Tuesday, April 3, 2012

We need a serious conversation about end of life

The modern medical system is great at keeping people alive well past their expiration date but not so good at making that time worth it.  As Brooks explained earlier,

Life is not just breathing and existing as a self-enclosed skin bag. It’s doing the activities with others you were put on earth to do. 

But yet the modern medical system is focused on keeping the body alive even when the brain is shriveled with age.

A large share of our health care spending is devoted to ill patients in the last phases of life. This sort of spending is growing fast. Americans spent $91 billion caring for Alzheimer’s patients in 2005. By 2015, according to Callahan and Nuland, the cost of Alzheimer’s will rise to $189 billion.

Ouch.  I'm thinking of all the spaceships and stem cell research and AI technology that we won't do because of this money being wasted on people who can barely understand that they're alive.

So in Brook's column today he writes about one of the subjects of his life report, a senior that lived a accomplished life married to the woman of his dreams.  He wrote a somewhat self indulgent piece, basically saying "Look at how great my life is!"and mentioning how good it was to be taking care of his now senile wife. 

But the story is far from roses.  He ended up offing himself and his wife

So Brooks has another column out today reflecting on the contradiction between his advocacy not to worship life itself over coherence, against the fact that a dude killed himself based on that advice.

He believed that caring for his wife made him a richer, fuller human being: “It’s not noble, it’s not sacrificial and it’s not painful. It’s just right in the scheme of things. ... Sixty-one years ago, a partner to our marriage who knew how to nurture, nurtured a partner who needed nurturing. Now, 61 years later, a partner who is learning how to nurture is nurturing a partner who needs nurturing.”

One side says he did it out of love:
“This is a total shock to everyone in the family, but we know he acted out of deep devotion and profound love.”

Others say he did it out of selfishness:
 A woman from Canada who has spent 25 years nursing Alzheimer’s patients, argued that none of us have the right to decide that another person’s life is worthless. Some argued that the nurturing process at the end of life, like the nurturing process at the beginning, requires patience and that those who are desperate should seek help, not a firearm.

Well, the difference being a baby becomes an adult, while an old person simply withers.

Brooks ends with this malarky that doesn't help us one bit:
If you look at life through the calculus of autonomy, then maybe Snelling made the right call. Maybe his moments of pain from here on out would have outnumbered his moments of pleasure. But if you look at a life as one element within a mysterious flow, it’s hard to escape the conclusion that Charles and Adrienne Snelling still had a few ripples to create.

Regardless, we have to have a serious discussion in the world about this.  At what point should people have to pay to keep alive another human being?  How long do we deserve to live when we're no longer contributing members of society? Given the skyrocketing costs of medicare, this discussion is unavoidable unless we want fiscal catastrophe.

Do you see us having this discussion?  I don't know...

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