Monday, 2 August 2010

What Kind of Life Would You Settle For? Questions about How to Treat Life-Changing illness

At the moment we have a dear friend who is up against a progressive cancer, and who is being treated more and more agressively. Her hope is to get a few more years of active life, but from the viewpoint of an observer, it seems that she might be chasing an illusive dream. The treatment is devastating and so far the results are not promising. The question is: would she be better off to spend what time she has left receiving supportive care, and not to submit to such drastic stuff.

We can not enter into that discussion, being merely friends, but two articles this week provide a good frame for reflection. The first is in today's Le Devoir, detailing a study at Montreal's Jewish General Hospital which suggests that two out of three cancer patients there receive drug therapy where one or more of the drugs may exacerbate problems.

The second is a thoughtful essay in The New Yorker by Atul Gawande, entitled "Letting Go: What Should Medicine Do When It Can't Save Your Life?" One of the chief things he mentions is the need to discuss exactly what one expects from treatment, and to weigh the consequences of treatment. One of the anecdotes he recounts is about a doctor whose father who had become quadriplegic. What kind of minimum life would he settle for: to be able to eat chocolate ice cream and watch football on television was the reply. Therefore a series of interventions were ordered which resulted in his survival--for ten years, during which he wrote several articles and did much more than his minimum desiderata. But at one point, it all became too much, and he elected to stop treatment in order to die in peace.

Big questions, not necessarily welcome on a lovely summer day, but ones which we all will have to face.

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