Jonathan Rauch has an excellent piece in the May Atlantic called “How Not to Die” The key to it is “unwanted treatment,” which Rauch calls “American medicine’s dark continent.”
“The U.S. medical system,” Rauch says, “was built to treat anything that might be treatable at any stage of life—even near the end, when there is no hope of a cure, and when the patient, if fully informed, might prefer quality time and relative normalcy to all-out intervention.”
This made me think of a friend’s father who, three weeks before his death, was subjected to a massive cranial operation. I can’t remember the hope anyone had for this operation, but it seemed a classic case of unwanted treatment. The recovery from it was brutal, and was interrupted by his death. There was little normalcy to Jack’s last days—and all, as Rauch would see it, because he and his family never had The Conversation with his doctors—a conversation that would have addressed the fact of his approaching death.
In 2009, as Rauch points out, it was Sarah Palin who “mendaciously (and effectively)” labeled such frank discussions as “death panels.” Anyone who questions medical maximalism,” Rauch continues, “risks being attacked for trying to kill grandma.”
I rode the edge of this dilemma with my father in 2005, after he fell and hit his head. Blood spilled freely because of the blood-thinning Lasix he was on, but I stanched the wound, called our Hospice nurse and eventually got him into bed.
Somehow, perhaps through his GP, my father’s cardiologist heard about the fall and demanded that I bring my father in for a CT scan, in case there was some bleeding inside his skull. But the Hospice nurse came to the house, looked Dad over and said, “The guy’s doing okay, we’re not going to take him anywhere.” After all, if they found bleeding on his brain, what could the doctors have done? Nothing my brothers and I would have accepted—and nothing my father would have wanted. Though still walking, he was 92, suffering from advanced Alzheimer’s, and extremely frail.
I understand, a cardiologist must be thorough. But to this day I bless that Hospice nurse for helping me stand up to a classic case of unwanted treatment.
Kudos to Jonathan Rauch for a trenchant article.