Wednesday, October 7, 2015

Matters of Life and Death

Here in California, Governor Jerry Brown just signed into law a bill that gives people the ‘right to die’, ostensibly on their own terms.  But think about it.  The terms are that two doctors have agreed that you have less than six months to live and that the illness that is killing you will do so with extreme pain and suffering.  It is now legal in California to hasten that dying, to shorten the miserable end that is your prognosis.  So, rather than dying on your own terms, I would call this a fearful choice between two heartrending options: actually choosing to end your own life immediately or hoping that your last days will not be a harrowing journey of immense pain, limited function, and being a burden to loved ones.  I find the timing of this legislation fascinating since I just finished Being Mortal, by Atul Gawande, in the past month.


Being Mortal: Medicine and What Matters In The End was published precisely a year ago today.  It is a surgeon’s account of coming to grips with the limits of his profession to make living better for people as they approach the end of their physical existence.  As he discovers in the lives of his own patients and in the life of his ailing father, over-treatment is often more harmful than under treatment in the terminally ill.  Caring families with their
‘safety first’ approach often hasten the physical, spiritual and mental demise of their loved ones by taking away what makes living worthwhile — autonomy and purpose.  Effective health ‘care’ at the end is more about making the moments that remain enjoyable or at least bearable through effective pain management in a setting of familiarity - home.

Too often, the last months of those with terminal illness are spent grasping at yet another round of treatment in the hopes that this will prolong life.  Sometimes it does.  But the weight of evidence is beginning to show that the death most of us will face in an advanced society — of slowly diminishing physical and mental capabilities as our bodies wear out — will come less slowly and with less suffering when treatment is focused on care rather than cure.  Because we all die in the end.

Though still in good health, I can see the encroaching effects of aging.  My children inadvertently remind me that the vibrancy of my youth is long past.  While I hope to have a number of productive working years yet, I can also sense the narrowing of opportunity that comes after investing decades in a particular skill set no longer as in demand as it once was.  Whether I have a less than a decade or multiple decades remaining, this book made me pause and ask: Have I invested my time wisely for the past many years?  Have I shown in word and deed to my wife and daughters what is vital and beautiful and good?  Or have I been deterred from the essentials of real living by the lure of financial security?  When my time comes to release this mortal frame, will I grasp at every possible life-extending option, regardless of how unlikely it is to succeed, or will I go gently and gratefully into the stream of eternity?  

Read Being Mortal for an encouraging prescription for how to prepare for the wearing out of the human body we inhabit.  It is a useful guide both for ourselves and those we love, in a system that knows much about treatment, but often not enough about real caring.  Consider reading it in close proximity with my favorite book in recent memory, Gilead, where author Marilynne Robinson reflects on the themes of aging and eternity in an entirely different way.


Perhaps most importantly, give grace to those whose suffering forces them to consider the awful choice of ending life early.  And live each day with your own mortality in mind, considering how you want to be remembered by those you will leave behind and those you will join on that mysterious other side.

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