Immortality Research

“All your patients will die. Maybe not today, but someday.  The defining fact of life is that it ends.  Only a fool would dedicate their career to fighting something that can never be beaten.  Therefore, a doctor’s task cannot be to fight death.  A doctor’s task is to heal when possible and prevent suffering always. Our calling is to support life. Fighting death may deprive patients of the opportunity to live the last part of their lives well or at least on their own terms.”

This is my introduction to a lecture on the importance of quality end-of-life care.  I emphasize the need to be honest about what is happening and what is truly possible.  I urge doctors to give information and support so that patients can cope, rather than the ephemeral hope of excess treatment and tests.  Empower and equip patients to live, as well as possible, during their final days.

Recently, on completing this talk for a group of physicians, we had a talkback session. The discussion ranged from the legal, ethical, and financial, to practical ideas about pain control and treating depression.  These are common concerns among doctors who deal with very sick people and their families.  However, there was one comment, which was not only unique, it gave me disturbing insight into the obstacles we face in providing palliative medicine.

A physician raised his hand and said; “I think that the increasing emphasis on end-of-life in medicine, and among patients, is a dangerous slope.  If we are not careful, it will set us back a hundred years.  When we change from curing, to dying, we are giving up.  We will no longer try to defeat disease.  New medical research will stop.  Hospice does not only mean that individual patients are dying, it also means the end of modern medicine and maybe all of our society.”

OK, I was shocked. This was the strongest, clearest, most twisted argument I have ever heard against end-of-life care. This doctor is saying that you must have it one-way or the other.  Either we fight disease and death with every sinew of our beings, pumping chemotherapy and filtered air into every withered body, seeing death always as failure, or we surrender to the infinite reality that we are mortal, accept the Darwinian facts of our demise, and simply wait to die.

In such a world, where the idea of a terminal diagnosis is blasphemy, the last days of life would be a guinea pig opportunity for experimentation and research.  We would treat until the last drop of blood is consumed.  What would be the ultimate goal of medical research?  Relieve suffering?  Improve quality?  No; if we do not recognize our limits, if we do not seek peace in the face of the inevitable, then the holy grail of medical research will be to fight death itself.  The goal will be immortality.

This is a frightening concept; instead of discovery that seeks to elevate and improve life, we will sacrifice human beings on the gristmill of horrendous fantasy.  There is no limit to the potential for Mengelian butchery when we can justify any price in a goal to become god.

A health care system that does not empower patients with honest choice during the last of their lives, whose core value is not to respect individuals and support their needs, will treat without end and dissect without mercy.  The paradox is that if we do not recognize the absolute nature of death, we devalue the beauty and marvel that is life.



