Friday, August 21, 2009

When Should We Think About Our Mortality?

I am outraged by the people that say, “there are no ‘death panels’ in the Democratic health-care bills, and to say that there are is to debase the debate” but then go on to say that end of life counseling is the “subtle pressure applied by society through your doctor” to “gently point the patient in a certain direction, toward the corner of the sickroom where stands a ghostly figure, scythe in hand, offering release.”

These quotes come from Charles Krauthammer in the Washington Post. His goal in the essay is surely not to assert that the “death panel” claims is a bunch of lies, it is to assert that there is no efficacy in the living will as a legal document.

Krauthammer writes about his own living will:

“My own living will, which I have always considered more a literary than a legal document, basically says: ‘I've had some good innings, thank you. If I have anything so much as a hangnail, pull the plug.’ I've never taken it terribly seriously because unless I'm comatose or demented, they're going to ask me at the time whether or not I want to be resuscitated if I go into cardiac arrest. The paper I signed years ago will mean nothing.”

I think he has missed the point of a living will and perhaps documents naming health care proxies. I find the claim that a family can know a person’s wishes better than that person knows himself or herself dubious. Krauthammer passes along a story about the death of his father. He writes:

“When my father was dying, my mother and brother and I had to decide how much treatment to pursue. What was a better way to ascertain my father's wishes: What he checked off on a form one fine summer's day years before being stricken; or what we, who had known him intimately for decades, thought he would want? The answer is obvious.”

Just because you say it is obvious does not make it correct or obvious. This confuses a family’s emotional desire to not lose a loved one with the wishes of the loved one. If the efficacy of the living will is so limited why have one at all.

I don’t understand why Krauthammer believes that doctors, the “white-coated authority whose chosen vocation is curing and healing”, would ignore, in the end of life consultations, the possibilities of life saving efforts that “can prolong the patient's otherwise hopeless condition for another six months” and focus on “hospice care and palliative care and other ways of letting go of life.”

I am sure Krauthammer would agree that life and death are both serious matters, as is the choices people make in both. So why would we want to diminish people’s wishes and minimize the value of a legal document that people create when they are thinking about the seriousness of death.

The question that needs to be asked is, when are we able to rationally think about our own mortality? Is our approach to death more practical as we get closer to mortality or in an earlier time in our lives? These are important questions that should be pondered by serious people. If Krauthammer has written a legal document that he does not take seriously why should we take him seriously?

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