Going Gentle Into That Good Night

There's an article that has been getting a lot of press recently, written by a doctor called Ken Murray. The subject of the article is how doctors themselves often don't wish to undergo lots of invasive procedures when they approach the end of their own lives. It's a fascinating article, and well worth reading the whole thing.

The question is, why not? The author suggests that it comes from a greater understanding of how many treatments may cause a lot of suffering, but only prolong life but a short amount (if at all), and usually under miserable conditions. Coming in for particular scrutiny is the practice of administering CPR to the very elderly and terminally ill, characterised as "experienc[ing], during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right)." And in terms of the result, it is described thus: "If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming."

But I wonder how much another factor may come into play - namely, a greater familiarity with, and acceptance of, death. Doctors, especially those who interact with emergency rooms, are forced to confront death in a way that few other people are. Beyond a certain level of exposure, it is just viewed a fact of life, and an inevitable one at that.

To state that, of course, is to state the bleeding obvious. And indeed, once upon a time, the average person did indeed come into contact with dying and dead people, and was thus forced, however fleetingly, to reflect on their own mortality.

Modern man, by contrast, is enormously shielded from death. It occurs out of sight in hospitals, and we spend the rest of our time avoiding contemplating it or, if we do, thinking about it in abstract terms reserved for other people. ("20 dead in Russian bridge collapse").

A doctor, of course, does not have the luxury of avoiding the concept of death. It haunts the halls of every hospital. But I suspect that a large number of people making end-of-life decisions for themselves or a loved one have not yet come to grips with the inevitability of death. Because once you accept the fact that, one way or another, you will die, you start asking much more seriously whether it's worth going in for that long shot last round of chemotherapy. The first step is to realise that it won't stop you dying. It will only delay it, and at best you'll die of something else. And the second step is to ask the hard questions about how you want to die, and how much life you are willing to trade in order to live out your last days the way you want to.

I would be interested to see what the decisions are for people outside the medical profession who deal in death - funeral directors, priests, that kind of thing. I suspect they may be more like doctors than like the average person.

But maybe not. Maybe everybody clings to life in the same way, mortal familiarity be damned. It may be as Ken Murray suggests- the only difference is that doctors understand from grim experience the futility of the odds and the consequences of their actions better than everybody else.