First of all, let me reassure you all that I am not (to my knowledge) dying of anything at this time. I just had a physical and a bunch of tests and they all came back clean, so rest assured that I’m not writing this in anticipation of pending departure.
I am writing it because of an article I recently read about how doctors die, and how very often they make different, truly informed choices about their end-of-life care. That many times doctors will choose not to undergo invasive, painful treatment that has small hope of success and will, instead, choose to live out the remainder of their lives in quiet dignity, enjoying the time that they have remaining with their family and friends.
What a pity that more people aren’t counseled toward that option. Even more, what a pity that the families of the terminally ill aren’t supported in helping their relative make a choice that will allow them to retain their dignity and reach the end of their lives in a manner that is loving and positive.
Modern medicine has made amazing strides, and certainly I’m not scoffing at the notion of continued research toward effective treatment and cure of diseases like cancer. And I’m not saying that people who hear the “C” word should immediately update their will, make their funeral arrangements, and lay out their burial clothes. There are many cases where treatment is worth trying, and each patient should be fully informed of the treatment options and the likely prognosis.
But there comes a point when treatment is less about the patient’s quality of life and more about the doctors making certain that they are safe from accusations of malpractice. When doctors offer patients treatments that they wouldn’t accept themselves and to which they wouldn’t subject their own family members. And it’s hard for them to say, “you should consider stopping” because there is that one-in-a-fifty patient who does respond to this particular therapy, who does get better. No one can tell for certain who will be the lucky one who grabs the brass ring, so how can one counsel a patient that the horrible side effects of this particular treatment are not worth the small chance of winning the treatment lottery?
We want medicine to be better than it is. We want medicine to be miraculous in its ability to save us. We live in a world where we have overcome most of the diseases that used to kill us in childhood, where a minor wound doesn’t present a serious risk of fatal infection, where a fever is unlikely to run out of control and damage our brains.
But we all still die. We don’t do it with the regularity of the past–discounting accidents, we don’t die in our youth or young adulthood very often–and we don’t do it in our homes, among our own relatives, at least not usually. Thanks to the hospice movement, more of us are dying at home, but frequently not until our dignity has been shattered into a billion pieces and hospice is a method of trying to scrape back together some of that dignity and make some peace with the pain and anguish that would otherwise be our last memory of our loved one.
This is still not a very gracious way of reaching the end of our lives.
I hope it’s a very long time before I have to make these kinds of decisions, for myself or for anyone else. I hope, really, that when death comes it is swift and painless. But if these decisions become ones that I have to make, I hope that I will make wise ones. Almost a quarter of medical expenditures in this country are made in the last year of life, and most of those expenditures have little impact on the final outcome–save to make that last year of life a sad, painful, miserable journey that leaves the grieving family with painful final memories.