The Next Domino to Fall? Part I

Riding the Tsunami of Secularism

In Proverbs 8: 35-36 we read:

For whoever finds me finds life
    and obtains favour from the Lord,
but he who fails to find me injures himself;
    all who hate me love death.

The extended context is one of Wisdom being personified.  It speaks of how God's wisdom is immanent throughout the creation.  Consequently, those who "dismiss" God from their lives end up hating life and loving death.  Proverbs 8: 35-36 is a fearful condemnation, for it indicts the smart and intelligent as well as the ignorant and the brutish.

In the West we have seen how this works out at the extreme end of the spectrum.  Literally.  Abortion is a love affair with death and a hatred of new, innocent life.  It deploys an entire infrastructure and industry devoted to death in the name of human rights.  It is celebrated by those who hate God's wisdom as a profound respect for life (the "mother's").  It loves the death of the child.  It cheers and celebrates the murder of the defenceless, innocent child.  Surely our culture hates God.  Surely it loves death.

In New Zealand we are about to debate (and probably legislate) another preference for death over life.  "Assisted dying" is likely to be approved by our Parliament, and made the law of the land.  One can see the logic.

The Contrarian Mind

. . . Achievable with Love, Morphine, and Whisky

There is a lot to be said for a contrarian mind.  In fact, as Douglas Wilson has observed, in a prevailing secular humanist clime, having a contrarian mind is arguably a basic requirement for Christian living.

Urbane contrarians, particularly those with a merry impishness, are national treasures.  He is an example:

Dying of cancer is the "best death" and we should "stop wasting billions trying to cure" it, a leading doctor has said.  Dr Richard Smith, a former editor of the British Medical Journal, said that cancer allowed people to say goodbye and prepare for death and was therefore preferable to sudden death, death from organ failure or "the long, slow death from dementia". . . .

"You can say goodbye, reflect on your life, leave last messages, perhaps visit special places for a last time, listen to favourite pieces of music, read loved poems, and prepare, according to your beliefs, to meet your maker or enjoy eternal oblivion," Dr Smith wrote in a blog published for the BMJ, a journal he edited until 2004.  "This is, I recognise, a romantic view of dying, but it is achievable with love, morphine, and whisky. But stay away from overambitious oncologists, and let's stop wasting billions trying to cure cancer, potentially leaving us to die a much more horrible death," he wrote.

One up for contrarians!

Death and Dying

The Importance of Hospice-Type Care

There is an important article about to be published in The New Yorker on how modern technological medicine has often made the last months and days of life so much harder and more difficult. The advanced technological procedures have also made it much, much more expensive. The article is entitled Letting Go: What should medicine do when it can’t save your life? and is by Atul Gawande, a surgeon.

The following excerpts give the general themes.

This is the moment in Sara’s story that poses a fundamental question for everyone living in the era of modern medicine: What do we want Sara and her doctors to do now? Or, to put it another way, if you were the one who had metastatic cancer—or, for that matter, a similarly advanced case of emphysema or congestive heart failure—what would you want your doctors to do?

The issue has become pressing, in recent years, for reasons of expense. The soaring cost of health care is the greatest threat to the country’s long-term solvency, and the terminally ill account for a lot of it. Twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.

Spending on a disease like cancer tends to follow a particular pattern. There are high initial costs as the cancer is treated, and then, if all goes well, these costs taper off. Medical spending for a breast-cancer survivor, for instance, averaged an estimated fifty-four thousand dollars in 2003, the vast majority of it for the initial diagnostic testing, surgery, and, where necessary, radiation and chemotherapy. For a patient with a fatal version of the disease, though, the cost curve is U-shaped, rising again toward the end—to an average of sixty-three thousand dollars during the last six months of life with an incurable breast cancer. Our medical system is excellent at trying to stave off death with eight-thousand-dollar-a-month chemotherapy, three-thousand-dollar-a-day intensive care, five-thousand-dollar-an-hour surgery. But, ultimately, death comes, and no one is good at knowing when to stop.

In the first Christendom, dying was a much more natural part of life, with a prescribed set of procedures.

Dying used to be accompanied by a prescribed set of customs. Guides to ars moriendi, the art of dying, were extraordinarily popular; a 1415 medieval Latin text was reprinted in more than a hundred editions across Europe. Reaffirming one’s faith, repenting one’s sins, and letting go of one’s worldly possessions and desires were crucial, and the guides provided families with prayers and questions for the dying in order to put them in the right frame of mind during their final hours. Last words came to hold a particular place of reverence.

Contrast the modern approach, where death occurs within an Unbelieving secular humanist context:

These days, swift catastrophic illness is the exception; for most people, death comes only after long medical struggle with an incurable condition—advanced cancer, progressive organ failure (usually the heart, kidney, or liver), or the multiple debilities of very old age. In all such cases, death is certain, but the timing isn’t. So everyone struggles with this uncertainty—with how, and when, to accept that the battle is lost. As for last words, they hardly seem to exist anymore. Technology sustains our organs until we are well past the point of awareness and coherence. Besides, how do you attend to the thoughts and concerns of the dying when medicine has made it almost impossible to be sure who the dying even are? Is someone with terminal cancer, dementia, incurable congestive heart failure dying, exactly?

Gawande offers the following contrast between palliative or hospice care and remedial care:

“That’s not the goal,” Creed said. The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focussing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.

Moreover, sometimes palliative care can prolong life, along with less pain and suffering.

Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer. When Cox was transferred to hospice care, her doctors thought that she wouldn’t live much longer than a few weeks. With the supportive hospice therapy she received, she had already lived for a year.

Here is the concluding summary:

The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.

More often, these days, medicine seems to supply neither Custers nor Lees. We are increasingly the generals who march the soldiers onward, saying all the while, “You let me know when you want to stop.” All-out treatment, we tell the terminally ill, is a train you can get off at any time—just say when. But for most patients and their families this is asking too much. They remain riven by doubt and fear and desperation; some are deluded by a fantasy of what medical science can achieve. But our responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and to escape a warehoused oblivion that few really want.