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October 4, 1995

The Naturalness of Dying

Author Affiliations

University of Texas Southwestern Medical Center at Dallas

JAMA. 1995;274(13):1016. doi:10.1001/jama.1995.03530130022020

To the Editor.  —We agree with the concerns expressed by Dr McCue1 that physicians may complicate the process of "natural" death by overuse of diagnostic procedures and treatments. This may reduce quality of life and dehumanize dying persons, at considerable cost to society. However, we reject the notion that marked intellectual and motivational losses, anorexia, and "senility" are natural parts of the aging process. This represents resurrection of an old, discredited, and erroneous view of aging.2"Natural" infirmity and decline in "old age" (whichever decade that might be) is a myth. While dementia is a significant problem in the elderly, a majority of octogenarians and nonagenarians have intact mental faculties.3 Furthermore, among elderly individuals who die with intellectual decline, postmortem examination reveals pathologic changes in the brain indicating specific nervous system diseases that would account for the symptoms in more than 90% of the cases.4,5The

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