It seems to me that most living organisms struggle to stay alive. It seems to be a basic property of a living being to want to live and to keep on living. Most people alive today know that there have been scientific breakthroughs that allowed for amazing things to happen, amazing travel at amazing speeds, amazing experiences such as live tv from the other side of the world and amazing advances in health care. I recently mentioned the book and audiobook "The Demon Under the Microscope" by Thomas Hager. You can't go through the story of World War I soldiers dying from infections and World War II soldiers living to heal without infections and be insensitive to the exaltation that can come from knowing you are on the brink of death and being saved by medical science and skill.
It is a hard fact that an oxygen-burning engine, such as a human body, cannot last forever. In most cases, it can't last 100 years. So, it seems fundamental to face the fact that we will die. In today's world, many of us experience death as something that happens to old people but other eras found death more often at all ages from birth to the last years. Americans have an optimistic can-do tradition and like to pride themselves on their imagination and tenacity. Add all that to the love we feel for our relatives and we have the perfect formula for the current difficulty Gawande discusses in the article linked above.
The financial difficulty is the first layer of the problem. 25% of all Medicare expenses are from treating and caring for people in their last year of life. As long ago as the early 80's, W. Edwards Deming emphasized that the problem of medical care and health-related expenses could easily be a bottomless pit for our wealth, our thought and our energy. The situation is much worse now. Through various relatively simple procedures, medicine can keep many bodies in a state approximating life more or less indefinitely, although what we would call the quality of life for those bodies is very low.
However, you can see how blind obedience to the principle of "keep on trying and never give up" can couple with the current ability to keep people technically alive and result in more and more bodies being mechanically breathed and artificially fed through tubes and put through procedure after grueling procedure, all because no one has the will to say "When", to say "That is enough, we are failing. Stop now!" As his article makes beautifully clear, simple, honest complete conversations with knowledgeable physicians and fact-facing family members can spare months and even years of torture, procedures that still end in death but after isolation, expense for us all and false hopes that cannot be fulfilled.
If you are 60 years old or older, tell everyone you love now that you love them. Don't wait. You can always repeat your statements later if you are still able. Then, talk with your physician and your family about how you want to be treated when you are told you have an incurable condition and that medicine can do nothing more of any practical value for you. That day will come, so work on it now.
