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Our lives have a starting point and an ending point. In other words, mortality is the basis of our evolutionary biology. Just as life plays an integral role in reproduction, so does death. Imagine a world with immortal beings; the hypothetical consequences of this would be an increased fertility rate and an overcrowded environment, leading to a fight for limited resources. Death is the regulator for this eventual chaos. Our bodies are wired to only live to a certain point until they can no longer hold. Death also plays a very important role in natural selection, or the process by which organisms better adapted to their environment have the best survival rates.

Order is restored if mutations that harm the eldest groups are also mildly damaging to younger individuals. In this case, natural selection prevents too many problematic mutations collecting over time.

– Adam Kucharski

So albeit the evolutionary requirement of it and its necessity for regulation, why do we stigmatize death so much? There are many elderly patients who have to sit in the Intensive Care Unit (ICU), living a slow, painful, dragged death, as their nurses give them another cocktail of medications to gulp.

Photo by Melanie Wathugala
Photo by Melanie Wathugala

There are many stories of patients only suffering even more from medical treatment. As humans age, their biological processes begin to malfunction—and modern medicine is compelled to treat that malfunction. The treatment philosophy seems humane and benign on the surface, but if we delve deeper, we find that it is not always so.

The experience of Katy Butler with her father’s deteriorating health offers a perspective on the prolonging of death.

My father Jeffrey—a retired Wesleyan University professor who’d tossed me laughing into the air when I was a baby and taught me to read when I was four—had suffered a devastating stroke at the age of 79. A year later, to correct a slow heartbeat, he’d been casually outfitted with a pacemaker that kept his heart going until his life became a curse to him rather than a blessing. He’d told my mother, “I’m living too long.”

By the time the hellish summer of 2006 arrived, he was 84 and I’d come to believe that his pacemaker should never have been installed at all. The man I loved more than any other was going blind and falling into dementia. He did not understand the purpose of a dinner napkin and when I visited, I had to coach him to take off his slippers before he tried to put on his shoes. In June, he spent an entire weekend brushing and re-brushing his teeth. In August, he suffered a brain hemorrhage, fell in the driveway, and spent nearly a week in Yale-New Haven hospital, where he suffered a terrible form of cognitive decompensation, often afflicting the elderly, known as “hospital delirium.” When he came home, he asked my brother Michael why the living room was filling up with leaves.

–  Katy Butler

This personal account shows the accumulation of health problems in an elderly man. Katy’s father started off with a pacemaker, and eventually ended up with a cascade of other health issues that essentially took away his ability to live comfortably. A man who started to hallucinate and lose both memory and eyesight cannot live his few, remaining moments of life peacefully. His life is dragged on by the medications and medical installations. Katy and her mother have to see him suffer on a daily basis. They cannot just turn off the pacemaker or cut off his medications, since that would be considered a crime. He has to bear the brunt of a slow, painful death.

There is always a clash between doctors and patients’ families. Sometimes, the family presses on, at times even with legal action, to save a relative’s life, while the doctor insists that nothing can be done. Most of the time, family members keep the dying alive. This implies that the vast majority of the elderly do not even have a say in their will to live or die. Their family members’ decision to keep them alive for as long as possible is what really drives this slow, torturous, painful death. Rather than having a natural death, their suffering is only prolonged by the different medications that their doctors prescribe them.

The only way to override this doctor-patient’s family “clash” is to assess the severity of the patient’s condition, itself. In the United States, there exists a Physician Order for Life-Sustaining Treatment (POLST), which applies to patients whose life expectancy is within a year. The POLST is different from a Do Not Resuscitate (DNR) order in that the patient now has control of his/her end-of-life treatment; it essentially acknowledges the patient’s wishes, without any external intervention. This essentially puts an end to external control (such as family) over the patient’s life by allowing the patient to choose his/her direction of treatment for the final days. In other words, any doctor-patient’s family clash cannot be justified since the dying patient had already requested a POLST.

So, this is the dilemma of modern medicine: should we deny treatment to the severely ill, or should we treat them for the sake of their families’ happiness? The discourse around this issue is on whether to let the body take its natural path or to set it on a certain path to satisfy probably everyone but the patient. We see that life and death are the bread and butter in the evolutionary perspective, yet our medical practices still somehow aim to delay the death aspect.

Featured Image by Melanie Wathugala

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