In The Art of Dying, I quote doctors and nurses and experts who all say the same thing: Aggressive medical care, when a patient is at the end of his life, is not a good idea. Some experts said so more strongly than others, but all of them had one thing in common. They were all dealing with dying patients on a regular basis. Their emotional connection to the patient, while positive and healthy, was not so strong as to overcome their professional opinion. CPR, feeding tubes, ventilators and other final treatments should be used sparingly and with great care. In most circumstances, patients and families should have already planned for death and should be ready to accept it.
I still agree with that diagnosis. It makes sense medically speaking–and financially speaking too. A lot of money is spent on people who are about to die. Still, there’s a reason experts don’t like it.
Aggressive resuscitation efforts happen all the time, doctors say, often with patients who are on an unstoppable downhill path. As a result, Dr. Paul R. Helft, an oncologist and director of the ethics center at the Indiana University School of Medicine, said in an interview, “you can walk around any I.C.U. and see patients who are receiving aggressive therapies where the team decided days or weeks ago that the treatments are futile — these patients are not going to be restored to health.” The patients, he added, “have no prospects of leaving the I.C.U. — they will never wake up.”
But an article in The New York Times yesterday argues that before we spout off statistics and professional opinions about who deserves what kind of medical care, we must consider the people involved.
“When health care planners assume that data on the comparative effectiveness of various treatments will improve care and save money, they are missing part of the equation. … “If we don’t think about the emotional nature of our decision-making,” said Dr. Lisa Rosenbaum, a cardiology fellow at NewYork-Presbyterian/Weill Cornell hospital, “then no amount of data will change things.”
Partially this is a question of public policy and economics, which is the perspective of this writer. Underlying the article is the question: “How do we cut medical costs by reducing spending that everyone agrees is useless? The author’s advice is to somehow appease the concerns of family members who may agree, in theory, that such spending is futile but not when applied to their own loved ones.
My response is, of course, not one of public policy but rather of Christian culture. In the past, people simply accepted the fact of death’s arrival. It was a familiar presence, and so they did not need to go to heroic efforts to forestall death. They prepared themselves throughout life for death to come. When it did, they accepted it. Some–including many martyrs–rejoiced when they knew they were soon to meet Jesus. In the 19th century, the dying were sought after for their wisdom. After all, they thought, someone near death was nearer the Lord.
That attitude is too far from our own for us to expect people to immediately return to. Maybe we shouldn’t want to completely return to those ideas. And, with our comparatively low mortality rates, we will never be as familiar with death.
Still, we can re-learn an acceptance of death. To do so is one of the key ingredients to a good death.