Life - and - Death

"When people are well they tend to choose death over disability.  But when people get sicker, they adapt to disability and they still find quality in life, and they have trouble then saying, 'No, I'm not prepared to die'."  Dr. Romayne Gallagher, palliative care expert

None of us, actually, is prepared to die.  We trust in what we know so well.  We know life.  We have no idea what lies beyond life.  It is death, of course, the animate become inanimate.  Decay.  The corporeal essence becoming the dust of which it was created. And, of course, the illusion that the soul, the human mind, struggles on without the body encasing it.  Ascending to heaven.  Where the Heavenly Father gathers His flock.

Or, of course, not.  Or, in the case of nothing, nothing.  Bleak, black, vast, nothing.  A chasm of non-existence.  Unfathomable to the human mind.  It is rejected.  It is the realm of which we know nothing at all.  But of which we hazard many a suspicion.  Knowing nothing, we seek to forestall the inevitability of death, striving to forget it is inevitable.

Longevity is desired.  Life without end.  The purpose of life then becomes to endure.  Quality of life which we strive to achieve throughout the years of our lives becomes a quality that loses its own endurance, but not its appeal.  Quality of life most certainly is not demonstrated when the body has succumbed to the years that have worn out its practical existence.

When we are hospitalized through the emergency of no longer being capable of performing normal bodily functions.  When we are connected to an artificial ventilator, unable to swallow, to talk or breathe on our own.  Tube-fed then.  Resuscitated if the heart stops.  Existing in a medicated, sedated state.  The body, frail and insubstantial, manually turned in the hospital bed for relief, and fed for sustenance.

If consciousness prevails then so too does pain and suffering and acute depression.  Anxiety and guilt about our loved family members.  The knowledge that how we are suffering, the extent to which we are being manipulated and forced to endure the unendurable in the name of 'extending life' has become an intolerable torment for our families.

Who, later, when that body has been laid to rest, will recall the horror of those end days, and not the miracle of life enjoyed when everyone was in good health and loving one another, appreciating each other's presence, despite the exigencies of life and relations that sometimes become strained.

Patients suffering from severe health decline whether due to agedness or recurrent bouts of implacable disease or chronic ill health, are suddenly faced with the intolerable thought of what next?  Confused and upset they are in no state to be questioned by the attending medical professionals.  Asked what their preferences are under those circumstances they are incapable of responding. 

Willing to leave such decisions in the hands of the medical professionals whom they trust.  And those medical practitioners, embracing the 'do no harm' principle that guides their profession, look to the solutions that have been established through the mediums of advances in medical science and the huge leaps in medical technology - all of them geared to prolonging life.

The code that nature has written into the destiny blueprint of all living things, from gigantic powerful suns revolving in the galaxies of the firmament, to the merest minuscule amoeba, is the will to survive and to continue existing.  Until choice is removed and other forces make the decision that define their ends.  Fighting death, battling the natural evolution of life, the primeval drama of defeating death when the final chapter is part of life.

Heroic means are taken to maintain life.  Cardiopulmonary resuscitation at end-of-life scenarios is not benign, but violent.  It can lead to broken ribs, punctured lungs and a resulting high rate of stroke and serious brain injuries, with slim survival odds.  "The chance of being resuscitated when you're terminally ill with cancer is like one in 100,000.  The chance of making it out of hospital is zero", says Dr. Larry Librach, director of the Joint Centre for Bioethics at the University of Toronto.

"We're going to have to come to terms with the notion that death is inevitable.  Clearly, for all of us, there is ultimately going to be something that can't be cured", says Dr. Robert Fowler, associate professor in the departments of medicine and critical care medicine at the University of Toronto, critical care doctor at Sunnybrook Health Sciences Centre.

These health professionals have experience, and expert knowledge in their profession.  They know that they, just as all the others that they see and they examine and they treat, are vulnerable to the very same unavoidable end-of-life scenarios, and that they will have to deal with them on their own behalf, just as surely as they do for their patients.

And then there are those health professionals whose concerns are the amelioration of pain and suffering, the guidance toward acceptance, and even forestalling the inevitable to eke out a few more months of life.  Like Dr. Romayne Gallagher who still sees value in holding out hope, because nothing is instant and inevitably immediate; there are reversals that obtain time for those willing to hold out a little and continue savouring life.

"From the physician's point of view, if you're advocating a treatment plan and then start talking about death and dying, a lot of physicians have felt in the past that they may actually be depressing the patient, or influencing them, or making them upset needlessly - because it's not a topic that can be discussed when people are unwell without a considerable amount of emotion", explains CMA president Dr. John Haggie.

People are obliged to themselves and to their families to discuss these uncomfortable and emotion-draining topics. With all the uncertainties involved. When they are well.  When they can be rational and not pressed for time, or in pain and feeling desperate for a solution.  To give instructions to be followed under certain circumstances.  Whether to commence, continue or withhold extraordinary life-prolonging treatments.

It takes the wisdom of Solomon to be able to judge oneself and one's tolerance: life or death is not the issue; it is life and death that is.