The End-of-Life War

Atul Gawande, excellent as always, tackles the difficult issues around end-of-life care, arguing that modern medicine has failed people facing the end of their lives. “The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task,” writes Gawande. “Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.” Expensive end-of-life care (and cancer treatment costs), of course, also contributes to runaway health-care costs.[%comments]

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  1. John says:

    You know Custer is a crappy example of fighting to the bitter end, right?

    Custer and his men were left to die while other troops stood by. The Little Big Horn is better example of a stop loss than a bitter-ender scenario.

    Custer’s actions might be a study in foolhardiness.

    Custer’s case is certainly a study in what happens when your enemy shows up with better rifles (you don’t want to be the guy holding a Springfield when the guy riding against you has a Winchester).

    But, at the end of the analysis, Custer’s Last Stand was the result of Reno’s decision to enact a stop loss.

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  2. Laura says:

    The question is whether we are prolonging death, not prolonging life. I don’t know anyone who wants to prolong their death. If the question is asked “Do you want us to do everything we can to prolong grandma’s death?” Would everyone jump up and say “yes?” Everyone should have an advanced directive and medical professionals should be required to follow it, instead of caving to the family who hasn’t had enough time to say goodbye. Just let me go, when it is my time. I hate the thought that my family members can elect to prolong my death. What I choose should be adhered to. But unfortunately, doctors often ask the family to be sure, putting them in a terribly uncomfortable role of “choosing” to end grandma’s life, when grandma already chose for herself. So many facets to this problem.

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    • Kelly says:

      The bottom line is that Nobody is getting out of here Alive…..
      One thing that every single human being has in common is that we will all die someday. Knowing that, wouldn’t it make more sense for us a a society to emphasize quality of life, rather than fighting the inevitable? I don’t mean that we should not save lives, fight cancer, etc. What I mean is that in a terminal situation, with no hope at all for recovery, wouldn’t it make more sense to enjoy the time you’ve got left, and come to terms with the reality and inevitibility of death? What is heroic about forcing someone to suffer uselessly for as long a period of time as we possibly can? Nothing.
      It is fear of death, of the unknown, and also the reluctance on the part of loved ones to be selfless enough to do what is in the best interests of the person who is dying, rather than hang on as long as possible, regardless of the suffering caused by this.

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  3. Bubba Sixpack says:

    My vote:

    Let them have all the end of life “care” they want.

    They or their heirs pay for it.

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