Death. The ultimate taboo word in our culture. It is spoken of in whispers in the fear that we may bring it upon ourselves if we talk about it, say the word.
Lie
Existential therapists describe death anxiety as the central driving force of one’s life and behaviors. Nothing reminds you of your own mortality as acutely as
medicine and healing. We witness death frequently and routinely. It is an inevitable part of our life in medicine.
During medical training though we are not t
aught much about death. We are only taught about life. We are taught about human bodies, diseases, treatments, and keeping a person alive and away from death. I cannot remember a single lecture where we discussed this topic. We internalize the belief that to be a worthy healer, we have to defeat death for our patients, no matter their condition.
Consistent with the strong undercurrents of perfectionism snd unrealistic expectations in medicine, it sometimes appears that the single biggest failure of modern medicine is its inability to find a cure for death (and aging). We try our damnedest to beat it, keep it at bay as long as we can. In the process, we as a society forget to acknowledge the suffering of the person behind all the tubes. The biggest casualty in our quest for longevity is human dignity and quality of life. We focus so much on life-sustaining interventions that life-enriching ones have become obscure.
Most of the patients I worked with who had terminal cancer spoke about their desire to die with dignity, surrounded by loved ones, and as painlessly as possible. Several of them described a strong sense of acceptance, finding peace, and the satisfaction of having lived a life of meaning and purpose.
I have been present for numerous family meetings where loved ones grappled with finding that same kind of acceptance. The grief was overpowering and difficult to witness but so was acceptance once it settled in. . It is a powerful and sobering thing to witness.
At the end of the day, medicine and science cannot defeat natural death. The life-cycle is such that for new life to come and blossom, each of us will need to go. For patients with life-limiting diseases, an honest and empathic conversation is needed to understand their desires and what they want in terms of treatment. This may be uncomfortable, difficult, and triggering but needs to be done.
Palliative Medicine and Hospice do a remarkable job in supporting such patients and families. However, every clinician involved in the patient’s care needs to be competent to hold space and empathy for such conversations. And the training should start in medical school. We need to teach students that inquiring about suffering and emotional pain in such patients is as important as other symptoms. Only then will medicine truly become patient-centered. Ultimately, we have to understand and accept that death with dignity is not a luxury, it is a basic human right.
Comments