Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.

In his book Being Mortal: Medicine and What Matters in the End, Atul Gawande, a practicing surgeon, addresses his profession’s ultimate limitation, arguing that quality of life is the desired goal for patients and families. Dr. Gawande suggests that, rather than asking how to extend the life of someone who’s life is nearing its end (due to terminal illness, or simply old age), perhaps we should be asking how to provide a good end to that life.

Craig Boworn, a hospital-based internist in Minneapolis, also broaches this subject in his Washington Post article, “Our Unrealistic Views of Death through a Doctor’s Eyes.”  When speaking to the family of a man with Parkinson’s, heart failure, weak kidneys, anemia, and mild dementia, who just suffered a stroke, Dr. Boworn hopes the family will accept the news that their loved one’s life is nearing its end and not ask him to “use [his] physician superpowers to push the patient’s tired body further down the road, with little thought as to whether the additional suffering to get there will be worth it.”

Both doctors raise a very interesting question: when is “enough?”  We all want our loved ones to live as long as possible, but our culture seems to view death now as a medical failure, rather than a natural conclusion to life.  In Dr. Boworn’s opinion, “[a]t a certain stage of life, aggressive medical treatment can become sanctioned torture.”  Dr. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly and demonstrates that a person’s last weeks or months can be rich and dignified.

If you are caring for a loved one with a terminal disease, including dementia, one of the most important questions you can ask is “what is a life worth living to you?”  For some, it may be eating chocolate ice cream and watch football; for others, an inability to dress or feed themselves may signal the end of a meaningful life.  Everyone’s answers will be different. Really knowing and understanding our loved one’s answer to this question will allow us to help ensure their end of life is as good and meaningful as everything leading up to it.

Cheri Elson, J.D.
Gray Matters Consulting

To read more:
Our Unrealistic Views of Death through a Doctor’s Eyes

Being Mortal: Medicine and What Matters in the End