Though he survived for years, he eventually died in 1999.
"Death transforms our living in ways that we in this culture don't understand," said Bartholome, who passed up pain medication, which dulled his senses, to savor every moment of living. "We need to think of death as sugar . . . something that gives life that pizazz. I'm discovering what it's like to live in the light of death."
In a later episode, Moyers explores the controversy about physician-assisted suicide by telling the story of Jim Witcher, a former veterinarian diagnosed with the degenerative nerve disorder Lou Gehrig's disease. Witcher hoped to end his life with a doctor's help once paralysis advanced to just below his neck.
During an emotional conversation with his doctor and his wife, Witcher learns the bottom line: Assisted suicide is illegal in Louisiana (and everywhere else, except Oregon).
His only option is a device to give himself enough of a pain-relieving drug _ say, morphine _ to end his own life. But that would mean killing himself while he can still move his arms, something Witcher doesn't want to do.
"It stinks, to be real honest," he tells the camera during Moyers' third installment, his eyes brimming with tears. "It's not fair."
Eventually, he would die after refusing a respirator and feeding tube.
The power of On Our Own Terms springs from these moments: A grown son pleads with doctors and his father to keep fighting the advance of pancreatic cancer; a doctor details to family members the physical changes a woman will go through while dying from cancer at home; a Catholic doctor who opposes assisted suicide eventually withdraws fluids and nutrition from a patient dying of liver failure, sedating him into unconsciousness to ease his suffering.
Why did people allow Moyers into the toughest moments of their lives?
"When you have reached the last act, most people tend to think beyond themselves," he said. "I think they let us in because they wanted to share stories, knowing that the sharing might help other people."
Moyers puts a face on it all: not just death, but the process of dying. Before long, viewers learn to see death through the eyes of the dying. It's a transforming experience.
"As I was editing these images, I began to feel like a doctor must; you get accustomed to death, but you never take it for granted," said Moyers, noting that nearly every patient profiled on the show is now dead. "And just like I use seat belts in case the unlikely happens, . . . I want to be prepared (for death). What we're talking about in this series is seat belts for dying."
To that end, PBS has organized a lengthy study guide on Moyers' series, available at its Web site, http://www.pbs.org/wnet/ onourownterms/. There, Internet surfers can see excerpts from the reports, browse a list of national organizations involved with end-of-life issues, register for online discussions and more.
Piggybacking on the interest generated by Moyers' project, Tampa PBS affiliate WEDU-Ch. 3 also will present half-hour panel discussions after each installment of On Our Own Terms. On Wednesday, WEDU's show will answer call-in questions from viewers.
"The subject of death is taboo . . . so people procrastinate to the last possible moment," says Patricia Suarez, director of education and outreach for WEDU, which tapped a committee of health care professionals and experts to develop a Tampa Bay directory of contacts for end-of-life issues. "People are in crisis trying to make decisions they should have talked about years ago."
For Moyers, such outreach isn't just a welcome byproduct of his shows; it's the main point.
"We think this series, if we're lucky, can start a new discussion about death and dying," he said. "Television for us is only the beginning of the matter, not the end."