Saturday, September 4, 2010

Fight or Die?

I ran across this article at one of my regular blog-stops, Building Cathedrals. It discussed the realities of aggressive medical interventions at the end of life, from a nurses point of view. She wanted to make the point that sometimes palliative care or hospice care is the best choice. Sometimes, of course, hospice may be the right answer; and sometimes, when people are so intent on fighting a disease, when they go into battle mode (an attitude toward illness that is always considered virtuous in our culture) then the patient can become the battlefield. Red, at Building Cathedrals makes the point that our culture fears death so much that we run the risk of relying too heavily on institutions and interventions. In this way the patient misses the chance to face death and accept it.

Death is not pretty, and doesn't look dignified. But, with faith, it can be beautiful. My father died in January of this year. I couldn't be there, but the rest of his children and my mom were there, and I witnessed his death through their eyes and ears. It was tough, but he faced it. He knew it was coming and accepted the consequences as well as one can when only semi-conscience. Months earlier he was under the care of hospice, but they had a hard time keeping up with him. Between running errands, painting the house and "hitting a few golf balls", he struggled to keep appointments with the hospice nurses. My initial fears when Dad left his regular doctor's care and went under hospice care was that he would give up. I worried he would stop fighting, and then stop living his life. And he did stop fighting, in fact he turned down experimental treatments because they required him to come off of his pain meds and he knew the medication was helping to keep him active.

He stopped fighting the cancer, and he chose to live the rest of his life as best he could, preparing for his death practically and spiritually. He wasn't in battle mode. He was in acceptance mode: though not without fear and uncertainty, he was joyful and he was Dad...taking care of things as he always did.

The article really made me think through those last days that my Dad had, my initial fears about what Laura Ingraham calls the "hospice shute", and the general fear of death and dying that we have as a culture. The nurse in the article seemed to want doctors to lean more towards palliative care and less towards aggressive treatments. I understand her concern, but I am not sure I want doctors being the ones to decide when it is time to stop fighting. It is not their responsibility to decide when to get out of battle mode. It is their job to be honest, and realistic with their patients; to not give false hope; to make sure basic needs are taken care of (such as food, hydration, pain relief); and then to proceed with the treatment, or lack of treatment that the patient desires. The patient then is limited only by his resources....which becomes the real difficult issue, doesn't it?

We have a hard time with the idea that a person might not get to have the most cutting edge, aggressive treatment because they simply can't afford to pay for it. We want everyone to be saved from cancer. While that is a generous sentiment, it ceases to be virtuous when we then expect government to pick up the bill. Government can only provide equal care to all by taking money from those who have it and redistributing it to those who don't have enough. This necessarily puts "health care professionals" in charge of who gets to keeping fighting and who must give up the battle.

We may have a culture that fears death too much, that doesn't allow people to die "with dignity" (whatever that means), least until Obama care kicks in... it is our individual right to make that decision, mistake or not. I, frankly, prefer it that way.

1 comment:

  1. I always enjoy reading your insightful posts. When reading about your dad's final months, I was thinking back to my dad's of course. In some ways, I think they are fighting in a spiritual mode. Accepting their future, or trying to accept, while preparing to battle their souls into Heaven.