This article is another adding to the discourse about all of the unnecessary care the medical community is giving these days.
We’re having trouble coming to grips with the understanding that our ability to perform a certain treatment or provide a certain type of care doesn’t mean we should perform or provide it.
Just because we can prolong a life doesn’t mean we should.
“If people were more informed about their options, they wouldn’t want a lot of the ‘medical care’ that they end up getting in our hospital system today.”
The American approach to death in the past century has followed an arc not unlike our approach to food. One of the most common pieces of advice given by nutrition experts today was coined by Michael Pollan: “Eat food. Not too much. Mostly plants.” But amid war and scarcity in the early and mid nineteenth century, producers flaunted triumphs science in food processing and preservation—in their capacity for synthetic tastes, bright colors, and infinite shelf lives. Wonder Bread, Tang, Spam, Velveeta, perfection salad, and Twinkies were created not because they should have been created, but because they could be created.
It was decades later that the the “real food” movement supplanted the virtue of processed foods, favoring anything natural (or at least appearing to be of nature). Part of that shift was due to advances in agriculture and transportation making natural-food access possible, but an even larger part was consciousness of nutrition and health. For many people, the central questions of consuming food shifted away from “Can we?” and toward “Should we?” Nearly in step, those were the questions facing doctors in a culture that tended to pursue invasive measures by default, for patients near the end of their natural lives.
The dilemma of modern medicine, in the era of tremendous medical capabilities—when almost any person can be kept alive well past the point when they would have otherwise died (and, in some cases, after they did die)—is, when are health professionals missing the point? When does care become, to use the word Volandes and Gawande do in their lived stories, torture? Because it is a very rare case now, when there is nothing more that doctors can do.
In recent years, the trend has slowly begun to reverse. Since 1990, more and more Americans have died the way they wanted. By 2010, 45 percent of Americans died in hospice care—most of them at home. The rates, among the highest in the world, are what Gawande calls a “monumental transformation” away from a “miserable” system perpetuated by tradition and familiarity. But this remains, he believes “an unsettled time.” In our 21st-century approach to dying, “We have begun rejecting the institutionalized version of aging and death, but we have not yet established our new norm.”
“[Doctors] think our job is to ensure health and survival. But really, it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive.”
The Fallacy of ‘Giving Up’