Saturday, July 16, 2011

The American Way of Death

What if you could live forever? What if science could extend your lifespan for decades? If you can’t have eternal life, would you settle for extended life?

Imagine that you answer, Yes, that you would want your life to extend well into the distant future. Would you continue to be as enthusiastic if you knew that you would be spending those extra years in a nursing home connected to tubes unable to speak or write or feed yourself?

What if older meant, as it seems to, more and worse bodily dysfunction?

How long would you want to stay alive in an increasing decrepit body? And how long would you want to stay alive if your body were subjected to increasingly debilitating diseases?

If you had to choose between death and living forever in a dysfunctional body, what would you choose?

Yesterday, David Brooks offered an original angle on the current debt ceiling crisis. If we all know that the nation is going broke because it is spending too much on health care, then shouldn’t we start thinking about the fact, Brooks explains, that we are spending (or wasting) a goodly part of that fortune on end-of-life care.

This money does not improve anyone’s life. It is not about waiting for recovery. It seems to be about wringing every last second out of a life that is going to end, either tomorrow or the day after tomorrow.

Brooks explains our problem in these terms:  “This fiscal crisis is about many things, but one of them is our inability to face death — our willingness to spend our nation into bankruptcy to extend life for a few more sickly months.

“The fiscal crisis is driven largely by health care costs. We have the illusion that in spending so much on health care we are radically improving the quality of our lives. We have the illusion that through advances in medical research we are in the process of eradicating deadly diseases. We have the barely suppressed hope that someday all this spending and innovation will produce something close to immortality.”

One would be hard put to dispute Brooks’ point here. He is especially cogent on the idea that we, as a nation, seem to believe that extending life is equivalent to extending quality of life. Not only do we believe that we will live forever, but we believe, as the late Jack Benny, suggested, that we will always be 39. Or that we are only one new scientific discovery away from it.

But given that science has not yet beaten the aging process, what should we say to those who become elderly and infirm? Should we say: “Do us all a favor, and die already. Your life is not worth living any more, and besides, if you die sooner you can help us with the federal budget.”

I am not saying that Brooks is wrong. On the question of our having a rather bizarre attitude toward death, I agree with him. Yet, translating his idea into policy is not for the faint of heart.

Do you want to stake your political career on pulling the plug on Granny? Or better, do you want to get in the business of persuading Granny to pull the plug herself? That would seem to be unbecoming for a Times columnist.

Think about Dr. Kervorkian, and you will appreciate how difficult this question is. No politician who values his career is going to stand up and say that we should cut of funding for end-of-life care... regardless of how wasteful it is.

To buttress his point Brooks links to a poignant article by Dudley Clendinen.

Clendinen is suffering from Lou Gehrig’s disease, ALS, and he has thought long and hard about what will happen to him once this degenerative disease incapacitates him beyond what he wishes to endure. Before that day arrives, he is planning to end his own life.

Brooks seems to believe that Clendinen’s decision, not yet actuated, should be a shining beacon for those of us who will eventually become: “a conscious but motionless, mute, withered, incontinent mummy of my former self. Maintained by feeding and waste tubes, breathing and suctioning machines.”

On the other side of the suicide issue, we recall the late Tony Judt, who also suffered from Lou Gehrig’s disease, but who kept working until the end.

I would recall that many religions do not look very kindly on suicide. If you glance through the Wikipedia entry on religious views of suicide, you will see that most religions consider it a grave sin.

As we saw in the trial of Dr. Kervorkian, it is not very easy to judge quality of life and survivability. Who knows whether people who are severely depressed will not be lured into ending their lives prematurely? Just because the end stage of ALS is fairly clear, that does not mean that all other illnesses are similarly unambiguous.

While induced suicide does not seem to be the answer, Brooks is right to say that we are wasting far too much money on end-of-life care.

And he is also right to say that we, as a culture, have a rather peculiar relationship with death.

Brooks says that we are afraid to face death, and most people would agree. I have my doubts about the concept, mostly because it leaves open the question of how you would go about showing that you are not afraid of death.

Still, there is another issue that must needs be addressed here, one that our secular age is often afraid to broach.

As fearful as we all are about what will happen when we die, we seem to be even more afraid to raise the question of whether or not there is an afterlife.

Giving up your life with equanimity would seem to be easier if you believe that it is God’s will and if you believe that there is another life to come. If you believe that you have only one life and that there is nothing after it, then you are likely to want to hang on to it as long as possible.

Prof. Leon Kass articulates the problem: “It is probably no accident that it is a generation whose intelligentsia proclaim the death of God and the meaninglessness of life that embarks on life’s indefinite prolongation and that seeks to cure the emptiness of life by extending it forever.”

As Kass points out, and as Brooks echoed, we are not, as a culture, just trying to prolong human life indefinitely. We are also trying to prolong youth indefinitely.

But, fearing the aging process is not the same as fearing death. The strange part of it all is that while we, as a culture, no longer believe in Heaven, we want our earthly life to resemble It as much as possible.

We want to be forever young and vital. But isn’t that only possible in a place where we are not chained to a human body, when we are purely metaphysical beings?

If we were able to be young and vital forever, wouldn’t that mean that the metaphysical dimension had come to master physical reality.

Americans are, supposedly, a pious people. They attend religious services more frequently than do their more sophisticated European counterparts.

And yet, when was the last time you heard a serious thinker go on a television talk show and argue that Heaven exists as a real, albeit, metaphysical place? When was the last time someone who was not standing in a pulpit told you that you need to mend your ways because otherwise you will not make it through the Pearly Gates?

From a religious perspective, this life is not only not the only life; it is not even the best life.

If you lose your faith and lose the sense that there is anything more to your existence than your physical body, you will have sacrificed the spiritual and the mental in favor of a highly mechanistic view of the world.

Perhaps it is God’s way that a culture that loses sight of what really matters must pay dearly for it.


Kentucky Packrat said...

C. S. Lewis famously said that if you aim for Heaven, you get Earth too. Aim for Earth, and you get neither.

The problem I see is that we are using Other People's Money here. If I have to decide between a $100k cancer treatment that extends my life 3 months, but leaves my family unable to keep the house after I die, then maybe I skip the cancer treatment. OTOH, why should I not spend $100k of "the government's" money or "my insurer's" money?

Rather than requiring a third party to set my "end of life", we should be able to, and prepared to, fund ourselves. Given our current health care system, this isn't possible.

Anonymous said...

I have often read that we spend too much money on end of life care. It is pretty clear after the fact that someone is at the end of their life. However, unless one has something like ALS, how do we know that the end is near? I had a couple of uncles die this year after lots of time in and out of the hospital. Except for maybe the last week of their lives; both showed signs of improvement during their many treatments, leaving the hospital and going home.

David Foster said...

Basically, the proposal here is that Americans should shorten their lives so that politicians will not have to moderate their own rampant power-lust and greed.

Stuart Schneiderman said...

Did you see Jennifer Rubin's column in the Washington Post--

I'll try to say something about it later

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