The baby boomers, the largest generation in American history, are now almost all in the last third of their lives (if average life expectancy is 78). They have spent the previous, early and middle thirds of their lives transforming cultural ideas, expectations and practices (e.g with the civil rights movement, environmental movement and women’s movement, etc).

The question now is, “Will the baby boomers also transform our cultural ideas, expectations, and practices regarding the end-of-life?”

I say yes! Here are my predictions and recommendations for this generation of “revolutionaries”:

1. Baby boomers expect to live longer and will seek out technologies to do so. We continue to see life expectancies extended (although the obesity problem may soon change that) and the boomers will focus on ways to further extend their years on the planet. I strongly recommend however that they seek technologies that will extend quality life rather than quantity alone. For example, but do not choose medical interventions that will prolong your days if those days are going to consist of lying in a bed, unable to poop or pee without assistance. Choose technology that creates quality alone, quality plus quantity, but never quantity only, at the expense of suffering.

2. Baby boomers will author and create the “natural death” movement. The natural birth movement was predominately a product of the baby boomer consciousness. Taking root in the 1960s, a movement occurred to “de-medicalize childbirth” with varying degrees of penetration into general culture. The outcomes ranged from the growth of midwives and the home birth movement, to changes in the architecture of labor and delivery rooms — to make the birthing experience more intimate and family centered, as it had been for all of human history before modern medicine.

Similarly, I expect this boomer idea to cross-fertilize end-of-life movements:

• Death will become “de-medicalized” and will again be viewed as a natural event that can be managed in natural settings such as the home. The hospice industry will see phenomenal growth to accommodate this shift in desiring to manage dying at home. (90 percent of Americans already say they want to die at home but nearly 80 percent of us presently die in medical institutions.)
• For those who must experience dying in medical institutions, more efforts will be made to humanize the experience and to make it more intimate. Dedicated hospice units and rooms will be built with a design emphasis on comfortable, home-like surroundings encouraging family gathering and final intimacies.

3. Boomers like to be in charge and will seek more control over the dying process. One present expression of this is the right to die movement. While I am opposed to physician assisted suicide and euthanasia, I understand and support the impulse to gain control over the dying process and to minimize suffering. I personally feel that this can be accomplished without choosing to ingest a life-ending substance, however. At the right time (for you), choosing comfort-focused medicine over cure-focused medicine will allow you to gain control over the dying process: physical suffering can be controlled with appropriate medications, allowing time for quality emotional, social and spiritual closure and reconciliation to be obtained between you and others. Additionally, choosing comfort-focused care more often enables you to die, expectantly, where you desire to be the most (usually at home).

Thus, I expect boomers to gradually increase the dialogue about assisted suicide and other novel pathways for obtaining control over the dying process.

4. Expect more non-traditional, cost-conscious funeral preparations. A great example of this is my husband, Kris, who is one of the trailing baby boomers, born in ’61. He wrote a great treatise on this topic entitled, “Final Resting Places and Dealing With the Funeral Industry Monopoly” (Chapter 22 of It’s OK to Die). In this chapter he argues compellingly that the funeral industry hangs us out to dry if we haven’t made plans in advance. We don’t “shop around” in the midst of our grief and just pay for whatever is easiest (but not most economical), while wiping our tears.

Kris gives unusual tips for saving thousands of dollars on funeral costs and tells a story about how we drove his deceased father, in a full–sized casket, across multiple states in an SUV to save on flight costs for the casket and the whole family. It was a very “thinking out of the box” experience (slight pun intended), which turned into a trip that gave final closure to the whole family, saved thousands of dollars, and felt like an adventure. Sounds like something every baby boomer should look into.

Monica Williams-Murphy is an emergency physician and author of It’s OK to Die.