Note: The text below is a spontaneous response to a very touching poem that appeared in JAMA. You can read it here.
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Dying is one of the most personal events in one’s life. Dying in hospital is actually rarely indicated. What that actually means is that getting hospitalised during one person’s final health deterioration is rarely beneficial (with whatever criteria one may judge that and from whoever’s point of view). People should be informed of that and of the limits in what medical care can achieve.
Medicalising death is another example of our current culture of easy/practical transfer of responsibility to the “experts”. But, the experts in that situation are not doctors, but rather family and friends (and perhaps a caring nurse). I have personally felt as awkward (and more) as the doctor in the poem (see link) almost in all such times. “I shouldn’t be here” and “The patient shouldn’t be here” are some of my thoughts. Indeed, I highly suspect that the patient in the poem was wrongly hospitalised.
The dying person does not need another blood sample taken from his hairlike veins to diagnose his deteriorating renal failure, nor another stethoscope on his sweating back to confirm the limited air coming in. The dying person needs love and compassion. Even if good nursing care is important (depending on the individual case), that rarely justifies getting hospitalised in acute care hospitals. Facing death with more open eyes and less closed (hospital) doors would be a big step of maturation, both personally and socially.
The same holds true for many other examples of modern medicalisation, with birth of course being the prototype of that fallacy. Indeed, a birthing woman does not need a highly trained, busy obstetrician next to her, but rather her partner along with a caring, experienced midwife. A birthing woman (and her partner of course) should experience in full their life changing transformation from a woman/man to a mother/father. And of course this cannot happen if the emphasis is on anaesthesia, iv lines, induction of labour, enemas, shaving of the genital area, “daddy, you stay out now”, and other not much talked daily practices.
Again, that requires a qualitative change in how we view such life events. And of course, that can only happen with doctors explaining clearly and in more detail all the above to laypeople. And that, in turn, can only happen if doctors (re)learn to use their feelings along with their scientific training.
© Kostis Tsarpalis, April 2015
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