Map of life expectancy at birth from Global Education Project.

Thursday, April 02, 2015

Well, Stayin' Alive

In Democracy (which you should bookmark) Diane E. Meier has a review of Atul Gawande's "The Way We Die Now." The irony, if that's the right word, is that the central issue is how long we live.

In 1900, life expectancy at birth in the U.S. was 47.3 years. Alzheimer's, cancer, heart disease, osteoarthritis and osteoporosis, chronic kidney disease, frailty and infirmity -- very few people had to worry about all of that. And if you did get cancer or heart disease or dementia or kidney disease? At least the good news is that you didn't have to live with them for very long.

So our problem is that we have created a new stage of life, a decade or two or more of ever elaborating co-morbidities and physical and mental decline. Not everybody's fate, to be sure. Some of us are fortunate enough to keep the wonderful one-hoss shay together and then just not wake up one morning, but most of us are not. 

Gawande's main complaint is that nursing homes and other services for the elderly are designed to emphasize safety and medical management; but when we're sick and old, we're still people, and environments built with those goals foremost are not pleasant places for humans. We need to stop making a fetish of longevity and instead make life about living.

It seems weird, then, that quantity of life seems to be the highest value, indeed a trump card over every other value, for so many deeply religious people. This position, which to me is ethically inexplicable and just weird, is causing all sorts of problems and frankly, in the long run, it's completely unsustainable. Like burning fossil fuel. But they don't believe that either.


Anonymous said...

I heard him interviewed on NPR a few months back. I agreed with everything he said as I have volunteered for hospice. Most people want their dignity. They do not want to be burdens nor do they want their desires ignored. Families don't talk about wills or dying because it scares them, but then a power struggle can ensue, leaving the patient to suffer. It's like how funerals are truly for the living.
Dr. Gawande's account of the "nursing home" in Massachusetts that allowed their dementia or Alzheimer's patient get dressed and go out with staff for a cocktail at a Chili's or something like it was wonderful.

Daniel said...

Last fall I helped my Mom through hospice in her home. She was 93 and, due to PAD, developed infections in her legs that meant a double amputation or hospice.
My Mom was in the hospital for wound care when she was given the options, but there is one thing I’d like to note. Mom’s family doctor of many years made the rounds in the hospital and talked to her every day. He explained the options to her and the family. How would Mom have dealt with the situation if a hospitalist who she didn’t know told her she could have a double amputation or be discharged because there was nothing else to be done under hospital care? I’m glad she had a more comforting relationship with her doctor. Her end of life at home was no picnic, even with hospice, but I’m glad that I was able to care for her and declined the offers to move her into an institutional setting during those last couple days.

After being with Mom for 3 weeks while she suffered horribly I think there we should have better options. Hospice helped very much, but still there was much prolonged suffering.

Don Quixote said...

Great column!Thank you! Man, this needs to be discussed. I'm sorry, but on this big Christian holiday of Easter, I have to say that I believe Christianity and its perspectives are at the root of so much of the catastrophe that is western "civilization."

Cervantes said...

DQ: No thoughts on Judaism?

kathy a. said...

Daniel, great point about the importance and comfort of having a longstanding relationship with a caring doctor.

When my mother had complications after a massive stroke, a specialist said that if she didn't start eating, we would "have to put in a feeding tube." We had to be pro-active about hospice -- and thankfully we knew that was an option, because nobody offered it.

I'm part of a support group for families dealing with a particularly nasty (and frequently early-onset) form of dementia. One topic recently was "would you have your loved on treated for cancer?" Virtually everyone leaned in the quality of life direction -- these folks have a fatal disease already, many so advanced that they could not understand or cooperate with treatment. Or even diagnostic procedures, like colonoscopies or mammograms.

Don Quixote said...

Well, I don't think any other religion can hold a candle to Christianity in terms of sheer numbers of people killed in its name. Judaism as an organized religion has been co-opted at times by its radical elements, as well; I think religion is fine as long as it's personal. The problem happens when it gets real big and radical factions use it for ulterior reasons. Take the Crusades, for instance. As far as killing on the part of the Jews, I assume you're speaking of present-day Palestine and of the stories in the Bible--but you don't believe those, do you, Cervantes?

kathy a. said...

Dudes, 100 year anniversary of the Armenian Genocide. 1.5 million killed. (Armenians have their own Christian church, and the Ottomans didn't like it.) Which is straying from the point of this post, but since it wandered into killin' for religious or other reasons. and since this is part of my kids' heritage....

Back on point, I really like hospice and palliative care when nature (not religious wars) (or executions, if we are going to talk about killin' on purpose) is pushing someone toward an end state.

Cervantes said...

Well DQ, I'm sure the Hebrews were involved in various wars and conquests, but no, I don't think the Bible stories are necessarily true and I don't presume they were more bloodthirsty than the next tribe.

As for modern Judaism, I think a faction of it took a wrong term in reaction to the holocaust. But that's much more about tribal identity than it is about religion.

Don Quixote said...

Right. Sorry . . . on point again, it seems palliative and hospice care--as well as hospital care--workers are basically forced to do what should be legal, but is not. It makes little sense for people in terrible physical and/or mental shape to go on and on . . . but doctors and nurses and other workers assisting people in end-of-life situations end up administering morphine, etc., as necessary to end suffering. It's kind of like a lot of other things in this country--prostitution and marijuana use, for example--they may be "illegal" but people are using them all the time. The same with end-of-life decisions. It seems we are a deeply hypocritical society.

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