In the Midst of Life

far, far stronger than the rational mind, and when the time comes, instinct will win. People will consent to operations that will keep them alive for a bit longer, or take pills that they know will prolong their infirmities, though they know in their hearts that it is the fear of death that drives.
    In the natural course of events, the period when death is taking over a body is fairly brief. My grandfather (who had no medication) had about a fortnight of this period in his life. Today it can drag on for months or years.
    I spent twenty years in medicine, and I loved every minute of it. For me, it was a vocation and a privilege, working with the sick and the dying. To cure the sick was a joy, and exhilarating. To ease the process of dying was a sacred duty. I respect and admire the medical profession more than can be expressed. And I lament the sublime irony that the profession that has cured so much disease, and enhanced the quality of life for millions of people has, through its own success, been the instrument of distress at the end of life.
    Healing the sick used to be described as ‘the art and science of medicine’. Recently I have heard it called ‘the science and technology of medicine’.
    In the last fifty years medicine has changed profoundly. The scientific advances in pharmacology, made by multinational drug companies, are mind-blowing. The technology of medical treatment has advanced exponentially, and this will continue. Surgery and anaesthetics are such that staggering things can be achieved. And all is directed towards preserving life. This is what most people want, expect and sometimes demand, as though we have an intrinsic right to good health. In a post-religious age we place vast and unmerited confidence in the powers of medicine. When someone goes into hospital, it is expected that the doctors will be able to cure whatever is wrong. If they cannot, there is often a sense of outrage amongst aggrieved relatives. Even if someone is ready to go, relatives often feel that death cannot simply be allowedto take its course. They do not realise how quickly active old age can slip into extreme old age and imminent death.
    If you look out for it, you will find in many local newspapers an indignant relative telling a story to an editor, who can see a good front page headline: ‘Hospital allows Dad to Die!’ This will be accompanied by a picture of a tearful woman holding up a photo of Dad. Then follows the story that the old man was around ninety, had had a heart attack or a stroke, or perhaps had broken a major bone, which had led to immobility, and in consequence he had developed a lung or kidney infection and died. The relatives claim, ‘It shouldn’t have happened. It was sheer neglect. He was in good health, enjoying life. He shouldn’t have been allowed to die like that. I blame the hospital.’
    Doctors and nurses are the first to see the futility of strenuous intervention, but the fear of legal action can drive them into what is known as ‘defensive medicine’. This is bad medicine. The beleaguered doctors and nurses feel unable to make a decision based solely on professional judgement. They must always temper it with the thought that a decision or action might lead to an accusation of professional incompetence or neglect, or worse. Hospital practice today is driven by this necessity, and even if death is inevitable, doctors and nurses must be able to
prove
that they made every effort to prevent it. This is widely expected, nay demanded, by the general public and the law.
    If people were with their elderly relatives all the time, day and night, as nurses are, they would be able to see for themselves the suffering and manifold indignities caused by the strenuous efforts to maintain life. Then perhaps they would be more inclined to say, ‘Enough is enough – and no more.’ Such a statement from a layman to a medical team is, I know, incredibly difficult. But the professions will usually accept it, and frequently with relief and gratitude.
    Not infrequently an elaborate game of double-bluff is going on. Medical teams find it hard to suggest ‘no more, this is futile’ because they fear the reaction of relatives; at the same moment, relatives are perhaps thinking the same thing, but feel constrainedfrom saying so in case someone thinks them callous or avaricious. No one will speak openly and truthfully. And whilst this is going on, a helpless old person at the end of life is unable to