Note: Atul Gawande and his book will be featured on a Frontline episode airing on PBS tonight.
We’re all going to die. (There’s nothing like starting on a positive note! ) We’re all going to die, and if we are fortunate enough to survive long enough to become old, we’re all going to experience a decline of one sort or another before we die: reduced hearing and vision, less strength, poorer memory, etc. As a society, and as a medical profession, we have been reluctant to confront those issues head on. Dr. Atul Gawande faces them unflinchingly in his thought-provoking new book Being Mortal: Medicine and What Matters in the End.
In a simpler time, there were fewer old people; they were respected for their knowledge and were cared for by their families who supplied their increasing needs as age made them more dependent on others; they died at home surrounded by supportive loved ones. Today we warehouse our elders in nursing homes, where they are denied the independence of even making simple everyday choices like when to get up and when to eat. We consign them to a regimented, less enjoyable, less meaningful life; and they frequently die alone in hospitals, connected to tubes and machines.
Doctors are not always good at making it clear to terminally ill patients that they are going to die soon. They are not always good at discussing end-of-life issues and securing advance directives. They often treat end-of-life diseases so aggressively that they end up causing more suffering or even shortening lives. (more…)
We all seek immortality in some way. Death has been one of the prime terrors haunting us since humans first started realizing that every living thing dies and death is permanent. After all, no one wants to face the end of everything that one has been, is, and will be. Indeed, a key feature of many religions is a belief that death is not the end, that there is an afterlife where we will all live forever. In some religions, in the afterlife evil is punished and good rewarded. Even if, as seems most likely, death is simply the end, and the time after death is just like the time before we were born (or, more properly, before our first memories), something that seems relatively benign just thinking about it, emotionally we still don’t want it. Being human, I get it, particularly now that I’m on the wrong side of 50 and, unless I’m far more long-lived than my genes are likely to permit, have considerably less life to look forward to than the lifetime I’ve already lived. I also realize that the number of people who are remembered long after they are gone by anyone outside of their family and friends is exceedingly small—and even that memory fades rapidly among family members. As the succeeding generation dies off, direct memory of the generation that spawned it disappears. I get it. Fifty years from now, it’s likely that all that will remain of my existence will be some scientific papers and a faint memory held by my nieces and nephews and maybe, if I’m lucky, a few of my youngest readers.
I don’t, however, get cryonics.
Detroit, like many large cities, has a free weekly “alternative” newspaper, The Metro Times. This week’s issue features this cover:
Science isn’t the only game in town. Literature can teach us things about the world that science can’t. It can give us vicarious experience and insight into other minds. Two recently published novels illuminate why perfectly rational people might reject the help of scientific medicine and prefer to die a little sooner but to die on their own terms. (more…)