Wednesday, July 28, 2010

EXCELLENT New Yorker article on life/death issues

It's about time a doctor wrote an article like this. Oregonians have the right idea in having passed the right-to-die law there.  I do hope California will soon have one like it.  Although this essay doesn't address euthanasia, it importantly talks about the often unnecessary prolongation of life with undue suffering of the patient.  It presents end-of-life options, other than continuing with chemo, radiation, intubated feedings, etc. that only prolong misery and suffering.  There is a natural course to life and death -- and too often the natural end course is dealt with as an enemy by the medical field.  In many cases, quality of life needs to be weighed against the cost of a little more quantity of life.
by Atul Gawande

EXCERPT: People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.

Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months
. The lesson seems almost Zen: you live longer only when you stop trying to live longer.