A recent article by Jane Gross in the New York Times science section again touched on the issue of end of life treatment.  Whether an elderly, demented or end-stage cancer patient is subjected to a battery of tests, treatments or resuscitation  often falls into the hands of the treating physicians.  This occurs despite the 'living will' or health care mandates of particular individuals which clearly states that such treatment is contrary to their wishes.

It seems to me that my fellow physicians need to take classes in the great metaphysical issues–the nature of life, of death and the role of the physician in the process. The process should begin in medical schools but needs to be updated for those who actively take care of patients, who practice in the real world.

 We are trained to treat, not withhold treatment.  We are programmed to diagnose, to combat the enemy of disease, and never to admit failure.  We are also paranoid about failure to successfully defeat death.  The specter of malpractice law suits has permanently scarred our collective psyche.

My colleagues need to discuss these issue from a new perspective–one that combines philosophy, ethics, spirituality, religion  ie–a metaphysical approach.  But their efforts cannot possibly succeed without society as a whole facing these same issues.  End of life discussions are always difficult and painful but until we see them publicly debated and discussed on Oprah's show, in houses of worship and between individuals in their private lives, change will not occur.

Despite our individual differences, I believe an open forum will allow us to narrow such disparities.  'Allowing' physicians to withhold unnecessary and expensive testing and treatment to patients at end of life must be validated as the humane approach.  Society needs to re-explore the nature of life and death, to accept death as natural and unavoidable and to extend to our loved-ones the gift of a peaceful transition.

Our entire death-denying culture is as much to blame for physician's responses as anything.  We need to allow fear to be replaced with compassionate realism.  It will be healing for us all.

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