Wednesday, June 8, 2011

Jack Kevorkian, "Dr. Death," Dead

The irony of a dead Dr. Death is almost palpable.  At 83, Kevorkian lived a fairly long life and according to current accounts was in pretty good health up until fairly recently.

Kevorkian had been diagnosed with a few health issues, including cancer, but nothing doctors considered terminal.  So it's not ironic that Kevorkian was seeking to extend his life, the only irony is his nickname juxtaposed with his current status.

On the whole, I find Kevorkian's stance on physician-assisted suicide as, if not noble, then at least necessary.  Doctors take a vow that states up front, "Do no harm."  Well, that's a stumbling block, that sweeping statement.  The art and science of surgery was held back possibly hundreds of years by Hippocrates' well-meant oath.   You can't exactly call cutting a living person open doing no harm, can you?  But if you're cutting him open to remove a tumor or repair a rupture or something else, you have to take a longer view.  You're doing him harm right now, but it's nothing compared to the harm that might come to the individual by doing nothing.

Modern health care has, at its core, a basic flaw.  It treats each person as if he or she could reasonably expect to live forever.  There's pediatric care for the very young, general care for the average person, obstetrics and gynecology for the unique plumbing associated with the female body, geriatric care for the very old.

Not a lot in there about terminal care.  That's changing, slowly.  There's hospice care, which I don't think is treated as an actual discipline within the larger school of medicine.  I think it should be.

You're going to die.  Everyone who ever lived, eventually died.  Elijah in the Bible may be an exception.  Everyone who is alive right now is going to die.  That's a fact and there's no getting around it.  Barring a stunning new development in the understanding of telomeres, you can reasonably expect your threescore and ten and now, thanks to advancements in modern medicine, maybe a score or so more.  Telomeres being reset to make you the genetic equivalent of a 20 year old might give you a new lease on life, but does it mean you'll live forever?  No.  It's just a stay of execution.  You too will discover what lies beyond the veil, someday.

Doing no harm has to have some asterisks, some footnotes.  Harm is causing injury unnecessarily.  What about when the patient has no hope of living?  You can extend his/her life with intensive care.  Put the person on machines that circulate and oxygenate the blood, help the breathing.  Dialysis.  Beat the cancer back for another month with Gamma Knife treatments, interferon drips.  But nothing will change the fact - it's coming.

We have at our church an absolutely delightful lady who has been diagnosed with cancer.  I think it's a terrible shame.  Bless her, she has a deep and breathy voice that doesn't sound great when she sings the hymns, but her musical talent and skill is such that she takes her oddly bullfroggy voice and sings the most excellent counterpoint.  She raises goats.

She has a month or three left to live.  How much effort should be put into "saving her life?"  It can't be saved.  The cancer is all through her, if you were to try to cut it all out, there'd be nothing of the lady left.

Now we get to the stickier question of "quality of life," the fuzzier part of the Hippocratic oath.  To do no harm is admirable, but when nothing can be done with causing unnecessary harm, the pendulum swings toward the patient's wants.  Needs are basic: food, shelther.  Life is terminal and will end regardless, so stop worrying about the extension of the patient's life.  If the patient wants you to extend his life, do so.  Do what you can.  Advise as you can on the way: this procedure will extend your life but it will hurt a lot.  This one won't extend it as much but it won't hurt as much either.  This one won't extend your life at all, but you won't be in as much pain.

None of them will save your life.  You can't have the threescore and ten.  The end is coming.  The doctor can push the end back a little, at the expense of great suffering, or you can allow the end to come as it will, but the suffering won't be as bad.

I'm pretty sure which way I'd choose.  I'm still not comfortable with the concept of my own mortality, even though by most other measures I'm a perfectly rational person.  I don't like to think that there will come a day whose sunset I may not see, a dawn that never comes.

Maybe a new, greater dawn is waiting.  That should be quite an awakening.

So it's still illegal in many parts of the world to have a doctor help ease that last passage.  Doctors seem to think they have to have a hand in so many things that they really just don't.  People had babies long before there were ever doctors and they seemed to do just fine.  They still do, in fact.  Yes, having doctors around does make the process a lot less risky, but really - do we need them that much?

How many people who are not really very healthy still made it to adulthood to have children?  My eyesight is lousy, as a hunter-gatherer I would probably not have made it to pass my genes along to the next generation.  My wife's eyes are pretty bad too; when our kids were born we were halfway expecting them to not have eyes at all, like cave lizards.  Or a heart murmur, or a propensity for springtime allergies?  These are the kinds of things that weaken a body, but with doctors and treatment we don't succumb to them.   We just stagger along for our threescore and ten, and maybe a score or so more.

But whatever is ailing you doesn't necessarily go away.  The weight of years is always there.  Lungs get weaker, the heart gets weaker.  Joints can't hold up the weight.  Eventually, you go down, but you're not quite done.  You won't be getting up again, but you're not done yet, either.

And the doctors will extend your life.  Gasping for breath though you are, they can make sure you gasp longer.  Your heart hammers to push the thinning blood through your veins; they can prescribe blood thinners to make it easier to pump.  They can install pacemakers to keep your heart pumping regularly.

How much suffering will you tolerate to have a few more years, a few more months, another hour?  Eventually there comes an hour that must be your last.

Kevorkian's mission had been to make that last hour and the ones leading up to it less awful.  People talk about dying with dignity, and I think that's so much baloney.  Very few things associated with the workings of the living body are what you could call "dignified."  Bathroom trips, eating, having babies: these are all biological absolutes that you don't get to escape and none of them have any dignity associated with them.  What you can have, however, is a little control over the context in which they happen: doors on the bathrooms and knives and forks at the dinner table.  The functions become less of a spectacle.

Kevorkian's machine.  The life-extending procedures are all used up and now the inexorable decline begins, or we simply pull the car off the highway here and say, that's enough of that.   I don't have to plow my battered old ride into the bulldozers at the end of Vanishing Point.  I'm just going to step out now.  No big crash.  No unnecessary drama.  So long, and thanks for all the fish.

Well, I'm a little addled.  Just clambered out of bed.  Hopefully this all made sense.  Kevorkian's gone and went suddenly enough that he didn't wind up his own last customer.  I guess that's my main point, that and when your life's options have pretty much run out, he still made it possible for people to have a little control over the ends of their lives, to have one more option.  That's the gist of it.

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