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April L. Bogle Headshot

How Would the Rainforest Handle Alzheimer's Disease?

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It's simply unnatural to encourage old people to live on well past their functionality; I'm convinced of this now more than ever since I returned from the rainforest of Costa Rica's Osa Peninsula. This may sound like a heartless statement, but it is just the opposite.

For more than 10 years I've watched my father -- a brilliant college administrator and professor of history, a progressive thinker and agent of social change, a man who loved to ride his bike for exercise, work in his rock garden for meditative therapy, grill hamburgers for his wife and two daughters and write stories about his past for fun -- deteriorate into a lost, scared, immobile man living in a nursing home.

He is surrounded by others who have been sentenced to the same death watch, people who also had full and wonderful lives, whose families have placed photos of who they once were in window boxes outside their rooms. Irene used to work in the food industry and now spends her day scolding people, taking their possessions and pinching their arms. Pokey, still beautiful and blonde, worked at a bank until her children were born and now sits contentedly holding, stroking and rocking a doll she's convinced is a live baby.

And there are so many others whose names I'll never know. One clutching a blanket up to her chin, a look of terror on her face. Another so lost in her sadness that I want to cry. Still another, glazed eyes, staring somewhere only she recognizes, emitting occasional snorts and snickers. Many stay contorted all day long in reclining chairs, lining the hallways rather than being isolated in their rooms.

That's the visual scene. But for those of you who've visited a nursing home, you know that's not nearly the full perspective. There are the smells that you can't hide no matter how attentive the staff. And the sounds. The jabbering, moaning and crying is a constant, like the ocean, wave upon wave. And then, of course, there's the television that's always on, even though everyone knows TV is not a viable activity for people with late-stage Alzheimer's.

In a nursing home, there is no system for life and death except the endless waiting. The rainforest, on the other hand, has it all worked out. Obviously it is a brutal plan, but I argue no more horrendous than the "care" people endure in a nursing home. In the rainforest, everything is about survival -- from being eaten, from lack of sun or water, from limited nutritious soil. Yet everything, except perhaps the big cats and big snakes, gets eaten. Everything dies. And the remains are taken care of by four different kinds of vultures and thousands of other natural recyclers.

Monkeys befriend toucans and then break their necks before eating them. Frogs eat mosquito larvae and other pesky bugs. Termites eat rotting trees and build large nests that birds invade for dinner. Even the trees know how to survive -- the walking palm sprouts new roots and kills old ones so that it can "walk" to find the nourishing sun under the thick tree canopy.
And the smells? Earthy fresh, clean, sometimes floral, occasionally appetizing (flowers that smell like garlic). And the sounds? A symphony of the original tweets and twitters, clicks and clacks, even howls and squeals. Some are songs of joy, some are sirens of warning, some are simply announcements of being alive.

Is this more brutal or terrifying than an Alzheimer's home? At least in the rainforest, nature is in balance and everything is there for a purpose. It is a highly complex system of interconnectedness and interdependency that functions perfectly when left on its own.

So what can we learn from this? That unnatural ways of extending life aren't necessarily a good thing. There is no design for handling the prolonged decline and decay, and this is breaking down some vital systems. The cost of care is draining Medicare and Medicaid coffers and threatening their continued survival. Family finances are being wiped out, forcing relatives who are living full and productive lives to sacrifice their possessions and downscale their activities. Once vibrant family caregivers are dying earlier than their sick loved ones, zapped of energy, creativity and vitality. Investors are profiting from the burgeoning senior population, while communities across the nation are in serious debt and forced to cut back on education and other programs that support the growth and development of new generations.

As our life expectancy continues to increase thanks to modern technology, we need to squarely face the consequences. People living into their 80s and 90s are likely to get Alzheimer's or other forms of dementia, and physical decline is inevitable.

No way am I suggesting we leave our loved ones to die and let nature run its course like the rainforest would. But I am urging our society to create a responsible plan for cleaning up the mess it has made. Just as the rainforest is an ecosystem that naturally balances its life cycle, so too can our society be intentionally restructured to provide more humane end-of-life options for people stuck in the "new old age." We need to start a serious conversation among religion and law, and the health sciences and the human sciences, to figure out how we can let people die in a way that allows human reason and decision-making to play a major role.

At the very least, we should allow people to determine -- when they are still of sound mind and body -- what they would like to do when they reach the point of no return, either mentally or physically. This "Enhanced Advanced Directive" would be legal for health care providers to follow, even if it calls for assisted suicide.

I know its fraught will all kinds of moral and legal dilemmas. But if we can prolong life beyond its natural time line, we can surely figure out how to allow people to end it -- on their own terms and with the dignity they deserve.

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