Saturday, 4 December 2010

A good death....

The euthanasia debate promoted by the Greens continues to expose the bizarre contradictions in our society.

On the one hand, some are seeking the 'right' to have someone murder them - or in practice to murder others who become inconvenient to them or the system.

On the other hand, instead of investing heavily in good palliative care to cope with an ageing population, our health system is gearing up to spend enormous amounts of money desperately trying to prolong life when there is little or no chance of ultimate success.

And of course it is that latter dynamic that is driving, in part, the push for euthanasia.

Costs of intensive care

Take this story today in the Sydney Morning Herald, reporting on the results of a study of intensive care beds, which cost around $3000 a day compared to around $1000 for an ordinary hospital bed - and less for a palliative care bed.  It found that in 2007:
  • over-65s constituted nearly half of all days spent in intensive-care beds;
  • over 80s made up 12% of intensive care use, nearly double that of a debate ago and continuing to rise rapidly.
The story claims that the aggressive treatment of seriously ill people at the end of their lives reflects community expectations, and family inability to cope with the prospect of a loved one dying: "Because we don't discuss dying, people are not so happy to die without some therapy being offered,'' said Associate Professor Gillian Bishop, the director of Campbelltown Hospital's intensive-care unit.

So why don't people want a good death?

The traditional idea of a 'good death' of course is diametrically opposed to this futile attempt to pretend that we control when and how we die.  The ideal is to be lucid before you die so you can receive the sacraments and the comfort of the prayers of family and friends around you.

No fake reality denying pseudo-canonisation funeral services are necessary, because the family and friends left behind know that the person has every prospect of getting to heaven at least eventually, and that they can do something positive to aid this through their prayers.

So the obvious solution to this cost pressure is for people - and their families - to accept that they are dying when they actually are, and go into palliative care if necessary rather than intensive care.  But there are enormous cultural barriers to this that really need to be addressed. 

Sci-fi exploration of the issues

The sci-fi show Stargate Atlantis actually had a really great episode that drew out these issues a year or so back.  In it, one of the main characters, a genius scientist, Rodney McKay, comes down with the alien equivalent of Alzheimer's, due to a parasite in his brain.  The program chronicles the gradual decline of his mental capacity, and reactions to it with a series of dated video clips where he attempts to recall a series of pieces of key information about himself and his work. 

At first McKay seems to cope well with the process of his decline.  But as it goes on, he tries, rather incoherently, to push his friends away, urging them to leave him alone and remember his as he was, not as he is.  And McKay's doctor girl-friend strives desperately for ever more interventionist and unlikely medical solutions, even when it is clear that none have any prospect of success. 

When his local alien friends tell of a shrine (the show is set in another galaxy) that will allow the dying man one last day of lucidity so he can say his good-byes properly, including to his sister who has arrived too late to talk to him properly, the doctor in particular is horrified: for what could be worse than suddenly waking up and knowing exactly what has happened to you, and knowing that this is the end?
Fortunately, alien cultural practices win out, and they set out to have one last perfect meal with family and friends before McKay dies. 

Now this is scifi and so in of course the shrine also turns out to provide way of curing him.  Still, the episode nicely draws out the secularist horror at the idea of facing death head-on rather than the expectation, even desirability, of going down quietly unknowing into death in a haze of drugs and life-support equipment.

Promoting cultural change

If we are to beat the push for euthanasia, we need to find ways to rediscover and reassert the value of that alien cultural custom of the good death here and now.

Of course, if you don't actually believe in an after-life, or worse perhaps half do, and know that you aren't headed for the good place, it makes sense to rage against and deny death...

But there are some attempts being made, as this paean to palliative care, advocating its repackaging "symptom management" makes clear.  The SMH also has a useful related story (albeit one a little over-focused on questions of economics rather than the dignity of life) on the "marginalization of ordinary death" and its consequences.  It is a start.

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