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Posts Tagged ‘Marcia Angell’

Wiseman_NearD
From Frederick Wiseman’s Near Death

Dear friends and readers,

In a NYRB review (Jan 8, 2015, 72:1), A Better Way Out, Marcia Angell with a few important qualifications heaps praise on Atul Gawande’s latest book on how medicine treats aging and dying, how people sickness, aging, death because of modern medicine’ goals, training, politics: Being Mortal: Medicine and What Matters. I’ve discussed Gawande before (see Realities of Medicine: how misunderstood), and Marcia Angell’s writing several times (see her on privatizing all aspects of medicine) and this review seems to be publicly on-line, available to the public. So let me just call attention just to a central section of the book and one of its silences.

In the book’s “most powerful chapter,” “Letting Go,” Angell reviews the book so as to bring out Gawande’s theme about the deeply inhumane and dishonest way cancer is treated by modern physicians and hospital staffs (and I’d add hospices too). Knowing how bleak an outlook, doctors lie and offer painful maiming operations and immiserating chemotherapies and radiations whose outcome they cannot predict. They make the last months or year of a person’s life an experience of toxic suffering, giving them (as I know too well) no opportunity to decide to enjoy what they can of their last months. She does not mention that if you refuse the doctor’s treatments, they tell you to go away; they will not provide half-way or palliative care to enable you to carry on in your own way. It’s all or nothing. It’s also highly exploitative. A multi-million edifice for its practitioners and drug companies. A friend told me recently about The Confessions of a Surgeon by Paul Ruggieri where he exposes the pressure put on doctors to recommend operations in order to make huge sums for hospitals (a brief inadequate review). Statistics quoted include physicians on average telling terminally ill patients they will live 5 times longer than they do; those who can find a palliative specialist and stop chemotherapy very early, having no operation, live about 25 per cent longer than those who submit to these treatments.

Do read Angell’s essay. Everything she writes is worth reading and thinking about.

She faults him in two areas: the first is money. He hardly ever discusses money in his writing: yes there are a couple of essays where he discusses money and the way medicine is delivered generally, and advocates moving gradually to a single-payer system, but since what drives each and every encounter between patient and medical person is a fee (and often hefty) this kind of general discussion doesn’t begin to get near the problems (see Money-Driven Medicine). Worse he gives a superficial and prejudiced account of physician-assisted dying: he is against it — he is strongly for high-tech solutions when he thinks they provide a “good outcome;” she points out there is no evidence in any of the US or European states where such practices have begun that assisted dying is resorted to unless the patient decides for it. That Gawande calls this resort a measure of failure shows how somewhere deep in himself he has not accepted the inferences of his own arguments; he may know enough not to use the metaphors of bravery and courage, and heroism (which should have no place in discussions of killing and therefore painful diseases) but he thinks of the decision to die rather than live through a hideous self-destruction unacceptable. Why? when he himself has said it’s not a question of life once it’s most cancers: life’s not on offer, occasionally it is a question of prolonging life (and this is where patients get sucked in, especially when young); for most it quickly enough becomes how and when and where the person dies.

That latter was Jim’s phrase when at first he wanted to do nothing. I couldn’t face his death, and I should have and proposed we go on a trip, and he try to have the best last few months he could. And then he couldn’t face it either.

Endings matter, for animals too.

home-remedies-for-cats
A sick kitten being cared for

Sylvia

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