We say we have it. And yet, most of us do everything we can to hang on to every last vestige of this life.
It’s as if faith and death are not connected in any way–maybe we just don’t want to test that.
I’m talking about the treatment of terminal illness, of course, something we become more familiar with as we age. If it’s not our parents or grandparents, it’s our friends, and we’re often faced with a ringside seat to their choices and the outcome of their choices. They can do nothing and die sooner. They can pursue aggressive treatment and live longer but with impaired quality of life. Or they can pursue aggressive treatment and get quality of life back for a year or two or more. Or, as that beautiful young woman in Oregon did, in some places they can choose to end their own lives.
How to decide?
It’s a crap shoot, and truly a matter of life or death. It’s important, too, because we might face these choices, ourselves, one day, if we haven’t already.
Stanford University School of Medicine released results of a study last year that said more than 88 percent of physicians would decline aggressive treatments for terminal illness, such as aggressive chemotherapy for terminal cancer. The researchers noted that there is a point where high-intensity treatment is worse than the effects of the disease. That is, if you accept the idea that we are all mortal. Physicians, apparently, accept that fact. The rest of us tend to do everything we can to hold on to this life, seeing death as the far worse fate.
After all, this is the only life we know: our family, our friends, our activities–we want them to continue as they always have. And if we’ve got a chance at that, most of us are going to take it.
Life after this one? It’s unknowable. We’ll take the known, thank you very much.
The study said noted that most Americans would choose to die at home without aggressive, life-prolonging measures. While that’s all well and good in a study, it’s much a much harder choice for patients who stand a chance of more time–functional time– if they can only get through aggressive treatment. IF. That “if.” It’s a fine line we still don’t know how to navigate.
But the alternative? It terrifies many of is. Mention “hospice” and many of us completely freak out, because we know what that signifies. So treatment often seems like the least frightening option. But maybe it shouldn’t be.
A doctor with terminal cancer interviewed for the study said, “I will accept further treatment only if it enhances the quality, not the quantity, of the days I have left.” Yeah, good luck figuring that out.
Chemo is a vicious beast, killing everything in its path without differentiating. Good cells and bad, they’re all annihilated and as good cells disappear, those awful chemo side affects crop up. Secondary infections of all kinds make quality of life questionable. Conditions like neuropathy and chronic pain, infections or new cancers as side effects of chemotherapy are not uncommon.
Aggressive treatment ain’t for the faint of heart.
But there’s plenty of evidence that some people do get through the horrors of aggressive chemo and buy a few more good years, years with acceptable quality of life. The problem is that medicine can’t tell us who will succeed and who won’t.
The study said that many physicians recommend aggressive treatments, but that’s not what I see. The doctors I see offer patients the options and allow them to make their own decisions. But these are decisions we’re poorly equipped to make.
One hundred years from now, or maybe even in our children’s lifetime, medical professionals will look back on slash and burn chemotherapy and shudder at how primitive it is.
But right now, it’s all we’ve got. State of the art.
But the crux of the matter, to me, is how we view what comes after this life, and most of us have always had a problem with that. Those of us who believe that life goes on still, for the most part, find it hard to live as if we really believed it. Or to act on that belief.
If we really, truly believed that our souls go on, that the spark that makes us unique, that’s the heart of us, continues, we might not undergo those horrible treatments.
My own struggle with issues of faith and that fine line of when to stop treatment began 15 years ago when I watched my mother go through her final illness. She wanted to hang on to this life at all costs, and it did cost her, dearly. She spent the final year of her life in the hospital. It wasn’t easy on her and it certainly wasn’t easy on her family.
Looking back, I can see that life is a series of transitions that are almost unnoticeable when we are younger. But when I turned 60, my point of view changed, almost like completing a section of a book and turning the page to a new one. Now, I am hyper-aware of the many more days behind me than ahead. I’ve begun to see that that in some of my friends, too. We consider lifestyle matters now that were never on the radar screen before –such as access to good medical care. Decisions about aging in place, long-term care insurance and other things we’ve never had to consider are now topics of discussion.
It’s obvious that our generation is struggling with core issues we never entertained before. And decisions about aggressive treatment end of life are key among them.
Because for us, at this age, it really is a matter of life or death.
HERE is an insightful essay about radical cancer treatments by a woman who lost her husband to brain cancer.