Death, Taxes and Overtreatment

Episode: 
42

Benjamin Franklin once said, “In this world nothing is certain but death and taxes.” I’ve encountered both of those realities recently. Taxes went up in our home state, and a friend’s wife died last fall. While most of us get angry about the first certainty—taxes—we’re often fearful and unprepared for the second one. Facing death is something we all must do, and something that medical technology has made more complicated.

“Facing Death,” the title of a recent Frontline episode, follows the experiences of four dying patients, their families and physicians as they make decisions about the end of life.[1] We learn that most of us will die in a hospital after a long illness, instead of in a hospice or at home. Medical technology has changed how we die, introducing new dilemmas. For example, we may be offered “too much of a good thing”—we may be overtreated.

End-of-life treatment includes mechanical ventilators, feeding tubes, and CPR. In many seriously ill patients, these treatments can be the road to successful, long-term recovery. However, these treatments may only increase pain and prolong suffering for someone who is terminally ill and dying. Some patients are aggressively treated with more and more rounds of chemotherapy, radiation or experimental drugs during the final few weeks of their life. The side effects can be horrendous, without offering any significant benefit.

Is this desirable? Not surprisingly, eight out of ten Americans with progressive illness such as cancer or heart disease want to avoid hospitalization and intensive care while they are dying. They naturally wish to die peacefully, surrounded by family and friends.[2]

Unfortunately most patients in traditional hospital settings do not “die peacefully.” The number one goal of treatment is survival, not comfortable death. Some doctors practice “exhaustion medicine,” exhausting all medical options, even if the disease is incurable and death is near. On the other hand, the patient or family will often request aggressive treatment, hoping that “this one last thing” will heal them, or at least give them a few more days of life. Stopping treatment, regardless of the burdens or benefits, is sometimes perceived as “giving up.”

We all want to “die well.” As one doctor stated in the Frontline episode, “Nobody wants to die and nobody wants to die badly.” Aggressive overtreatment during the final weeks of life can prevent us from “dying well,” especially when the treatment is more burdensome than beneficial. End-of-life decisions are difficult, and it’s best to discuss them while you’re healthy. Talk with your family, your pastor and your doctor, and seek God’s wisdom and guidance. Plan ahead with an advance directive, a legal document that communicates your preferences in the event you cannot.[3]

Facing death may not be a priority, but it is a certainty. Have you taken the time to be ready to die well?



[1] PBS Frontline, “Facing Death,” http://www.pbs.org/wgbh/pages/frontline/facing-death/ (accessed January 5, 2011).

[2] Marilynn Marchione, “Americans are Treated, and Overtreated, to Death,” Associated Press, June 28, 2010, http://www.boston.com/news/local/massachusetts/articles/2010/06/28/americans_are_treated_and_overtreated_to_death/ (accessed January 5, 2011).

[3] An advance directive is available in English and Spanish on The Center for Bioethics & Human Dignity’s website at http://cbhd.org/resources/issues.

 

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