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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.

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3 thoughts on “Futile Medical Care–It Depends on Who’s Being Cared for

  1. There’s a lot that could be said here, but for me, one thought is prominent now and I’ll share that. I find spiritual and practical value in using lige’s moments of loss as a rehearsal for death: my own and the death of those I love. I’ll give you an example. My grand-mother is 92. She lives independently and is cognitively, emotionally and spiritually strong. She had a double knee replacement a few years back that has allowed her to be very mobile. Up until last year, she was also driving, until she had an accident one day. Fortunately, it was a one-car accident. She wasn’t hurt. Neither was her car. The doctors think she had a mini-stroke at that moment, and consequently, strongly recommended that she no longer drive.

    This is a huge loss for her. An it is a loss for my parents, who live a few blocks away and now need to drive her everywhere she needs to go, even though she seems very healthy and independent. And when it happened, I cried. Not a cry of desperation or deep sadness or longing. Just a cry that says, “Yup, it’s coming. Some day, Grandma will no longer be with us.”

    One of these days, I’m going to get the call from my Mom that her Mom has gone to meet her Lord. I’m hopeful that I’ve spent years letting go and it won’t be quite so shocking or so painful as it might be otherwise.

    Thanks for the food for thought.

  2. That’s why Donne preferred “a preparing sickness”. He and his contemporaries knew it was better to have some time to get ready. They found sudden death very troublesome.
    We need that time to prepare ourselves. I think that’s why we need to have the right attitude when using medicine. Of course we want to offer relief of suffering or even extend life. But if those possibilities act to prevent us from using the time we have to prepare ourselves–either for our own or a loved one’s–death. Then we haven’t used the time or medicine wisely.

    Thanks for your comments, Jennifer. Would you want to write something on these topics based on your experience?

  3. Pingback: This Week’s Top Five Reads « Exploring the Art of Dying

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