Friday, November 04, 2011

Don't Cling to This Life

George Washington University sociologist Amitai Etzioni has an interesting article called "Put the Elderly on Ice?" The title is taken from an Eskimo folk tale which says that elderly people are put on an ice flow and allowed to float away into the sunset, and their death. Etzioni doesn't suggest we should do that (and the Inuit didn't do it either), but does have some things to say about the American way of dying and death.
  • 35% of 80-year-olds will have surgery in the lst year of their life. The purpose: to prolong their already-lengthened life.
  • Some of these surgeries are necessary.
  • Some of these surgeries "reflect our reluctance to accept death or let go."
  • "As the surgeon Atul Gawande put it in The New Yorker: "Our medical system is excellent at trying to stave off death with eight-thousand-dollar-a-month chemotherapy, three-thousand-dollar-a-day intensive care, five-thousand-dollar-an-hour surgery. But, ultimately, death comes, and no one is good at knowing when to stop."
  • Etzioni cites an essay in The New Republic by bioethicist Daniel Callahan and physician Sherwin Nuland, entitled "The Quagmire: How American Medicine Is Destroying Itself." (Years ago I read Nuland's sobering How We Die. If you want some light bedtime reading I'll lend you my copy.)
  • Most of us who will live to a very old age will end badly: "with our declining bodies falling apart as they always have but devilishly -- and expensively -- stretching out the suffering and decay."
  •  A "reasonably full life" is defined as: 70-80 years. It's longer than  for most people on our planet ever hoped to live. After that, geriatrics "should be offered high quality long-term care, home care, rehabilitation and income support, but not extraordinary and expensive medical procedures."
  • Ultimately, age is the wrong criterion for who should have access to life-extending health care. Can one return to a meaningful life? That should be the guideline.
  • "We should learn to accept death more readily; we should stop aggressive interventions when there is little hope; we should provide dying people with palliative care to make their passing less painful and less traumatic."
I find this reasonable, from my Jesus-POV. I have a hope, grounded in the historical Jesus. But for those who do not have such a hope, then this life is all there is, and they cling to it.


Callahan and Nuland write:

"For nearly a century, but especially since the end of World War II, the medical profession has been waging an unrelenting war against disease—most notably cancer, heart disease, and stroke. The ongoing campaign has led to a steady and rarely questioned increase in the disease-research budget of the National Institutes of Health (NIH). It has also led to a sea change in the way Americans think about medicine in their own lives: We now view all diseases as things to be conquered. Underlying these changes have been several assumptions: that medical advances are essentially unlimited; that none of the major lethal diseases is in theory incurable; and that progress is economically affordable if well managed.
But what if all this turns out not to be true? What if there are no imminent, much less foreseeable cures to some of the most common and most lethal diseases? What if, in individual cases, not all diseases should be fought? What if we are refusing to confront the painful likelihood that our biological nature is not nearly as resilient or open to endless improvement as we have long believed?"