Heroic Measures?
400-odd years ago, John Donne took on a topic that still
ignites controversy today: what is the right way to die? And by “right,” I mean
socially acceptable, which is to say, most considerate of our friends and loved
ones. In “A Valediction: Forbidding Mourning,” Donne praises those who are
capable of managing their deaths in such a gentle fashion as to make the fact
of their passing unclear. Such people are “virtuous men,” who “pass mildly
away,” by “whisper[ing] to their souls to go.” Less appreciated by all
concerned are those whose passage to the afterlife is a far more tempestuous
journey.
Bill Keller, in his NYT article “Heroic Measures,” paints a
carefully-phrased criticism of Lisa Adams’s cancer blog which details her
battle with metastatic cancer. In it, he sides with those who prefer a model of
death managed by palliative care rather than “heroic measures.” He quotes
Steven Goodman, an associate dean of the Stanford University School of
Medicine, who says that Adams’s blog “shouldn’t be unduly praised” for
being an adherent of the “combat metaphor.” Equal praise,” he says, “is due to
those who accept an inevitable fate with grace and courage.”
It is clear that Keller’s opinion has been shaped by his
own father’s death from cancer, where in England, he was provided with “a
humane and honorable alternative” by being “unplugged from everything except
pain killers and allowed to slip peacefully from life.” Certainly, Keller sides
with Donne here, and why shouldn’t he? No-one wants to see their loved ones
suffer in their last days.
But his article has caused controversy because of the
implied suggestion that a) the American model of managing death as a kind of
“frantic medical trench warfare” is wrong, and b) that people have a choice
when it comes to these things. What Keller critiques is an expensive universal
protocol that really ought to provide more leeway for dying people to manage
their ends — but what gets him into hot water is the notion that individuals
can somehow escape the system.
For a start, it’s not always easy or possible for a
dying person to think clearly enough to make decisions, especially about
something of which they are likely to be profoundly afraid (and afraid of admitting: that they are indeed dying).
It’s not easy for the dying person, and it isn’t easy for their family, who are
often the ones making end-of-life decisions which err on the side of doing
everything they possibly can to extend the life of their loved one, cost be
damned. It feels unseemly to think about finances when someone’s life hangs in
the balance. Then there is the overwhelming opinion of the medical
professionals to whom we turn in search of answers to questions we probably
have not ever had to consider. They, too, err on the side of the preservation
of life (and the hospital’s bottom line).
Keller cites a study that “suggests that patients given
early palliative care instead of the most aggressive chemotherapy not only have
a better quality of life, they actually live a bit longer.” While this may
indeed be true, what he may not be sensitive to is that for the person with the
cancer, all decisions loom like the sword of Damocles over the precariously
thin kite-string that has become their life: one wrong decision and whoops! there
you go floating into a tree. Deciding whether to have “aggressive chemotherapy”
(all chemo is “aggressive,” BTW), or forego it for palliative care is a tough
call for those who may have been dealing with this disease for years. Choosing
to opt out of the clinical cycle, even if it may provide more time, inevitably
feels like giving up.
So much about handling cancer is about attitude:
maintaining control over your treatment is seen as being proactive; hopeful;
strong — and it will seem odd for someone to make that switch from choosing
action to deciding against taking action and leaving one’s fate to the gods.
Susan Sontag wrote artfully of the way in which language
and vocabulary has helped shape our comprehension of disease, especially
cancer. When one considers the way in which the language of warfare dominates
the conversation, it is no surprise that people view cancer as a battleground
with winners and losers. Keller’s article maintains this metaphor even while
quoting Goodman, who “cringes” at it.
Ultimately, there are no winners and losers when it
comes to cancer, and dying. There are only folks standing around, like Donne’s
“sad friends,” arguing over how well you went.
