Death, Selfishly
Love Enough To Let Go
I have watched many people die. I have watched them suffer. I have watched, unable to ease their pain and agony. I have discussed, explained, argued and cajoled to no avail. I have been forced to witness people at their absolute worst. They invoke love, causing suffering.
Western society (and in time global society) has at its disposal the means to prolong human life far beyond what even the most religious amongst us would truly agree is natural. Medical science, in researching the heretofore unexplainable, allows physicians to keep alive even those whose souls have long gone on. We can provide the means to support and nourish those whose body's have sustained single or multiorgan failure. We comprehend the physiology and pathophysiology of wellness and disease wherein the phrase "natural lifespan" literally has no meaning.
The ability to sustain life while a person recovers from devastating illness and/or trauma has never in the eyes of physicians meant to be a means of not allowing those whose lives have ended to move on. Americans have truly not engaged in a nationwide discourse on this subject although there have been many persons educated and published in Ethics, Morality, Religion and Culture. The American Heart Association has an Ethics Committee which provides the basis for determining ceasing life-saving efforts. There have been gut wrenching arguments in the public when the media choose to sensationalize a person's suffering rather than provide education, understanding and insight. We have tremendous tools at our disposal to gain many insights concerning life and death but we generally choose to let others delve into this thinking. We also forfeit the right to proactively protect and honor the ones we claim we love the most.
By way of example, where was the information about Terri Schiavo's autopsy published? Generally not in the same place her parents and husband's domestic feud played out. And who amongst them loved Terri the most to stick with his convictions and the knowledge she had told him she never wanted to live as she was forced to do? Her husband. Not her mother. Not her father. Not her siblings. As a result the husband was vilified by the press and public alike, no one acknowledging in the same vainglorious manner of reporting her impending death that he, and he alone, loved her sufficiently to let her go. Although her autopsy completely vindicated him, I do not believe he needed those results to maintain the peace of acceptance he long ago experienced. Those, like her parents, saw in Terri's facial activity what they wanted to see. They wanted to see life where none existed. They rendered laymen's interpretations of what were obviously basic reflexes to so many experienced physicians. Even Senator Frist, a cardiothoracic surgeon, put aside his medical keen and discerning eye to turn a political stunt.
Disregarding the opinion of many, many neurologic experts the family chose to rely on emotions of selfishness and possibly greed to continue Terri's suffering. And suffering she did, for many long years. As a side note, the husband paid for this from the award of a malpractice case involving Terri, which by the by was totally unfounded medically and scientifically; it was settled by nonscientifically trained nonmedical personnel. But the fact remains that the ones who so vociferously proclaimed their love for her deliberately caused her the most pain.
Spanning atheism to a potpouri of belief systems, I have had the honor to care for many folks without any interference or judgment on my behalf regarding what they hold as true in the metaphysical realm. They oftentimes have explicitly discussed with me their perspectives on life in general and their own in particular. They have shared this with their closest family members and in some cases have availed themselves of the wonderful and frequently ignored Living Will. Although specifically or even generally laying out what is and is not acceptable to them for a medical team to do when they are terminally ill, in the name of love family after family continues to disregard and disrespect the very "will" spelled out for them to read.
Love, religion and cultural perspectives greatly influence any one individual's acceptance or denial of death. Much has been written on this subject thanks to the many wonderful persons who shared their thoughts and feelings with us as they lay dying. The Hospice movement has provided the living and those yet to come with profound insights about dying. Yet we, as Americans, cannot look death in the face and acknowledge it. We ignore it. We deny it. We drown in substances of abuse to avoid the inevitable. In fact, we do everything we can to disallow the one phenomenon all living beings share in common: death.
This did not used to be so. Prior to the late 1950's and early 1960's and the advent of molecular biology, human genetics and biotechnology afforded us opportunities not previously available, we accepted death as a natural outcome of life. Death was acknowledged, it was grieved and the living continued to do just that: live.
As a nation we grievously need to look at ourselves individually, as family members and as participants in society to acknowledge and deal with the truths before us. We absolutely need to stop the suffering of the dying.
In these acts of selfishness, there is also the tremendous economic and resource toll which is equally as ignored. But it all is coming around full circle, particularly as the next generation of folks begin to retire. Are you, in the name of love, going to ignore their stated wishes and cause them suffering? My guess is yes, in many situations.
