Medicine, a Power That is Finite (a review of the book Being Mortal, by Atul Gawande)

This book couldn't have come at a more opportune time, when my cousin and childhood friend lay in the hospital bed incapacitated from glioblastoma, the aggressive brain tumors the late senator John McCain succumbed to. His condition has been nosediving as of late, and he has recently begun to suffer from dysphagia - loss of ability to swallow. He has voluntarily stopped eating for fear of suffocating. He has not been all that coherent, and is in the late stages of the disease. What is the purpose of staying alive in this debilitating condition that continues to decline?

And this is exactly Mr. Gawande's point in "Being Mortal"; that the purpose of medical science should not be solely about prolonging survival, but to enable well being.  If that entails the patient making choices that shorten life span at the expense of quality living, then that's a fair tradeoff. "Over and over, we in medicine inflict deep gouges at the end of people's lives and then stand oblivious to the harm done" (pg. 249). Mr. Gawande is referring to physicians' tenacity in keeping terminally ill patients alive with surgeries, procedures and medications that leave patients in a reduced state of well being with little to no control over their fate.

Physicians should inquire with patients what their minimum requirement for living is, e.g. a patient may wish to continue watching Football on T.V. and eat chocolate ice cream. They should then ensure no treatment or procedure hinders the dying patient's wish.

"I knew a man who once said, 'Death smiles at us all. All a man can do is smile back'," Maximus in Gladiator. Let us hope medicine helps us smile back when our time comes.