Saturday, August 8, 2009

End of Life Counseling

8/8/2009—Since everything in America is partisan, I guess there should be no surprise that end-of-life-counseling has become a pawn in the fight over healthcare reform. But it is a shame that this has happened.

I am now watching the final stage of life of a dear friend of my wife and I see how valuable such counseling can be. My feeling has nothing to do with saving money and resources. It has instead to do with minimal decency in the last stages of life. I have just watched someone who will soon pass away driven forty miles in an ambulance for a transfusion that will extend life only for a very short while.

The context is that the technical capacity of medical science seems to have outgrown the ability of doctors and patients to communicate choices meaningfully. Once a patient’s illness is determined to be terminal, a frank conversation between patient and doctor would begin as follows: it is clear that you will die from this disease in a short time. Nothing we do will prolong your life for more than a few days to a few weeks. And, if we begin treatments, you will suffer more pain from the procedures than from your disease. Under such a course, it is likely that you will end your life in discomfort and confusion rather than in peaceful communion with your loved ones. If I were you, I would just go home now and get ready to die.

Hearing this, many patients would go home. A few would opt for treatments.

Why don’t such conversations happen? Of course sometimes they do. They do not happen more often for at least some of the following reasons. One, doctors don’t like to be candid in this way. They might be wrong about their diagnosis. Or, there might just be a miracle. Patients also know this. But in the instance I am speaking of, no one is even trying to cure the patient because there is nothing to do at this stage. So, whether the conversation happens or not, the invasive procedures that are going on are not even aimed at defeating the disease. The suffering they are causing is pointless.

A second reason is that some people are just not ready to die. They do everything they can to delay it at any cost of their own suffering. Perhaps this is not even conscious. I used to think that secularists would have this problem more than religious people. Now, I am not so sure.

None of this has anything to do with abortion or stem cell research or euthanasia. When the doctor and the patient agree to do nothing but treat the pain the disease is causing, life simply ends naturally. Hospice has done this for years. With end-of-life-counseling, this humane course might be followed earlier and much pain avoided.

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