It has been just over one year since I offered several postings on ‘end of life issues’.  This topic will not only not go away, it will continue to grow and fester in the public subconsciousness. I use these words advisedly because as long as we as a culture continue to refuse to address the end of life issues, they will continue to mushroom and produce massive dislocations in our personal lives, contribute to exploding health care costs, and impact the greater economic and social aspects of society as a whole.

The family member who is advised to have a feeding tube  or more technically a percutaneous endoscopic gastrostomy [PEG] is faced with a painful decision compounded by feelings of uncertainty, guilt, dismay, shock and utter confusion.  This decision is often compounded further by disagreement among close family members and lack of direction from physicians.

I do place a considerable degree of blame on my colleagues who are unable or unwilling to openly and honestly discuss the pros and cons of these decisions with families.  It requires that they step down from the detached place of diagnosis and treatment. It requires that they speak to families from a place of their own vulnerability, their own humanity.  This is difficult at best and most physicians are as uncomfortable with it as the rest of society.

  With our ability to maintain our citizens well into their 80s, 90s and 100s despite their unavoidable deterioration, these issues will only become exacerbated.

I would call on all our society’s ‘thought leaders’–from Oprah to religious and spiritual icons.  Our politicians, as well,  need to step up to the plate, despite the controversial nature of the topic.
There are economic issues at stake here as well. With limited financial resources, we need to be able to make choices on how we allocate and spend our money.  Providing unnecessary and unhelpful health care services to those at end-of-life deprives our truly needy and viable citizens.

‘End of life’ issues offer our society a powerfully unique opportunity in which doing what is metaphysically and spiritually ‘right’ is consistent with what makes sense economically as well.

We need to face the truth that it is not always wise, compassionate or spiritually enlightened to maintain a life which is unavoidably and inevitably winding down. On the contrary, it may be just the opposite.  To prolong a life which has no dignity or quality is to promote the suffering of that person we hold most closely to us. To inhibit the process of dying because it would be painful for us, the living, to ‘lose them’ –is paradoxically selfish and unloving.

Let us provide answers to the patient’s family who asks ‘so my mother needs a feedings tube…..?’ with at least an open and honest discussion and dialog.  This is the very least we owe to ourselves and our loved ones. 

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