After generations in denial, doctors and lawmakers are paying attention to
the importance of allowing sick people a dignified death, and to the value of
helping patients and their families let go and say good-bye. Aggressive medical
intervention in terminal cases is increasingly considered an avoidable cruelty,
inflicted on a suffering patient by someone — occasionally a doctor, but more
often a family member — unable to acknowledge the inevitable.
As an intern, I see this almost every day, and I’m grateful that most
physicians now go out of their way to emphasize to patients and their families
the limitations of medical technology. Medical students attend lectures on
caring for dying patients, and medical journals remind doctors of the importance
of letting patients die with respect and, as far as possible, without pain.
But as an experience in my own family made clear, this newfound concern for a
good death can be taken too far during a patient’s final days.
My uncle was diagnosed a year ago with metastatic cancer. Late one night last
March, he became acutely short of breath and was rushed to the cancer center
where he had been undergoing chemotherapy. My aunt called his doctor, who she
said sounded irritated at being awakened at 4 a.m. to deal with a terminally ill
patient suffering from a bacterial infection of the lungs. The doctor’s message
was clear: What’s the point of treating it if he’s just going to die anyway —
if not today, then tomorrow, or next week.
My aunt pleaded with the oncologist not to withdraw care, insisting that even
through his extremely painful cancer therapy, her husband had savored life and
the opportunity to spend more time with his family. The oncologist eventually
relented, ordering antibiotics to treat the pneumonia that had developed in my
uncle’s vulnerable lungs.
I have heard many conversations among physicians about incidences like this
one — often with the doctors expressing frustration that yet another family
seemed unwilling to accept a difficult diagnosis.
Remarkably, my uncle — always a fighter — rallied. After a couple of
touch-and-go days, he recovered from the infection and was soon discharged from
the hospital. Over the next several months, he went to work part time, attended
his granddaughter’s school play, enjoyed a Father’s Day cake and celebrated his
44th wedding anniversary, mugging for the camera while my cousin snapped away.
When he finally passed away in late June, I don’t think anyone would have
questioned the quality of his last few months of life.
Doctors see a lot of death, and it is difficult for them not to become
fatalistic. But if ”facilitating the transition” out of life is to be a skill
for the new physician, this should include not only the avoidance of unnecessary
treatment. It should also require the vigilance to extend life when that makes
sense, always remembering how much living some patients can compress into an
additional day, an extra week, an unanticipated month. I have the pictures to
David A. Shaywitz, an endocrinologist and stem cell scientist by
training, writes frequently about health and science. He is a
management consultant in New Jersey and a member of the healthcare
practice of the Boston Consulting Group. This article originally
appeared in the New York
Times in 2000 when
the author was a medical intern at the Massachusetts General
Hospital and a clinical fellow at Harvard Medical School.
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