Medicine has long had the intuitive goal of preserving life.  It is what medicine is for.  We are historically not the type of people to give up on life.  In our society demographically, lifespans are at an all time high, up from age 40 in 1900 to 79 for women and 74 for men.  Eradication of many childhood diseases through immunization, better care during childbirth, which historically killed one in four women lifetime, and better sanitation have all played a role. 

But medicine and infant mortaility are what have influenced the numbers most.  Death at age 0.0001 years old will pull an average down faster than any long life can pull it up.  In 1900 we had plenty of elderly, but much higher infant mortality.  We have seen a steady increase in the numbers of high risk pregnancies we can salvage.  With this, our ability to support premature birth has steadily progressed.  With the breakthrough of lung surfactant the limits of viability now hover around just 22-23 weeks, just over half of a normal 40 week gestation.  

The truth is we do this with prolonged life support, and at an extremely high cost with diminishing success toward the limits.  15% of the surviving extreme preemies will have a serious brain bleed, 40% will have chronic lung disease.  The question I can hardly wrap my mind around, is there a point where we are doing too much?  Is there ever a time when nature should be allowed to take its course?    

    The disability advocate in me screams no.  Every life is valuable.  I can’t stomach the arguments of the likes of Peter Singer.  I refuse to implement a social calculus like that the Nazis used in advancing their sick theories of eugenics. 

    But the Pragmatic part of me, influenced by training in today’s social climate, hesitates.  Would we drive our economy to ruin in a mad effort to save every last child?  Many, far too many of my peers IMO, are disgusted by the situation.  They become cynical.  They are repulsed by what happens in the NICU. 

     It is a sickness developed by the way in which we are trained, living at the hospital, seeing all the worst case scenarios, and not seeing the long term follow-up and the kids who thrive or do well.  We don’t often find it within ourselves to see through the perfectionism pervading our society, nursing a disdain for the imperfect form.  There is much to be learned by all of us from physical imperfections.  There is a toxic but hidden ableism that can develop in a children’s hospital.

     By and large I like to think of pediatricians as the altruists of medicine.  In large measure we are, but I think this is our achilles heel.  Many, many of us want to deal only with healthy kids.  Although most the subspecialists get past it in order to function.  It takes a lot of faith in humanity and the worth of souls. When I get cynical, the thought of putting a dollar value put on human life reels me back.  It is stomach turning beyond what cerebral palsy could ever be to me. 

    Perhaps more puzzling is what we do at the end of life.  We spend by far most of our lifetime healthcare dollars at the end of life.  We offer mechanical ventilation, artificial feeding tubes to many, many patients who statistically have a very low chance of ever regaining conscious function.  Families often do this with a hope, faith in a miracle.  I am not as sure this fits in with God’s plan.  Death is a natural consequence of life.  We are all too happy to extend it as we can with medicine.  This seems only right and good.  But it seems to me there comes a point where we would be happier, and fill the measure of our creation to a greater degree by moving on. 

   But can’t this lead to the same repulsion?  Can’t we start feeling the same contempt for our elderly that we see in the disabled.  I am sad to say the answer in my experience is yes.  Ageism is alive and well, thriving in our society.

    As quality of life does down, through dementia for example, does the right to life extending treatment go down as well?  Coming to terms with the death of a loved one is an exercise in inventorying what we exactly it is in our life that makes it worth living.  These are profound and trying questions.  There is much maturity and spiritual growth I have seen come in the face of death.

  So I lean toward the do everything at the beginning of life, let people go at the end mannner of thinking.  What about you?  How far do you feel is too far in pushing the extremes of life?

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