The Heroic Battle Against Death

Doctor's Choice

The government of Canada is debating a “Right to Die” bill at the moment. A certain percentage of doctors are adamantly against the whole idea. We have to wonder why. There are all sorts of reasons: thin edge of the wedge, who protects the helpless, can children make that choice, etc. But I think there is a more basic cause, deep within the ethos of the medical community.

The Battle Against the Great Destroyer

When someone keeps fighting for too long, another interpretation might be that the person doesn’t know when to quit. And that’s easy to do when someone else is feeling the pain.

Medicine is one place where the competitive nature of the human psyche is a great motivator but needs to be kept under control. We notice a whole lot of language in the medical workplace that revolves around images of battle, struggle, and competition. The war on disease, “losing” a patient, and all that. This shows an attitude that may lead to the more competitive doctors to overstep their mandate at times.

Both Parties Suffer

This causes trouble for both doctors and patients. After all, doctors may win many battles, but they eventually lose the war. All their patients will die. This makes a hospital a pretty poor work environment for doctors, nurses and all other caregivers. And it makes warfare a pretty poor metaphor for the doctor’s duty.

Extended Life Attempts

And the worst part of letting this competitive spirit take over health care is when the clinicians refuse to give up.

Oh, it’s all very well, up to a point. We want a team that won’t let us down. (Check the metaphor.) However, there is a point where the doctors must stop trying to keep the patient alive, and must instead concern themselves with helping the patient to die with ease and dignity. Many of us, given the choice, would prefer not to be kept alive through mechanical and chemical processes for weeks or months past our ability to do or say anything about it. But some doctors, caught up in their own battle against Death, would be happy to do this with every patient. In fact, some of them demand that this must be done. They have been so involved in their mission for so long that they have forgotten the reason they started.

Palliative Care for the Dying

This is an actual account, phoned in to a CBC talk show on the subject a few weeks ago.

A woman is in the last stages of dying. She cannot swallow, and all her sites for intravenous feeding are used up. The only choice is to stop trying and allow the patient to die. Unfortunately, this means the patient dies of dehydration, a painful process taking up to 8 days. In this case, at day 6 the woman is exhibiting signs of being in pain. The son asks the nurse why his mother can’t be given a bigger dose of morphine. The nurse says, “We don’t want her to become addicted, do we?”

Good Old Hippocrates

The present ethos of the medical community was created about 2,500 years ago, in a time when physicians did not have the methodology to keep people alive. So they had to try their utmost to do so. Hence the Hypocritical Oath, in which the doctor promises to do the best for the patient, whether the patient wants it or not. Note that Hippocrates lived in a stratified society where some people were seen as more able to make decisions than others. Nowhere in the oath, save for the part about “warmth, sympathy, and understanding,” is there anything about listening to what the patient wants.

We are a bit more democratic today, and it is usually agreed that patients should be making decisions about their own health care. One might be forgiven for being suspicious of doctors that revert to type once patients can’t speak up for themselves anymore.

Because now, with modern medicine, we have the technology to keep people alive much longer. And there is a dark side to that power. We also have the ability to cause people a great deal of suffering and indignity at a time when they are least able to stand up for themselves. If we apply our outmoded ethos to our modern methods we run the risk of doing our clients a great disservice.

What Does the Client Want?

Back in the old days, people basically wanted to live as long as humanly possible. Doctors developed their objectives to accomplish this. I, personally, want to live as long as humanely possible and then die in dignity and ease. I think many modern people want the same.

What the doctors must learn to recognize, because the patient may not be able to communicate it, is when the ability to lengthen life loses importance and when the need for dying with ease and dignity takes over. At the point where those two lines cross on the graph, the doctor has to start making changes in his attitude.

A Win-Win Solution

And this gives the doctor a chance to win all the way. If the objective is to keep the patient alive, the doctor will always lose. If the objective is to keep the patient alive as long as it suits the patient and then ease the death process, the doctor can be successful at both. Thus everyone is as happy as possible in an unhappy situation. The Great Game may be over, but at least we can eke out a tie.

 

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