Are you a maker of new year resolutions? Even if you are not, I hope that you will resolve to do the following: read the essay by Atul Gawande that appeared in the August 2, 2010 issue of The New Yorker magazine titled “Letting Go: What Should Medicine Do When It Can’t Save Your Life?” Gawande is a staff writer for The New Yorker, a Boston-area surgeon and the author of Being Mortal: Modern Medicine and What Matters In the End (2014). In fact, I feel so strongly about this recommendation that I am reproducing the article which I will be happy to send you by e-mail. Hard copies will also be available in the Ament Lobby outside Goode Chapel. And once you have read it, share it and discuss it with the people closest to you, the ones who may one day be placed in the challenging position of making medical decisions on your behalf.
Yes, I know…it’s a four-year-old article but it just recently came to my attention and I read it with a mixture of sadness, painful recognition and profound wonder and dismay at just how skewed our medical priorities have become in this country. Huge numbers of us, as a consequence of fatal diseases or the failures of bodily systems that often accompany old age, end up experiencing precisely the kind of death that, in our lucid and thoughtful moments, we know we do not desire: in ICUs, connected to ventilators and multiple tubes, undergoing countless tests and procedures, experiencing the indignities of modern medicine long beyond the point when healing is a possibility.
My work not infrequently brings me into contact with families agonizing over end-of-life decisions as their loved one lies unconscious or sedated beyond reach. And because that person never found the time, the right words or the right opportunity to convey to family what he/she wanted–or , more importantly, did not want–to have happen as life spiraled down, what often results is a death none of us would desire and which is a major factor in skyrocketing healthcare costs.
As physician/writer Gawande relates, for all but recent history, dying was a brief process. In our age, the advent of antibiotics, diagnostic techniques and sophisticated interventions has meant that death–The Enemy–is kept at bay in many cases, extending life-spans and enabling individuals to step back from the brink. But there are always situations, especially with terminal conditions brought on by certain cancers or advanced heart disease, when modern medicine offers interventions that do little to extend life and which seriously compromise the quality of life that an individual might hope to enjoy until claimed by death.
Gawande is quick to acknowledge that precious few physicians are prepared or equipped to engage their patients in the kinds of discussions that might lead to meaningful and helpful end-of-life decisions. All too often physicians are afraid of destroying hope even when they are well aware that such hope is unwarranted and is interfering with the possibility of a patient’s living out his/her remaining days with appropriate palliative care and support.
The silver-lining in this dark story is the role that hospice is capable of playing, especially when its services are introduced in a timely manner and not just in the last days or weeks of patient’s life. Studies have shown that when patients with a terminal diagnosis enter hospice care sufficiently early, they enjoy a superior quality of life, better management of pain and discomfort, fewer hospitalizations (and fewer expenses as a consequence) and, often, the opportunity to have their lives end in the comfort of their home. Moreover, long-term studies demonstrate that the family members of those who die under hospice care experience a much healthier grief, unburdened by guilt at having chosen medical interventions that caused their loved one to suffer and which did not appreciably extend their loved one’s life.
An advance directive, in which you answer some specific questions about what you would, and would not, opt for in the event of your hospitalization, can be a precious gift that you can give to the people you love who may well be the very people burdened with the terribly hard decisions that often accompany terminal or serious illness.
In seminary, back in 1983, I wrote my rabbinic thesis on Jewish perspectives on hospice care and my eyes were opened to the ways in which Judaism has, for millennia, struck that fine balance between belief that all matters of life and death are in the hands of God and an awareness that there is no inherent virtue in unnecessary suffering. Hospice care is fully compatible with Jewish values.
Most of us shy away from uncomfortable conversations, especially when they touch upon our own mortality of that of the people we love. But I am confident that virtually every one of us has horror stories to share about agonizing deaths and inappropriate decisions to try to prolong life at the expense of a person’s most basic well-being. So let us resolve, my friends, to bless our loved ones with the gift of dialogue about the most fundamental and important of subjects…life and death and how we wish to live until we die.