The challenges of living and dying

In the latest New Yorker, a Dr. wrote an article called Letting Go: What should medicine do when it can’t save your life.  In this piece, the Dr. chronicles the terminal illness and death of a young woman from cancer, intermingling other stories of the terminally ill as well as anecdotes about modern medicine, hospice, and medicare.  The basic premise was that when it comes to death and dying, people tend to try to do everything possible, regardless of whether the experimental treatment will be beneficial, instead of being presented options and making choices that sometimes mean stopping curative treatment for palliative treatment/hospice.  The Dr. bemoans the fact that most doctors do not spend the time discussing with families the options about treatment with an eye toward what the patient and family really want.  Instead, doctors talk about treatment options and often avoid discussing the high likelihood that the treatment will be a failure and potentially just be harmful.  The message from the article is to know that everyone has the option of saying, ‘enough is enough,’ and opting for comfort instead of cure. 

I take issue with a few points in this article.  First, as often is the case with medically related articles, there was a lack of discussion regarding the role of psycho-social and spiritual support in talking with families.  Granted that most people would want to hear from the doctor, because doctors still have an air of authority around them.  Nevertheless, many of the challenges confronting people when they face life and death would well be served with people who would provide an ear to listen to the struggles, etc. 

Second, as a chaplain in healthcare, I hear many common refrains, which the article defends, such as; ‘I wouldn’t want to live like that, on tubes and things.  I don’t want to be a burden on others.’  I have often thought about end of life decision making on a personal scale.  While as I am healthy I can say I don’t want X,Y and Z, in considering what I would want if I were sick, I am not so sure I wouldn’t want life sustaining measures, even if the amount of time was negligible.  I believe that when we are faced with death at our doorsteps, many of us would sing a different tune.  I could be wrong, but often I wonder if our judgments about what is quality of life is skewed because of health.  This is also why many were claiming the new healtch care bill contained death panels.  The fear of end of life discussion making was that someone else, the government, would be dictating to me, the citizen, when I should die.  Now, the reality is that the conversation is important to have, and have and have and have.  People should occassionally rethink their advanced directives and living wills for perhaps the choices change as the circumstances change. 

I think articles like the one in the New Yorker are valuable.  Awareness of options is important.  Yet, I caution readers to consider what they would if in the same shoes as the article’s protagonist.  I think more would have opted for the course she took than would have said: ‘fine, I give up.  All I want is to be kept comfortable.’  This is especially the case when “young.”

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