This week I am contemplating several ideas about how we relate to living and dying. Especially as to how this is played out in the direction our healthcare model has been evolving. Underlying this evolution is the drifting away from the original purpose of medical care – the alleviation of suffering and the duty to cause no harm. Somehow we have moved to an orientation that sets death against life, with the ultimate purpose of avoiding death at all costs, regardless of how this affects quality of life, creating more suffering and harm.
At a philosophical level, our model has become grounded in the concept that life and death are polar opposites and that life is always the best choice; death is always the last resort. The current debate about physician assisted death in cases of terminal illness represents a challenge to this thinking. It is very polarizing and very difficult for many to understand. How can it ever be a better choice to die?
One of the roots of this thinking is in our cultural ground. We fear death. We love life. We also fear life, and this is acceptable in our culture, yet it is alien to consider that we might love death. We have laws that prevent a person from taking their own life. If someone is despondent and feels that there is no reason to live, it is our duty as a society to prevent this death and “treat” this person to bring them back from the brink. Even if this treatment means using higher and higher doses of medication that prevent the person from feeling anything and delivering a fractional quality of life for the person. At least it is a life versus a death. Are we sure there is no harm in this? Or are we prolonging the suffering of the person when we prevent a death that may be the best choice? I am not advocating allowing anyone with depression to choose death as a healthcare policy. I am asking a question about how we have come to this position and whether we may need to take a closer look at how we got here.
One of the other roots of this thinking is in our “scientific” dogma. As our science progresses with the strong focus on measuring the quantifiable, and the minimal focus on those things that are not easily quantified, we have built a body of evidence that is skewed toward a worldview that may not best describe our actual experience. This is a valid critique of science and medicine, regardless of how heretical it is seen to be. A mechanistic orientation toward medicine has set the trajectory of evolution toward ever more complex pharmaceutical and surgical interventions. If the machine is broken, we can fix the machine no matter what it costs. As long as the machine continues to function and operate, we consider this a success. Yet we do not ask how much is the machine suffering as it continues to function and operate. And when we do ask, we do not consider the science as valid because how can you quantify pain and suffering? And why should pain and suffering be considered when we choose a medical intervention? As long as life is victorious over death, it is worth it! The ends justify the means.
I could go on with many examples of the ways that our current medical model is choosing “life” over “death” in ways that reduce our quality of life, and increases our pain and suffering. The entire disease management model attacking lifestyle that produces chronic illness is one of the areas that need to be looked at very closely. We assume that everyone will be happier if they are thin and fit, yet if the lifestyle that is required to reach that objective is counter to the personality of any individual, we ostracize that person as someone who is unable or unwilling to make the change that is needed to achieve the goal. Our culture is overflowing with this message at this time. We have created a culture of stigma toward the obese, toward smokers, toward the sedentary, and toward the fast food lovers. We will punish these people relentlessly if the work for a corporation that ties their lifestyle to healthcare benefits. How have we attained this orientation with all its negative perspective toward people who would just like to be left alone? This is complex, and I do not mean to be simplistic. There are many considerations. We do need to think about how much we have pushed whole classes of people into marginalized and stigmatized status in our culture.
A couple final comments here: First, the medical system needs to have sick people who are afraid of dying. This justifies the development in the pharmaceutical industry and the specialized medical intervention industry. How many bypass surgeries were performed last year? Before this surgery was developed, people typically would die once their heart was damaged to that point. In the crusade to prevent death from happening, we developed the surgical intervention that kept the machine alive. And then we prescribe a regimen of expensive medicines to prevent further damage. We also prescribe a lifestyle change that may be the furthest thing that the person ever considered in their definition of a “good life”. “Don’t you want to keep living?” we ask the person. Is life worth living if you cannot enjoy it? If the masses were not indoctrinated into the culture of fearing death and avoiding death at all cost, would we have a market for bypass surgery and the medications that are prescribed post-op?
Second, a life worth living is a very personal thing. It is not quantifiable. There is no science that can tell us what this is. Each person makes this determination for him or herself. For some the choice would be to live a life that is “healthy” and that may extend longevity. For others the choice may be to live a life that is “not healthy” and that may limit longevity. What we can see in the world around us is that there are individuals who live extended lives and have not had a “healthy” lifestyle at all. And there are those who are living the “healthy” lifestyle and they are dying at an early age. There are always exceptions in the statistical data that we base all of our science on. These “outliers” are usually removed from the data to smooth out the results. We justify the removal of outliers in statistical methods, yet maybe it is the outliers that have something to tell us that we need to know.
And finally, I would submit that there is a more powerful and basic factor at play. If we live a life that is based on fear of death, if we exist in a culture that is driven by the perspective that it is necessary to do everything to defeat death and preserve life at all costs, if we are all driven by a life of fear rather than a life of love, can we consider this as a “good life”? If our entire medical model is grounded in this fear and if our society and culture creates the expectation that we are to structure all of our institutions out of this fear, are we bringing the possibility of a “good life” to our world at all? Once again, I want to emphasize that I am not suggesting that we simply stop providing medical care and let people die every time there is a life threatening situation. What I am asking is “Are we sure that the reasons we are doing what we are doing are the reasons we really want to use for these decisions?” What would happen if we adjusted our thinking to one of more acceptance of death as a natural stage in our life’s process? It is something to think about.
Thank you all for reading this week. I believe this week’s topic may be slightly controversial and could promote some debate. If you do have a comment or any feedback, please log in on the WPC site and reply to this post.