The Troubled Dream of Life: In Search of a Peaceful Death

Chapter 6. Pursuing a Peaceful Death

Chapter 6 PURSUING A PEACEFUL DEATH On the face of it, one might be forgiven for thinking that death at the hands of modern technological medicine should be a far more benign, sensitive event than death in earlier times. Do we not have a much greater biological knowledge, thus enabling more precise prognoses of death? Do we not have more powerful analgesics, thereby enhancing the capacity to control pain? Do we not possess more sophisticated machines, capable of better managing organs gone awry? Do we not have greater psychological knowledge, suitable to relieve the anxieties and suffering of an anticipated death? Do we not, adding all that up, have at hand exactly what we need to enhance the possibility of a peaceful death? The answer in each case is yes and no. Yes, we do have much more knowledge than we did prior to modern medicine. But no, that knowledge has not made death a more peaceful event, either in reality or in anticipation. The enhanced biological knowledge and technological skill have served to make our dying all the more problematic: harder to predict, more difficult to manage, the source of more moral dilemmas and nasty choices, and spir- 188 THE TROUBLED DREAM OF LIFE itually (if I may use the term) more productive of anguish, ambivalence , and uncertainty. In part this is because, with the advent of modern medicine, the earlier superstructure of meaning and ritual was dismantled, thus setting death adrift in a world of uncertain values and import. But, also in part, it is because modem medicine brought with it a stance toward death that is ambivalent about its necessity and inevitability. The technologies of medicine, ever more clever in their ability to sustain failing organs, provide a set of tools that endlessly sustain this ambivalence and allow it to be played out in tortuous detail. Precisely because they have opened up new possibilities in the ancient struggle with our mortality, those technologies have made our understanding of mortality all the more difficult. To confound us further, they have misled us into thinking we have a greater dominance over our mortality than earlier people had. What can be done to gain a better way of thinking about medical technology and our human mortality? How can that technology be made to serve a peaceful death, not to be its enemy? What can be done to bring about a change? I want to try to make plausible a different way of thinking about the use of technology, and then suggest some ways of implementing it. The change I propose can be put very simply, however strange and odd it may sound: death should be seen as the necessary and inevitable end point of medical care. Death as the End Point of Medical Care In considering its appropriate goals, medicine should, so to speak, simultaneously work backward as well as forward. Medicine now characteristically works forward only, looking to promote the good of life, both to lengthen life and to improve its quality. Death is reluctantly admitted into the clinical realm of medicine as the limit to achieving those ends, but that limit is itself uncertain at its boundary, not readily located. Thus also is the Pursuing a Peaceful Death 189 termination of treatment judged to be a lesser moral evil, because the quality of life cannot be sustained at the level at which, ideally, medicine would like to sustain it. What if, however, we began our thinking with death? What if we asked how medicine should conduct itself to promote both a good life and a peaceful death? What if medicine finally accepted death as a limit that cannot be overcome and used that limit as an indispensable focal point in thinking about illness and disease? The reality of death as a part of our biological life would be seen, not as a discordant note in the search for health and well-being, but as the foreseeable end point of its enterprise, and its pacification as a proper goal of medicine from the outset. What if the aim of scientific medicine wasnot an endless struggle against death, with the fight against disease as the token of that struggle, but helping humans best live a mortal, not an immortal, life? These questions are almost naive. But I see no evidence that they are deeply and persistently asked in modern medicine. If they were, death would have to be...