How To Die — The British Way

I cannot resist a well written article on end of life issues.  The NYTimes by Bill Keller offers an example of the British concept of palliative care.  Unfortunately Keller cannot resist politicizing the argument by emphasizing the right wing of the Republican party's discussion of "death panels".  I don't think politics needs to be injected here, the issue is important enough to transcend even that. 
 Death is that unspoken  reality that most of us choose to ignore. And yet we all recognize it is a fundamental to life as night is to day.  Of course we choose not to dwell on a topic which is painful to ponder.  But this constant attempt to sublimate the topic of death only makes it more powerful.  Reportedly, young Buddhist monks in training were placed in a room of decaying corpses for the express purpose of shocking them into the reality of impermanence and ultimate death.  Having faced this truth, understanding life became more potent. 
Even more important than death itself (I'm a bit facetious) is dying.  The process is what is difficult and that cries out for discussion and dialogue.  It is a product of modern medical technology that we can and do keep people alive or "alive" for longer periods of time than in the history of humanity. 
The real question which needs to be addressed is should we and how?  The concept of palliative care is what Keller is referring to.  It has also been described as the Liverpool protocol in England.  But palliative care committees exist in many of our leading medical institutions in this country.  Why not all of them?  Difficult to say.  They ARE controversial.  They do evoke strong emotional responses from patients, families, doctors. 
 Palliative care is often confused with Hospice or with Kevorkian's methods.  Palliative care is not about ending life prematurely.  It is about allowing a natural process to proceed with control of suffering and with dignity when no reasonable medical treatments remain.  Of course there are areas in which many opinions may arise here.  But we need to address the issues squarely and without fear. 
 Enormous amonts of money are spent and "wasted" at end of life.  This is not a harsh or unfeeling statement.  It is fact.  I truly believe billions of dollars could be better spent on the early stages of life, on the health care of millions who now go without, and NOT withhold necessary procedures and treatments for the elderly who could benefit from them.  And I do not believe that age should be a criteria for not providing health care.  A completely mentally and physically intact 100 year old may benefit from a cardiac cath or colon resection despite their age. 
 It should be about the quality of their lives.  And forgive my use of the word.  I understand that term is difficult to quantify.  But let us not decide to ignore this topic just because it is difficult and painful.  It is needed and justified on many levels.  These include religious, ethical, moral, spiritual and financial.  This is one area in which they can all align for the good of individuals, families and society as a whole.

One thought on “How To Die — The British Way”

  1. As crass as it may sound, I think that one reason so many patients and families go into the “keep me alive at any cost” mode is that they can avoid thinking about death. If they were actually paying at least a portion of the medical expenses, I do think they would give the issue some thought. I also have a hard time thinking that we should be investing scarce medical resources on people in their 80’s and older. I also do not think we should be doing transplants of hearts, kidneys and such for people 70 and over, perhaps 55 or 60 and over. There is a time when individuals need to start thinking about the next generation. What baffles me is how many physicians readily administer useless and expensive treatments in the last 6-12 months of life for very old patients. Is it their fear of death as well?

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