Tuesday, October 27, 2009

Life and death

Since the health care reform debate began (and its accompanying myths and untruths), I've come across many articles lately in the blogosphere about medicine and its relationship to "the big questions": questions of life and death.

Some of these include questions from the beginning of life: when does life really begin? when is it okay to have an abortion, and when isn't it? and who gets to decide? why is a fetus of a certain age viable and worthy of medical treatment when others aren't? what of informing parents that their baby has Down Syndrome? should they be counseled to continue the pregnancy or to end it? or should they be counseled at all?

And the converse, questions from the end of life: when is it time to die? should we do everything we can to save someone who is clearly dying? when have we tried enough, and we need to say "let nature take its course"? How do we best spend the end of our lives? in a hospital bed? at home? in hospice? and who gets to decide?

My own recent medical experiences have made me realize that while doctors know a lot, they don't know everything. Medicine is still often more of an art than a science. Many decisions rely on the experience of the doctor, and even on their gut feelings about a case. Given that, do we want doctors making these sorts of life and death decisions for us? Or worse, do we want legislators making these decisions?

The reality is that these sorts of life and death decisions are often made without clear guidelines. If we are lucky, we have doctors, nurses, counselors, or others to help us through these difficult decisions. But often we are left alone. Or we are left with the legal system, which isn't always a very empathic friend.

It's ironic that two of the major sticking points of the health care reform debate -- the so-called "death panels" and public funding of abortion -- have to do with these very issues. I guess everyone feels some discomfort when confronted with these gray areas.

Wendy, a fellow Oberlin alum, wrote a very poignant piece about this issue in Newsweek last year. She says:
As I reflect on this experience (the death of her father), I keep thinking that with some small changes in how we as a society approach death and dying, we could make this a better experience for everyone. In school, we should teach not just about health but about the changes to the body that accompany death and dying. Give students words of comfort and acknowledgment. They will surely have opportunities to use these words with friends and family members, even in childhood.
We are a death-denying culture and by not being open about death and dying, we leave ourselves unprepared to face other deaths and, ultimately, our own.

P.S. I wrote this about a month ago, and since I seem to have no time to post these days, I'm finally posting this one. More soon, hopefully.


RivkA with a capital A said...

I don't know much about the health reform issues, but I did read an article that compared mortality rates in the US (under the current health policies) and the UK (whose policies are close to those of the health reform bill). UK mortality rates for particular cancer patients, including breast cancer patients, were much higher (indicating that mortality rates will likely INCREASE with the health reform plan).

I can send you the link if you want.

Christine said...

Yes, doctors don't know everything, but lots of times we act as if they do. I've been thinking: Isn't it odd how we comparison shop for so much, but we never know the costs of health care procedures and treatments? How come I don't know the cost of a test or an office visit? Why do I hesitate to ask "Why?," "How much?" and "Is it necessary?" I got a kick out of this fun, short video. Check it out. It makes you wonder why out health care system is set up the way it is.
What do you think?