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By now, many of you have likely heard of, or read for yourself, the moving article from The New Yorker, Letting Go, by Atul Gawande. The piece discusses the problems of advanced medical technology and how some doctors prolong life in patients with terminal diseases. The article suggests the advances of medical technology can be a pyrrhic victory. Drugs and intensive care unit interventions prolong life, but not quality of life. People now die in ways that they have not died before, often without dignity, or the chance to say goodbye to loved ones.
The article begs the question: Why are end of life issues so hard to talk about? Physicians avoid what desperately needs to be discussed when working with patients with terminal diagnoses. But psychologists can also fail to discuss what makes all of us so terrified--the idea of death.
Of course, the easy answer to the question is that we are all afraid of death. Understandably, we would not like to have these discussions with our patients. We not only fear our own mortality; we become attached to our patients and do not want to see them suffer or die.
But something more seems to be going on with the cultural tendency to deny the reality of death. Medical technology is seductive, and is a seductress that most of us are willing to engage, even though we can be suspicious of it. The reality is, a terminal diagnosis is likely going to end life. Patients know this on some level, as do we. But the tendency to hold on to hope is pervasive. One way physicians contribute to this dilemma is that they offer hope when it does not exist. A British Medical Journal study of physician's prognostic advice to patients indicated that sixty-three percent of doctors overestimated survival time in terminally ill patients! What can we understand about the psychology of doctors and patients from this research? First and foremost, medical technology has rendered physicians to the position of gods. These "gods," can and do prolong life. This happens in the intensive care unit and it happens when well-meaning oncologists suggest another chance at survival. However, those of us who have worked with terminally ill patients know that these chances at life are but a mere gamble. For example, a common chemotherapy agent for lung cancer, avastin, prolongs life for two months on average. When people have nothing left to hope for, a doctor's suggestion that a treatment might work can be very compelling. But do patients know their options or what their options even mean?
The Gawande article suggests that they may not. And prolonging life is not the same as promoting living with an acceptable quality of life.
Physicians consciously or unconsciously want to be a god, or at least have some sense of hope in the trenches of helplessness that informs their everyday lives. How would it be if you knew that half or more of the patients that you saw every day will die within a few years? I can't imagine. But I can understand the interpersonal need to want to offer hope to those who may have little. Many doctors entered the field to save lives, not to talk about the ending of life.
And as much as we don't like to think about it, we want our doctors to act as gods. If any of us were to have a terminal illness, we would want and demand that our doctors step up and save us. But the reality is, they often cannot, even with all of medical technology at their disposal.
But if doctors were to extend time mindfully, that might be a different story. What if physicians were to offer treatments that provided more time, with the caveat that patients could tie up loose ends and say goodbye to those they loved, and say sorry to those they have hurt? Then this game of medicine and medical technology might be something we can all get behind. But as it stands now, modern medicine is a mockery of how life should end. And we all have a part in how the game is to be played.
