DEATH & MEDICINE Late modern societies’ frontline in the war against death
MEDICINE TAKES CONTROL • Reflecting on the successes of the 20th century • Medicine inherits from religion the cultural responsibility to oversee final passage • Death prevention as the primary goal of medicine • Death-as-disease, death-as-the-enemy, death as result of medical failure Franz Glaubacker, “The Physician” (1923)
In 1163, the Council of Tours banned the clergy from practicing surgery.
The shift in control from clergy to physician can be argued to have occurred in 1879, when it became mandatory that a doctor certify death before a death certificate could be issued.
Now that fewer people, especially those in the Western, believe that life is a transitional phase leading to immortality, they are left with nothing after death to believe in. So their faith is placed in technology and physicians who, ironically, have become decreasingly equipped to deal with patients as humans.
The state protected professional titles and markets while, in turn, the professions undertook the provision of welfare state services for citizens.
Public expectations about medicine’s success in its war against death are continuously fueled.
Scientists may have cured cancer last week. (February 1, 2007) So, why haven't the media picked up on it? Here's the deal. Researchers at the University of Alberta in Edmonton, Canada found a cheap and easy to produce drug that kills almost all cancers. The drug is dichloroacetate, and since it is already used to treat metabolic disorders, we know it should be no problem to use it for other purposes. Doesn't this sound like the kind of news you see on the front page of every paper? The drug also has no patent, which means it could be produced for bargain basement prices in comparison to what drug companies research and develop. Scientists tested DCA on human cells cultured outside the body where it killed lung, breast and brain cancer cells, but left healthy cells alone. Rats plump with tumors shrank when they were fed water supplemented with DCA.
In November 2007, two research teams reported making ordinary human skin cells take on the chameleon-like powers of embryonic stem cells. The "direct reprogramming" technique avoids the swarm of ethical, political and practical obstacles that have stymied attempts to produce human stem cells by cloning embryos.
The biotechnology company Tengion has since 1999 been selling new bladders made out of the customer’s own cells. From biopsy to surgery, the process takes six to eight weeks.
CONSIDER THE SUCCESSES AGAINST CHILDHOOD CANCER • Reflecting on survival rates from childhood leukemia, Dr. Robert Butler observed: • "In the 1960's and early '70's, cancer was a death sentence. There was a 90 percent probability that the child was going to die. Now, there's about an 80 percent chance that the child will be cured. It's turned around practically 180 degrees.” • --Mary Duenwald and Denise Grady, “Young Survivors of Cancer Battle Effects of Treatment,” New York Times (Jan. 8, 2003)
FROM MORAL TO TECHNOLOGICAL RITE-OF-PASSAGE • More than half of attending physicians & 70% of attending physicians say they often violate their own personal beliefs and ignore requests from patients to withhold life support in cases of terminal illness (Am J. of Public Health, Jan. 1993, n=1400 from 5 major hospitals nationwide) • According to Dr. Nicholas Christakis (U. Chicago), 40-70% of patients die in pain (first phase study of Dying in America)
There remains in the medical arts the Cartesian model of man, which only recently has been challenged by more holistic conceptions.
In 1926, Fritz Kahn illustrated man as a working factory in his famous poster, Man as Industrial Palace. Tiny guys in each body system perform their own specific job. A camera man controls the eyes, groups of thinkers sit up top, and the guys at the bottom handle the dirty work.
Contender for the 2010 Oscar for Best Animated Short Film: “The Lady and the Reaper” (Spanish)
Chances that a U.S. adult does not want to live to be 120 under any circumstances: 2 in 3 --Harper’s Index, Jan. 2003; ABC News (N.Y.C.)
Thinking About Implications of “Successes” in Cultural War Against Death
In 2008, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients' lives - that's more than the budget of the Department of Homeland Security or the Department of Education. --CBS “60 Minutes.” “Cost of Dying” (Nov. 22, 2009)
A study of nursing home patients, by Dr. Susan Mitchell of Harvard and the Hebrew Rehabilitation Home for the Aged, found that those with end-stage Alzheimer's received more aggressive medical treatment — including feeding tubes, intravenous fluids and antibiotics and hospitalizations — than cancer patients at the end of their lives. • --Gina Kolata. “When Alzheimer’s Steals the Mind, How Aggressively to Treat the Body?” New York Times (May 18, 2004)
Thirty-four percent of US nursing home patients who suffer from Alzheimer's disease and other forms of dementia receive their food through a stomach tube, even though the practice is of dubious medical value, according to a study published in the Journal of the American Medical Association. • The study suggests the economics of Medicaid reimbursements favor the potentially harmful practice and that large, for-profit nursing homes were more likely to use the devices. In addition, the study found that nonwhites were more likely to be given feeding tubes than whites. • --James Collins. “Study links Medicaid fees, use of feeding tubes- Financial incentives for nursing homes seen Boston Globe (July 2, 2003)
“Effective at the beginning of October, Arizona stopped financing certain transplant operations under the state’s version of Medicaid. Many doctors say the decision amounts to a death sentence for some low-income patients, …”
Apple’s Steve Jobs had a liver transplant in 2009. The billionaire’s story became a parable of class privilege and the inequities of the nation's transplant system. Jobs relocated from his home in California to Tennessee, where there is much less competition for vital organs.
Avastin, which costs about $100,000 a year, was in 2008 one of the most popular anti-cancer drugs in the world. Studies showed that it extends life by only a few months.
On the Rise of the Right-to-Die, Death-with-Dignity Movements • 1990 merger between Concern for Dying & Society for Right to Die • Derek Humphry’s Final Exit reaches top of New York Times best-seller list in 1991 • Media attention given to Jack Kevorkian • The rise of hospice • Growing public support for euthanasia
In 2008 the city council of Salford, Lancashire, UK printed these wallet "right-to-die" cards. They're freely available in pubs, banks, hospitals, libraries, and other public places. They're sort of like a living will combined with an organ donor card. If you don't have the mental capacity to tell doctors how far they should go to save your life, this card lets them know you've already planned ahead for just such a situation.
Though most euthanasia cases involve the elderly, it is interesting to note how often the right-to-die campaign has been dramatized in the cases of brain-damaged young women: Karen Ann Quinlan (1975-1985), Nancy Cruzan (1983-1990), and Terri Schiavo (1990-2003 ).
Unlike the young women who had become the poster children of the right-to-die movement, in the Fall of 2009 the focus shifted to a 76-year-old retired truck driver from Billings, Montana. Now, in death, Mr. Baxter could make Montana the first state in the country to declare that medical aid in dying is a protected right under a state constitution. His claim is that a doctor’s refusal to help him die violated his rights under Montana’s Constitution
According to a Pew 2005 survey, 35% said they've given their end-of-life medical wishes a great deal of thought and 36% said they've given it some thought. Only 27% said they have put their wishes in writing and 29% said they have a living will.