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?
7 comments
Comments feed for this article
February 20, 2008 at 9:04 pm
disillusioned
Wow ! I so love you’re blog. I’ve been searching and searching for it! And from a doctor! Wow–I can’t even tell you.
Well–I have some interesting thoughts. Having a niece and nephew who are only in this world because of life saving efforts in the NICU and children’s hospitals–I think that many efforts should be made to sustain life. Having a nephew who also has a chronic illness, that is truly understood by VERY few subspecialists–and seeing the horrible attitude displayed by many toward my family members, as they’ve tried to just seek treatment for my nephew–I would have to agree with you on what you said.
How long and how much should we sustain life? Well, that’s a really good question. It’s been amazing to me through the years that, for the most part, I’ve fought for life. From Terry Shiavo (sp?) to embryos–I am so incredibly pro-life. Perhaps it is because of years of study at a very young age compared to many–into Hitler’s reign of terror, the effects of eugenics, and what occurred (and still can occur) in this country.
But, at the same time–I am not for the perfect life that the Opposition so pushes the world to demand. We were never promised perfect. When we raised our hand to come here, we did so knowing that life would not be perfect. That we had to experience opposition! I am appalled by the high rate of abortions because of the push for genetics testing before birth. I love people with disabilities–and truly believe that “fixing” is not what we came here for.
But, as you said–when my grandfather, after 25 years of having Parkinson’s–tried to grasp the last “straw”–tried to convince everyone that he was going to fly to California for brain surgery–I knew that, although I truly respected his right to life and to choose his treatment, that he would never come out of a surgery like that “better”. As he fought and fought and fought–for years, to stay alive–there were days I just wanted to say “Grandpa–let go!” Although I appall eugenics at any age–prayers that he would “let go” were said–often.
I don’t know what the answer is, per say. I do agree that many in the medical field do not see the results, as much as they see the torturous goings on within the hospital. I have seen many of their results–children whose lives were saved. And it’s all so amazingly good. These children turn into teenagers, and adults–most of whom have successful lives–even if they are not able to “function” like those of us who seem to think we’re “normal”.
All I know, is that it all seems to revolve around “letting go”. I think you’re so right! It’s all up to turning will over to the Lord–doing what we can–within Spiritual wisdom (too bad not everyone pays as much attention to that!), giving people the dignity to choose, and knowing that supporting life is better than promoting death–while still recognizing that death is a part of life, and that part of being a physician, a family member, a friend, and so forth–is supporting people kindly through this part of life! Anyway–those are my thoughts–as unhelpful as they may be.
February 20, 2008 at 10:13 pm
Doc
Disillusioned,
Thank you for the comment. We Doctors aren’t always such a bad lot once you get to know us ;-). It is a tricky balance. I haven’t really figured it out yet. On the Child side, I’m obviously biased, but that certainly doesn’t mean I’m wrong. Check out the physical imperfection link to the SOF podcast I left on L’arche. It is powerful. I learn from physical imperfection as much as from my spiritual imperfections.
I think most of us recognize there is a natural end to life and such thing as a life well lived, but we have been somewhat successful pushing that further away. The transhumanists would say go for it, science is here to make life better and longer. While obviously, by my choice of profession, I think medicine is a good thing, I really haven’t figured out where we should draw the line. I do think we no longer seem to know how to die with dignity in this country. Hospice taught me that it can be a powerful, moving and even spiritual experience, every bit as much as birth.
February 21, 2008 at 3:23 pm
Lincoln Cannon
Death is not good. It may be natural, but much in nature is not good. As Nephi described it, death is an “awful monster”. Jesus said the three Nephites were “more blessed” than the others because they desired to continue on with the work without dying. Joseph F Smith said the post-mortal dead looked on the absence of their bodies as bondage. The gospel of Christ is about overcoming death and hell — not embracing them in a Freudian death drive. To the extent possible without committing greater crimes, we should be combatting death with the means God has provided. In time, I imagine, the prophecy will be fulfilled that children will grow and live to the age of a tree, and then, not dying, be changed in the twinkling of an eye. I look forward to that day of transfiguration.
February 21, 2008 at 9:37 pm
Doc
yes but the overcoming was done by the Savior. This is part of the atonement. It seems to me you are wanting to bypass that and rely on the arm of flesh. I am going to leave the resurrection up to God. I’ve got too many smaller lessons to learn first.
February 21, 2008 at 10:50 pm
disillusioned
I never thought of the “more blessed” as pertaining to the fact that they asked not to die. They did still physically have to change–and the only way that could occur was if their physical body literally died. It just happened in a “twinkle of an eye” rather than through the normal physical progression of death. And, as I remember, those whom Joseph F. Smith said considered the absence of their bodies as bondage were mainly those who had “died in their sins”. Those who have taken advantage of the Atonement while on this earth, and repented (which is the purpose of this life), and learned to turn their will over to the Lord may not have been who he was speaking of. But, yes, we certainly will desire resurrection. Because the physical and spiritual were meant to be united. But, I for one have been blessed with the peace of seeing a family member or friend who has been suffering for years “lay down the ghost”. It certainly doesn’t mean death is pleasant–but life is not always pleasant either. I believe JF Smith described spiritual prison and spiritual paradise as 2 different things and places–and I know that one has been described as a “peaceful rest” from the cares of the world. I personally am working for that peaceful rest.
February 22, 2008 at 6:41 pm
Lincoln Cannon
Doc, I agree that the overcoming is done by the Savior in the atonement. However, we are clearly called to join Jesus in that work and become, as Joseph put it, the “saviors of men”. According to Paul, we become joint heirs with Jesus only “if so be that we suffer with him”; indeed, “Christ in you” is the great mystery, Paul taught. On at least one occasion, Joseph taught that transfiguration is an ordinance, and Brigham repeatedly taught that resurrection is an ordinance, which would be performed not only by Jesus.
disillusioned, they were not more blessed only because they didn’t want to die. They were more blessed BOTH because of how they wanted to live AND because they didn’t want to die. The other disciples clearly wanted to live in the same manner, but did not ask to continue living beyond the current natural lifespan.
February 22, 2008 at 6:49 pm
Lincoln Cannon
Doc, I have to add, too . . . 🙂
You can’t get away with the old “arm of flesh” bit. When we send missionaries out, are we relying on the arm of flesh? When we send food to poor countries, are we relying on the arm of flesh? What about when we send aid to disaster zones? How about when we call persons in our neighborhoods to be scout leaders, compassionate service leaders, home teachers, etc.? Is all of this relying on the arm of flesh? Of course it isn’t.
Why? Because we know that none of this would have or will amount to anything if, by the grace of God, we weren’t maintained from moment to moment in existence and provided means whereby we might act. Grace is essential.
. . . and so, for our mutual salvation, are works.