  • Josh B.
    I'm reminded of an excerpt from The Anticipatory Corpse by J.P. Bishop, discussing a woman dying of cancer: For Nancy, death threatened all that she knew as valuable and important, and at the same time, death also brought directly into focus the value and importance of living. Modern medicine, I submit, has failed to respond to this dialectic of life and death in an adequate manner, and its response leads to lives worse than death in the technological manipulation of the dying. In viewing death exclusively as the destruction of meaning, medicine has aimed to do more than alleviate suffering: without realizing it, medicine hides death with technology and dissolves death in discourses. In short, medicine seeks to remove death’s sting from the human community. Yet, like comedic heroes of literary tales, medicine comes along to stop suffering, to help, to bring a little relief, only to make things worse by begetting more and more dehumanization through its technological and psychosocial fixes. ... Thus, death would threaten to take her [Nancy] away from her daughter; death would focus her on staying alive for her daughter. Death would take away all that was important to her, yet all that was important to her came into relief because death was on the immediate horizon. Can medicine with its "fixes" envision death as both destructive of meaning and conducive to it? Can medicine with its "fixes" really manage patients in a way that does not do violence to those things held most sacredly, values that come most clearly into relief in and through the clarity provided by the threat of death?
  • meyati
    I think that I know the name of that doctor. I walked out--- I found an oncologist with an outlook similar to your's
  • Perhaps that doctor and I share a similar fear: It's already tough to get money into the hands of researchers with simple and practical ideas like, for instance the Tulane study (turn out All the light) and the Mayo study to bypass Tamoxifen and help more Bc women stay well. It would be so easy for the purse-holders to start thinking: "They're feeling no pain in over there in hospice, so let's put the money from researching their diseases into something else . . . Everybody wants to go to Heaven, but nobody wants to go prematurely, and palliative care is not without limits.
  • Jim Clear
    Kudos on the authenticity, balance, truth told here.....
  • Iris
    I believe MD's should have a private talk with the patient. Ask this person what he/she would rather have. Answer their questions truthfully. My kids drove me crazy that I wanted to runaway from home. I had it all planned because they put me in a prison. Even though I knew my prognosis from two doctors because I had gotten sick from something else too so the second time this year, I received a poor prognosis. I also had a family didn't follow it. My life is not THEIR life. They were yelling at me. I was a pain, I was causing them heartache....No one thought of my feelings. I had to people here to check me yesterday. I am getting better. The oncology nurse told me there is no way I was still stage 4. They were amazed. I feel the lupus is doing it because my hair is coming out again, but I don't have any repercussions from LC. I just live with SLE. I had it since I was young girl. Let the patient read what patients say about the end of life. Some lucky patients will pass peacefully, but not all. Some can die from the same illness but each body has its own agenda. People tend to forget about what's best for the patient. Some say hi and bye very fast....that's not visiting. Don't be afraid. Write a letter if necessary Thank you, Dr Salwitz, for bringing this discussion up. Don't let the other docs try to talk you down. For patients...........make sure you still have your driver's license.
  • Iris
    Josh, I would adivse you to speak to a neurologist. In fact all MD,s should. Not everyone sees the same thing. You will get more clarity from asking an expert in his/her field
  • Liz
    1) there is no accounting for "stupidity" - no profession is immune 2) personal triggers - be it MD's, counselors, teachers… - can result in behaviors that are not in the patient's/client's/student's best interests. In this case likely that MD was terrified of death and that fear controlled his decisions 3) Glad to hear this comment is unique… because if it was common THAT, from the point of view of many patients, in and of itself would set medicine back...
  • D Someya Reed
    "In such a world, where the idea of a terminal diagnosis is blasphemy, the last days of life would be a guinea pig opportunity for experimentation and research." Have to say, 'been there, done that.' How else would you explain an oncologist who would recommend a 99.9999% assured fatal regimen and expect it to be followed so that he can discover "how much I (he) can learn from your death." But don't stop there because it's possible to have it both ways...also be medical director of a hospice. Then when you're done "guinea pigging" you can have your patients die in your own image (of what a "good" death should be). And if these patients misbehave, you can always withhold their care and threaten them to your heart's content because you know (but they don't) that no one will believe them, it's your word against theirs and besides you can always say they're on drugs and/or grieving. It's even better if you have a second in command as an enforcer (think "I must break you" spoken like Dolph Lundgren in one of those Rocky offense, Dolph). Your second can say things like..."no patient has ever refused to do as requested by one of my staff" and (the patient) "will do as my people ask and I don't care how much pain she's in." The government won't believe you and even if they do, hospice currently saves Medicare a little bit of money per patient so there is no incentive for any agency to intervene. If these "poor misguided souls" (got called that one by the State Hospice and Palliative Care Association) still try to convince someone, just have your attorney send them a letter telling them that none of what they actually saw and experienced really happened (only) because no one has yet to believe them (since no action has been taken against the hospice). What is the name of the logical methodology that supports this assertion? But be sure to add the part about taking action against "them" if they continue to talk about their experience with you. "This is a frightening concept; instead of discovery that seeks to elevate and improve life, we will sacrifice human beings on the gristmill of horrendous fantasy. There is no limit to the potential for Mengelian butchery when we can justify any price in a goal to become god." Yep, learned that's true too. Just as you were shocked, I was equally so at the comment of a physician at a public hearing in our State Capitol on end-of-life. Yeah, I spoke. When I finished he responded by saying that he fully supports hospice because he hears "more good than bad" about their work. Brilliant insight! Perhaps "your" physician should get together with this one. Sorry to be such a broken record but I always allow your words to touch a nerve. Perhaps it's time to stop reading this blog for a while. Does anyone really believe me anyway? Nah, I'm not the kind who gives up.
  • I read this blog in part because of my belief in hospice care. When I read the negative comments above from the "other" physician - I was shocked as well. Hospice care is an evolution in patient care and definitely an expression of love for terminally ill patients. I've recently experienced the same type of shocking comments from my pet's veterinary oncologist who believes her desire to continue drugs, testing and aggressive treatment for as long as possible makes her a hero and extraordinary animal advocate - and me not so much. We no longer see her and my pet and I rely on the love and genuine care and understanding of a primary care vet. The journey got better the day I discontinued seeing the vet oncologist. Thank you Dr. Salwitz for writing this blog. It helps strengthen my belief in hospice care.

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