Our culture is in denial about death. Too often we view death, not as life’s natural conclusion, but as a medical failure. Medical miracles lure us to the false belief medicine can prolong life indefinitely. This unrealistic attitude about death’s eventuality can lead to choices in care that impair rather than improve the end of life.
We want to do all we can for failing loved ones. But our distorted approach to death often leads us to opt for medical treatment and procedures, not from compassion, but to assuage guilt or satisfy our compulsion to take action. We may submit them to a strenuous regimen of treatment which rather than being restorative makes matters worse. Then, instead of doing everything possible to help Mom, we put her through the wringer instead.
Two groups influence aggressive care: (1) health care professionals who are overly zealous, careless or entrepreneurial; and (2) family members who cannot let go of the loved one.
The Physician’s Perspective
In an op-ed piece in the Wall Street Journal, titled “Our Unrealistic Attitudes about Death, Through A Doctor’s Eyes,” Craig Bowron, M.D., emphasizes the family’s role in increasing the elderly patient’s misery through insistence on aggressive treatment. Dr. Bowron attributes our culture’s denial of death to two factors: (1) medicine’s advanced technology which fosters the false impression that old age is a reversible condition; and (2) a lack of exposure to decline and death brought about by family members living too far apart to witness their parents’ and grandparents’ aging.
Dr. Bowron opines that few experience the process of dying directly. He stated: “With unrealistic expectations of our ability to prolong life, with death as an unfamiliar and unnatural event, and without a realistic, tactile sense of how much a worn-out elderly patient is suffering, it’s easy for patients and families to keep insisting on more tests, more medications, more procedures.”
To illustrate the anguish health care professionals experience when they feel pressured to perform test after test and procedure after procedure because families cannot let go of their loved one, Dr. Bowron quoted a retiring nurse, who told him, “I am so glad I don’t have to hurt old people anymore.”
The Family’s Perspective
Physicians can be guilty of ordering procedures that, not only do not benefit the declining person but destroy quality of life completely. This can happen for a number of reasons: (1) The doctor was overly zealous; (2) Communication broke down between consulting physicians; or (3) the tests and/or procedures were ordered because our system rewards doctors who perform procedures. Families often never know which reason was the culprit.
Here is a case in point. This year, my father-in-law, 92, had several cancers excised from his ears. These surgeries were followed a few months later by a more complicated removal of lesions in his neck. When his doctor discovered these, he made referrals to a neck surgeon, an oncologist and a radiologist. The surgeon removed neck lesions. Three days after this surgery, the surgeon informed him another spot on the neck required yet another surgery. He endured this as well. Too weak to sustain the radiation treatment he was advised would be required to keep the cancer from returning, he was sent to rehab to increase his strength for radiation.
Three weeks into rehab, my father-in-law was sent to the radiologist to evaluate his condition. At this appointment, the radiologist, seemed alarmed that no one had previously discussed with him his PET scan performed prior to the neck surgeries. The PET scan revealed that the cancer had metastasized into the lymph nodes of my father-in-law’s chest. The surgeon and the oncologists had had the PET scan in their possessions prior to the scheduling of even the first neck surgery. Neither of them had informed him of the metastasized cancer..
The radiologist advised that radiation would be of no benefit and that the family should arrange for hospice care. My father-in-law underwent two unnecessary surgeries. Instead of making him better,they increased his pain and anxiety, exhausted him and may have indirectly shortened his life. He endured physical pain from the incisions, emotional trauma and separation from his family. He died three weeks later.
We Must Change Our Attitudes
We must change our attitude about death. We must learn to see death as a natural conclusion to life and not isolate ourselves or our children from it. As a 7 year- old, I attended my grandmother’s best friend’s funeral. My mother explained that Miss Mamie had had a long and useful life. She told me that older people’s bodies give out in the normal course of living and they die. That had happened to Miss Mamie. As a result neither Miss Mamie’s death nor her funeral frightened me. This experience helped prepare me when thirteen years later my grandfather died.
We Must Learn to Let Go
We must not insist that physicians and other health care professionals be Superman/ Superwoman or play God. We must support them in prescribing reasonable treatment and respect their positions when they recommend halting medical care rather than continuing heroic intervention. We must learn to let go. When our loved one’s body is saying it is their time, we must allow nature to take its course.
We Must Insist Upon Honest and Thorough Information
Family members must establish open and honest communication with medical personnel, especially physicians. Family members must insist on appropriate tests. Then family members should also be aggressive in demanding an honest and thorough explanation of the test results, prognosis, treatment options and potential outcomes. We must require physicians to explain the treatment options and the potential outcomes thoroughly and honestly. Only with proper information can we help our loved one make appropriate decisions.
If you have questions about this column or wish to suggest a topic of interest, please contact me by phone at 254.797.0211 or by email at email@example.com.
Sandra W. Reed is an attorney with Katten &Benson, an Elder Law firm in Fort Worth, Texas. She lives in beautiful Somervell County, near Chalk Mountain.