The Defining Issue of Our Generation

Baby boomers are accustomed to feeling self-important. The 78 million Americans born between 1946 and 1964 were dubbed the Me Generation for good reason. We have high expectations, we want only the very best, and we are savvy consumers of goods and services.

We are not the Greatest Generation - that was our parents - but we were raised to believe in the American Dream. It was there on television (black and white at first) in the lives of Beaver Cleaver, Donna Reed, Dick van Dyke and Mary Tyler Moore. It involved growing up with your mom and dad; completing school and getting a good job; falling in love and getting married; having two great kids, a house and a two-car garage; seeing your children grow up and have children of their own; and living happily ever after. No wonder we have high expectations.

Unfortunately, we soon discovered that real life was not like TV. Throughout our lives boomers have collectively revised and reimagined every facet of the American Dream. When we were having babies, for instance, boomers transformed the way pregnancy and childbirth was approached not merely by health care, but also by society as a whole.

In the 1940s, pregnant women were treated as if they were ill and childbirth was a medical procedure. (I was born under general anesthesia.) Women commonly spent a week in the hospital after delivery. The idea of a husband coaching his wife through delivery would have seemed as odd as having him coach her through gall bladder surgery.

But boomers refused to allow doctors and hospitals to medicalize pregnancy and childbirth. In addition to expecting competent medical attention, boomers insisted that prenatal care include counseling on optimal nutrition, exercise, training for labor and delivery, and breast feeding. No surprise, prepared childbirth has proven safer and healthier for all involved.

Now boomers have discovered that the final chapters of the American Dream are badly in need of revision. Disappointment, anger and shame are common themes of the parent care stories that people my age tell one another. We saw parents suffer and felt powerless to protect them. Many of us promised our mothers or fathers, "We'll never put you in a nursing home," only to find ourselves forced to do just that. In confronting disorganized, often inattentive health care systems, we learned the hard way to be prepared, know what to expect, what you want, and be willing to demand it when necessary.

Being prepared starts with a conversation. Illness and dying are only partly medical; they are mostly personal. It's critically important for your family to know what is most important to you personally - in your life - not just with regard to your medical ailments and treatments. It's important to give them clear authority to speak for you. Such conversations are the best ways to prevent future family conflicts and avoid having an ethics committee or judge involved in your intimate personal affairs.

So sit down with the people you love, pour some tea or coffee. It's time we talked….

Ira Byock is director of palliative care at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.. and author of "The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life."