As a consultant in infectious diseases at a university teaching hospital, I advise doctors on the management of desperately ill patients and observe their attempts to restore these men and women to health. In the course of my experience, however, I have become increasingly convinced that medical care, American style, is clearly running the risk of extending the dying process rather than prolonging life. Both doctors and patients are losing their sensitivity to the inevitability and the appropriateness of death in certain circumstances.
Because of the powerful tools at our disposal, we doctors sometimes abdicate our traditional role as servant and adviser to the sick and suffering, and become technicians who merely run the machines that sustain “life” (defined in a narrow physiological sense). By so doing, we relinquish the judgment of what should be done for what could be done, and end up applying medical technology wherever possible: Is respiration failing?—Use the respirator. Have the kidneys stopped working?—Start dialysis. Slowly and sadly our attitude is becoming: “If we have the technical capability, we must always use it.” And as a result, patients can be drawn into a dehumanizing spiral in which each organ failure is met by still another life-support procedure.
We must never lose sight of the fact that life is precious, a gift from God that cannot, must not, be dismissed lightly. But in understanding our relationship to life, and the extent to which we should fight to hold on to it, we must also come to grips with death. We must ask why technology is so often applied indiscriminately in the U.S. today (an approach interns call the “full-court press”). And why we have ...1
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