Life - and - Death
"When
people are well they tend to choose death over disability. But when
people get sicker, they adapt to disability and they still find quality
in life, and they have trouble then saying, 'No, I'm not prepared to
die'." Dr. Romayne Gallagher, palliative care expert
None
of us, actually, is prepared to die. We trust in what we know so
well. We know life. We have no idea what lies beyond life. It is
death, of course, the animate become inanimate. Decay. The corporeal
essence becoming the dust of which it was created. And, of course, the
illusion that the soul, the human mind, struggles on without the body
encasing it. Ascending to heaven. Where the Heavenly Father gathers
His flock.
Or, of course, not. Or, in the case of
nothing, nothing. Bleak, black, vast, nothing. A chasm of
non-existence. Unfathomable to the human mind. It is rejected. It is
the realm of which we know nothing at all. But of which we hazard many a
suspicion. Knowing nothing, we seek to forestall the inevitability of
death, striving to forget it is inevitable.
Longevity
is desired. Life without end. The purpose of life then becomes to
endure. Quality of life which we strive to achieve throughout the years
of our lives becomes a quality that loses its own endurance, but not
its appeal. Quality of life most certainly is not demonstrated when the
body has succumbed to the years that have worn out its practical
existence.
When we are hospitalized through the
emergency of no longer being capable of performing normal bodily
functions. When we are connected to an artificial ventilator, unable to
swallow, to talk or breathe on our own. Tube-fed then. Resuscitated
if the heart stops. Existing in a medicated, sedated state. The body,
frail and insubstantial, manually turned in the hospital bed for relief,
and fed for sustenance.
If consciousness prevails then
so too does pain and suffering and acute depression. Anxiety and guilt
about our loved family members. The knowledge that how we are
suffering, the extent to which we are being manipulated and forced to
endure the unendurable in the name of 'extending life' has become an
intolerable torment for our families.
Who, later, when
that body has been laid to rest, will recall the horror of those end
days, and not the miracle of life enjoyed when everyone was in good
health and loving one another, appreciating each other's presence,
despite the exigencies of life and relations that sometimes become
strained.
Patients suffering from severe health decline
whether due to agedness or recurrent bouts of implacable disease or
chronic ill health, are suddenly faced with the intolerable thought of
what next? Confused and upset they are in no state to be questioned by
the attending medical professionals. Asked what their preferences are
under those circumstances they are incapable of responding.
Willing
to leave such decisions in the hands of the medical professionals whom
they trust. And those medical practitioners, embracing the 'do no harm'
principle that guides their profession, look to the solutions that have
been established through the mediums of advances in medical science and
the huge leaps in medical technology - all of them geared to prolonging
life.
The code that nature has written into the
destiny blueprint of all living things, from gigantic powerful suns
revolving in the galaxies of the firmament, to the merest minuscule
amoeba, is the will to survive and to continue existing. Until choice
is removed and other forces make the decision that define their ends.
Fighting death, battling the natural evolution of life, the primeval
drama of defeating death when the final chapter is part of life.
Heroic
means are taken to maintain life. Cardiopulmonary resuscitation at
end-of-life scenarios is not benign, but violent. It can lead to broken
ribs, punctured lungs and a resulting high rate of stroke and serious
brain injuries, with slim survival odds. "
The
chance of being resuscitated when you're terminally ill with cancer is
like one in 100,000. The chance of making it out of hospital is zero", says Dr. Larry Librach, director of the Joint Centre for Bioethics at the University of Toronto.
"We're
going to have to come to terms with the notion that death is
inevitable. Clearly, for all of us, there is ultimately going to be
something that can't be cured", says Dr. Robert Fowler, associate
professor in the departments of medicine and critical care medicine at
the University of Toronto, critical care doctor at Sunnybrook Health
Sciences Centre.
These health professionals have
experience, and expert knowledge in their profession. They know that
they, just as all the others that they see and they examine and they
treat, are vulnerable to the very same unavoidable end-of-life
scenarios, and that they will have to deal with them on their own
behalf, just as surely as they do for their patients.
And
then there are those health professionals whose concerns are the
amelioration of pain and suffering, the guidance toward acceptance, and
even forestalling the inevitable to eke out a few more months of life.
Like Dr. Romayne Gallagher who still sees value in holding out hope,
because nothing is instant and inevitably immediate; there are reversals
that obtain time for those willing to hold out a little and continue
savouring life.
"From
the physician's point of view, if you're advocating a treatment plan
and then start talking about death and dying, a lot of physicians have
felt in the past that they may actually be depressing the patient, or
influencing them, or making them upset needlessly - because it's not a
topic that can be discussed when people are unwell without a
considerable amount of emotion", explains CMA president Dr. John Haggie.
People
are obliged to themselves and to their families to discuss these
uncomfortable and emotion-draining topics. With all the uncertainties
involved. When they are well. When they can be rational and not pressed
for time, or in pain and feeling desperate for a solution. To give
instructions to be followed under certain circumstances. Whether to
commence, continue or withhold extraordinary life-prolonging treatments.
It
takes the wisdom of Solomon to be able to judge oneself and one's
tolerance: life or death is not the issue; it is life and death that is.
Labels: Education, Family, Health, Human Relations