According to Merriam-Webster Dictionary;
Life: n. an organismic state characterized by capacity for metabolism, growth, reaction to stimuli, and reproduction
Death: n. a permanent cessation of all vital functions: the end of life
In a book called “Being Mortal”, author Atul Gawande said that “spending one’s final days in an ICU because of terminal illness is for most people a kind of failure.” In another survey done in 2013 by researchers at an academic medical center, it showed that 11% of their patients received treatments and aggressive management that are deemed futile.
Doctors: are we prolonging life or are we prolonging death?
This is a question that has been bothering me for a while now and I felt compelled to write this in order to release the preoccupation. This was asked by one of our medical professors during our mindfulness session, which I think was helpful to make us better empathetic doctors in the future.
It made me think, like seriously, at my level – do we really prolong life or do we prolong death? As a medical student, I think we prolong life by not giving up hope while we still have that fine thread between life and death. As long as the heart keeps beating, we are alive.
But as a normal person with a chronic illness like SLE, I think it is just prolonging death.
As I have mentioned early on, the definition of life involves – reaction to stimuli and reproduction. It is in these premises that we can argue about the state of a person who is in coma with little to no reaction to stimuli and certainly cannot be able to reproduce although this person’s body can still metabolize, which is also part of the criteria of being alive.
As a patient, do I want my attending physician to exhaust all things possible in order to delay death and prolong my suffering? Of course not. I would rather spend my last days at a remote cottage in the middle of nowhere and meditate about where in life I really am. Many think I am not afraid of death and yes this is true. Why should I be afraid of it when all of us will face it sooner or later? I think the fear of death is not for ourselves but for those who will be inevitably left behind. The fear of death may also stem from the fact that there is uncertainty on what happens beyond death.
As a future doctor, I would want to put myself on the patient’s shoes. Do I want to exhaust all treatments to prolong life and inevitably exhaust their financial resources as well? Do I want my patients to spend the rest of their lives in an ICU where only machines do the work for them?
It is hard.
The thing is – doctors, we are not God. We do not get to choose who gets to live or who gets to die but the decision is hard. According to Hippocrates, “The doctor must do everything in his power to save lives, preserve health or at least alleviate the suffering,” which makes our lives as doctors even more complex because we will decide whether we save lives, preserve health or alleviate suffering. Question is – how do we make the decision?
Fortunately, the decision is an interplay of minds between the medical team, the patient and the family. Although, as I have said, if I am the patient (and I am) when it comes to this decision-making, I do not want to die in a hospital. I do not want CPR. I do not want mechanical ventilation. I do not want tracheostomy done. I don’t want anything that will disfigure my already disfigured body from disease – just let me die in peace. The people who love me will MOVE ON – like the rest of the people who lost one because this is the essence of life, moving on.
Therefore, the answer to whether we prolong life or death depends entirely on the situation and I will cross the bridge when I get there.