There are many times life-support is not only appropriate but an absolute ethical and moral choice. There are equally, if not more times when life-support is abused. The majority of these times it is done so based on immature emotions and a failure to acknowledge the inevitable. We have a term for it in medicine: denial. It is perhaps the most pervasive mental illness afflicting mankind in the modern world.
If you ask anyone in your family, "would you like me to make sure you suffer prior to your death, lying in a bed surrounded by highly technical and elaborate devices which connect to you through a myriad of wires, electrodes and catheters; the catheters invading essentially every orifice you have?" I am confident the answer to this question is no. And that is as it should be.
Faced with this person's imminent death said family member will statistically, inevitably throw aside all prior conversations with their parent or grandparent; they will ignore the express written wishes of this loved one; they will demand all previous rational thought expressed by the person suffering to be cast aside in a desperate attempt to temporarily prolong what the family member(s) will eventually have to face: death.
What has so sadly been impressed upon me is the depth of selfishness family members will go to attempting to preserve a life which is ending because they are not ready for the family members death. While I wholeheartedly empathize with the family my sensitivities truly go out to the patient; it is he or she who will be tortured for one last session before the physicians are able to legally allow to end a natural process which they impeded by fiat due to the family members. The same holds true for the young adult tragically killed in an accident who has now become a potential organ donor. There is nothing more profoundly selfless and loving then for one person to recognize the awful plight of a loved one but to concurrently allow the heavy emotions of loss to be put aside momentarily and donate the gift of life.
So many misconceptions, religious edicts and superstitions surround a dying or dead person that the difficulty in letting go is readily obvious. However, this does not stand as an excuse for that person to either deny life to someone else or essentially demand suffering prior to the impending death of a loved one. Rarely is the impending or actual death of a person put in this perspective. It is time, long overdue, we as a culture and nation respect natural consequences and death as willingly as we accept love and life. For truly, they are one and the same.
As a nation, Americans need to be better readers and collectors of objective information. They should prepare themselves for the life events which are most certainly to affect them. I will venture you do not know the survival rate of breast cancer victims in stages 3 & 4 have remained essentially unchanged for the last 15 years. That if someone is diagnosed with congestive heart failure, statistically, greater than 90 % will die before the next five years pass them by. If you are diagnosed with Stage 4 Pancreatic Cancer, you will die before 6 months has gone by.
Folks with illness that can be treated and those with potentially life threatening conditions should be aggressively treated. But those whose body and mind have been ravaged by Alzheimer's Disease, stroke, heart disease, kidney failure or a combination thereof should be allowed by their family to not suffer during their death. Family members do not suffer in anyway near the manner in which a person admitted to the ICU will suffer to sustain all the treatments and procedures inflicted on her/him.
Do miracles exist? Absolutely. Are people inadvertently misdiagnosed? Absolutely. Do we need to be careful in our assessments of patients and their illnesses to provide the most accurate information concerning their condition and treatment? Absolutely. But sadly it is the exception, the rare family member or members who are so in touch not only with Life itself but their living family they can provide the love, empathy and care so needed by the dying.
A person familiar to me recently experienced the death of his grandfather, a man who lived until his late 80's. I remember him describing the phone call he received telling me, "It was all so unexpected - just a huge surprise. What, I ask you, is there surprising or unexpected in the natural death of a male who has lived long past his life expectancy? Is it not a blessing you had him to love and interact with during those extra years? Did God not provide him with more time to put his affairs in order and make proper good-byes to everyone? I say yes.
By and away the most common statement I hear from a family member when told of a person's terminal state is, "But I'm not ready for them to die. Can't you do something? I don't want them to leave. Do everything you can do humanly possible." And hence begins the final suffering in the name of selfish love.
When faced with death, either your own or someone else's', think in loving terms. Remember love is not selfish; love is not confining or dictatorial. Love is free and beautiful; don't use the word "love" to mean something painful, devastating and selfish. Do not impose your own insecurities or lack of psychological/emotional maturity on those already suffering. They have had enough.
There is much hope for all mankind in the true miracles of modern medical science. Just as true are the past and future horror stories wherein patients are mentally and physically made miserable at a time in their life when peace, tranquility and freedom from pain should reign supreme. Love freely and openly. When and where you can, provide peace and insight.
Dr. Dennis
posted by Dr. Dennis @ 3:21 PM
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