#585 Musings Beyond the Bunker (Thursday February 16)
Good morning,
END OF LIFE CHOICES
It is not surprising that so many people share my concern that end-of-life decisions are problematic and often not seriously considered. Too quickly, we rush to the dual flawed conclusions that (a) any lengthening of life span necessarily is a good thing, and (b) any and all potential therapies, tests, and invasive procedures must be pursued, notwithstanding data that would indicate the chances of success are small.
Joel Polachek offers some additional sources on this subject: He cites Dr. Kenneth Murray, a retired professor of medicine at USC. It is worth quoting Dr. Murray (published in The Wall Street Journal) in some detail:
“Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. It was diagnosed as pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient's five-year-survival odds—from 5% to 15%—albeit with a poor quality of life…
Charlie, 68 years old, was uninterested. He went home the next day, closed his practice and never set foot in a hospital again. He focused on spending time with his family. Several months later, he died at home. He got no chemotherapy, radiation or surgical treatment. Medicare didn't spend much on him.
It's not something that we like to talk about, but doctors die, too. What's unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.”
INTERFERING WITH THE NATURAL ORDER OF THINGS
Most people want modern medicine to perform each and every therapy—regardless of low-odds of success, cost (financial and emotional), and pain. While we are able intellectually to accept that life will end, we can’t seem to confront the likelihood that a loved-one’s life is near over. The argument for doing “everything possible” is that, to do otherwise is to put the doctor or relative in the role of “playing god” by denying care or “pulling the plug.” But as Dr. Jessica Zitter, author of Extreme Measures: Finding a Better Path to the End of Life notes, perhaps altering the body’s quite natural progression toward death, submitting the patient to what can be excruciating pain, is really more like “playing god.” Who are we to determine how much pain is appropriate for another human being when the odds are that they are at the end of the line?
Zitter describes these herculean measures that typically get to the same result, albeit at great emotional, physical, and psychological expense, as the “conveyor belt” on the way to death. We need to think about the costs—and, yes, those may include economic costs—associated with the objective of prolonging life in the face of long odds. In essence, we need to get people off the inevitable and relentless churning of the conveyor belt Zitter describes.
PRECIPITATING END-OF-LIFE
It is a small step from denying treatments with low odds of success and deciding to precipitate one’s demise in order to avoid the pain and decline that can accompany some of the more complicated illnesses. I, for one, favor allowing people the right to make the ultimate decision in their lives, so long as it is informed, clear, and unpressured.
“WINNING IN LIFE”
A few weeks ago, I wrote that there is never a good time to die—regardless of age. Several people wrote back on both sides of this sentiment. Here is a different point of view:
“While I agree with your sentiment that there is no appropriate time to die, I tend to view death at that age as winning. I suppose that it may seem rather unusual to view it in that respect...and I find that I question the whole thought as my own parents get closer to the age of ninety.
My father, who will start radiation at the end of the month, was told by his doctor that the treatment should give him about 20 years with the cancer. Being 87 this year, my father's response to the doctor was that he would have been pleased with five years. The doctor and the nurse were not quite sure how to handle my father's sense of humor in light of his cancer…
I look at Betty White as an example. Here is a person who had a life that lasted almost to her 100th birthday. [My mother made it past 100.] I see them both as winners. Given that none of us get out alive, they both managed to remain vital [and] disease free, for the most part…
While there may be no appropriate time to die, there certainly must be a designated point at which we can say that certain people were winners...they made it to the end...healthy, functioning...and for lack of a better way to phrase it, appropriately aged.”
I wish all of us “win” and living to an appropriately age!
Have a great day,
Glenn
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