Monday, January 10, 2011

Moving beyond death panels

It’s too bad Jacques Ellul hasn’t made Sarah Palin’s reading list. Given her public agitation over death panels, Palin might find some peace about end-of-life dynamics by reading a little of this 20th century French philosopher and Christian anarchist.

Ellul didn’t write a lot about health and medicine, but he did critique the means by which modern technology in general erodes human freedom and the Christian faith. He observed that technology has become the defining force of the social order in which efficiency is no longer an option but a necessity imposed on all human activity. If Ellul was here to be asked whether he’d have the courage to pull the plug on a comatose mother or father, he might question whether they should have been put on life-support in the first place. Palin and other opportunists who have used the specter of “death panels” to politically bludgeon ObamaCare should pause to consider the context in which people make decisions involving life, death and technology. I'm persuaded that medical professionals and administrators tend more toward the error of sustaining life beyond reasonable limits than to trying to end it. Our problem is too much medical intervention rather than too little.

There is a dynamic to biomedicine, Ellul writes, that “generates hope and provokes faith.” He does not mean this as a compliment. Healthcare that is efficiency oriented and technologically driven likes to “clothe itself in things that do not belong to it, to wear praise and recognition that belongs to God.” This hubris has driven the transformation of medicine into an idol. Our hospitals and clinics have become our temples. Writing a half-century ago, Ellul observed that biomedicine stands defiant against accepting the fragility and contingency of the human situation. He knew nothing of PET scanners, genetic testing, targeted cancer therapy or stem cell transplants—just to name a few of the new technologies that have upped the ante in our quest for immortality. Ellul would not be surprised, however, at where we have arrived. In the absence of trust in a transcendent God, who gives purpose and meaning to all of life, we have but our machines and our diversions to fill the spiritual void.

The issue we’re wrestling with in the U.S. is not healthcare reform per se but rather finance reform: how we pay for the extravagant system we already have. It’s the nature of this system that should be dissected and examined, but instead we get derailed by the connivance of people who would worry us about Medicare “death panels” and hysteria over who gets to decide when and how we die. It won’t happen while Congress does battle, once again, over healthcare payment issues, but what we must eventually face honestly is what our system actually accomplishes. Why do we lavish the resources upon it that we do, and what do we get in return? If biomedicine was truly satisfying our physical and emotional needs, there wouldn’t be such a rush to alternative healing practices. Our increasingly sophisticated technologies can't resolve end-of-life uncertainties, despite the trust we place in them. I’ve known many radiologists over the years, and while their talent at interpreting anatomic and physiologic markers can seem almost mystical, their diagnoses are more fallible than anyone will admit. Likewise, I can state from experience that oncologists and surgeons are not the high priests we might wish them to be. We must look elsewhere for release from the fears that gnaw at our souls.

It’s not popular to assert essential truths of the human condition: we suffer pain, we are afflicted with certain impairments, and we certainly will die. Some undergo greater pain, some more debilitating disorders, but we all equally face death. Nevertheless, as a culture we are mesmerized by the glitter of high-tech solutions to what ails us. We pathetically believe in fix-it drugs, we mistakenly think all pain is an evil to be suppressed, and we seek to postpone death at almost any cost. This is the assumption that underlies our attempts to make our medical care more efficient, however politically problematic this may be. What’s not up for consideration is critical, systematic consideration of the many wonders of modern medicine and whether the entire biomedical enterprise deserves the status it's been afforded. And with the exception of cranky philosophers, no one is asking how all of this technology enhances what it means to be human. We no longer expect to find meaning in faith communities (religious or otherwise) so have instead sought everlasting life through medical engineering and the pharmacopoeia.

As a practical example, it’s instructive to make note of the outcry over the Food and Drug Administration’s decision to revoke its regulatory approval of Avastin for metastatic breast cancer. Withdrawing a cancer drug is almost never done, and the FDA has been condemned by patient advocates (and drug companies) for becoming entangled in the political struggle over healthcare spending and effectiveness. My point is not that this treatment doesn’t help people; it apparently can extend the lives of some women with advanced breast cancer. But like many costly cancer drugs, it has a terrible side-effect: the ultimate failure of hope and faith that's placed in technology alone. Avastin does not cure, but that hasn’t kept it from becoming the world’s best-selling cancer drug (sales of almost $1 billion for breast cancer patients alone). It’s because of our fear of death that we have been seduced by technologies and drugs that can’t give us what we most long for: meaning, transcendence, love. Our drug addiction, at best, can only buy us time. It can’t buy peace.

I don’t wish to romanticize suffering; I’d rather cultivate the art of living. We do this in part by shifting our gaze from what can be done for us by biomedicine, with its depersonalized manipulation and management of our existence, to the radical liberty of living outside of a reductionist understanding of “health.” In Ellulian terms, we can profane the power of technology by denying it our obesiance. It’s better that hope not be assigned to what can’t ultimately save us, and to look instead to the life-giving source of all that is good. The difficulty of making medical decisions at the end of life shouldn't be treated lightly. But neither should the pathway go untraveled that leads to bold living in a world crippled by a fear of death. There would be no need for political posturing over healthcare finance or chatter over “death panels” if we placed our faith in that which is beyond ourselves. Drugs and technology at any cost, or even at no cost, will not make us well in the way that matters most. The care that we provide to one another, especially at moments of injury, accident and death, just might. This is where we must look for the light of God--not at the end of some MRI tunnel.


grsmouse said...


Having been involved in the medical picture in various ways since age 10, spending many hours with people suffering and dying, I must say, "Amen, Amen, Amen". When I die, please say, "He died". And please do not keep me alive when I am no longer living. Better quit before I begin preaching!


Britt Conroy said...


Thank you for sharing your reflections.