Crossing That Dark River

Often in the sturm und drang of a world gone mad, there comes, through the chaos and insanity, some brief moment of clarity. Such times pass by quickly, and are quickly forgotten — as this brief instance might have been, courtesy of my neighboring bellweather state of Oregon: (HT: Hot Air)

Last month her lung cancer, in remission for about two years, was back. After her oncologist prescribed a cancer drug that could slow the cancer growth and extend her life, [Barbara] Wagner was notified that the Oregon Health Plan wouldn \'t cover it.
 
It would cover comfort and care, including, if she chose, doctor-assisted suicide.
 
… Treatment of advanced cancer meant to prolong life, or change the course of this disease, is not covered by the Oregon Health Plan, said the unsigned letter Wagner received from LIPA, the Eugene company that administers the plan in Lane County.

Officials of LIPA and the state policy-making Health Services Commission say they \'ve not changed how they cover treatment of recurrent cancer.

But local oncologists say they \'ve seen a change and that their Oregon Health Plan patients with advanced cancer no longer get coverage for chemotherapy if it is considered comfort care.

It doesn \'t adhere to the standards of care set out in the oncology community, said Dr. John Caton, an oncologist at Willamette Valley Cancer Center.

Studies have found that chemotherapy can decrease pain and time spent in the hospital and increases quality of life, Caton said.

The Oregon Health Plan started out rationing health care in 1994.

We have, at last, arrived. The destination was never much in doubt — once the threshold of medical manslaughter had been breached, wrapped as always in comforting words of compassion and dignity, it was only a matter of time before our pragmatism trumped our principles. Once the absolute that physicians should be healers not hangmen was heaved overboard, it was inevitable that the relentless march of relativism would reach its logical port of call.

Death, after all, is expensive — the most expensive thing in life. It was not always so. In remote pasts, it was the very currency of life, short and brutal, with man’s primitive intellect sufficient solely to deal out death, not to defer it. There followed upon this time some glimmer of light and hope, wherein death’s timetable remained unfettered, but its stranglehold and certainty were tempered by a new hope and vision of humanity. We became in that time something more than mortal creatures, something extraordinary, an unspeakable treasure entombed within a fragile and decomposing frame. We became, something more than our mortal bodies; we became, something greater than our pain; we became, something whose beauty shown through even the ghastly horrors of the hour of our demise. Our prophets — then heeded — triumphantly thrust their swords through the dark heart of death: “Death, where is your victory? Death, where is your sting?” We became, in that moment, something more than the physical, something greater than our short and brutish mortality. We became, indeed, truly human, for the very first time.

That humanity transcended and transformed all that we were and were to become, making us unique among creation not only in the foreknowledge of our death, but our transcendence of death itself. Life had meaning beyond the grave — and therefore had far more weight at the threshold of the tomb. Suffering became more than mere fate, but rather sacrifice and purification, preparation and salvation. The wholeness of the soul trumped the health of the body; death was transformed from hopeless certainty to triumphant transition.

But we knew better. We pursued the good, only to destroy the best. We set our minds to conquer death, to destroy disease, to end all pain, to become pure and perfect and permanent. We succeeded beyond our wildest dreams. The diseases which slaughtered us were themselves slayed; the illnesses which tortured and tormented us fell before us. Our lives grew long, and healthier, more comfortable, and more productive. Our newfound longevity and greater health gave rise to ever more miracles, allowing us to pour out our intemperate and precipitous riches with drunken abandon upon dreams of death defeated.

Yet on the flanks of our salient there lay waiting the forces which would strangle and surround our triumphant advance. Our supply lines grew thin; the very lifeblood of our armies of science and medicine, that which made our soldiers not machines but men, grew emaciated and hoary, flaccid and frail. We neglected the soul which sustained our science; the spirit which brought healing to medicine grew cachectic and cold.

So here we stand. We have squandered great wealth to defeat death — only to find ourselves impoverished, and turning to death itself for our answers. The succubus we sought to defeat now dominates us, for she is a lusty and insatiable whore. We have sacrificed our humanity, our compassion, our empathy, our humility in the face of a force far greater than ourselves, while forgetting the power and grace and the vision which first led us and empowered us on this grand crusade. Our weapons are now turned upon us; let the slaughter begin.

We will, no doubt, congratulate ourselves on the wealth we save. We will no doubt develop ever more ingenious and efficient means to facilitate our self-immolation while comforting ourselves with our vast knowledge and perceived compassion. Those who treasure life at its end, who find in and through its suffering and debilitation the joy of relationships, and meaning, and mercy, and grace, will become our enemies, for they will siphon off mammon much needed to mitigate the consequences of our madness.

It has been said, once, that where our treasure is, there will our heart be also. We have poured our treasure in untold measure into conquering death — finding succor in our victories, while forgetting how to die. The boatman now awaits us to carry us across that dark river — and we have insufficient moral currency to ignore his call.

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7 thoughts on “Crossing That Dark River

  1. Randy Pausch says it well, pointing out that no one cheats the Grim Reaper by living longer but by living well. His example is one in a million. A good many people consider death to be optional. And for many, thanks to modern medicine, it really is… at least in the short-term. It’s no accident that an unbalnced ration of health care money, even for the impoverished, is lumped at the end of life.

    Those with limited resources need not worry, however. Theirs is a Hobson’s choice. Living longer — whether measured in months, weeks or hours — is not an option. Private enterprise already has a rationing plan in place, eliminating populations most likely to take too large a bite from the bottom line.

    The Oregon example is instructive. Oregon’s health care is not only limited by available funds, it is literally rationed by lottery. In this case, Genentech saw a great PR opportunity and jumped on it. They know about risk-reward analysis better than most. Yay for business enterprise!

    Your main point that moral relativism is leading us to embrace “physician-assisted suicide” is well-made. But from my years working with those sniffily called the “working poor” I see physician-assisted suicide as the medical equivalent of a root canal and crown. Those with the means have that luxury but for many the tooth would have been pulled long before.

  2. Has anyone else noticed that the self-same champions of the “right-to-die” and physician-initiated euthanasia of the elderly and of severely disabled toddlers are also among the most vociferous opponents of the death penalty for murderers?

  3. Ethics are but demographics. If butchers were doctors, medicine would have the ethics of the slaughterhouse – and still be ethical.

    Ethics are not morality; coincidence is mere happenstance.

  4. Hello! I am a second year medical student at the University of Virginia. I am doing a research project this summer on blogs maintained by medical students and physicians and I have really enjoyed reading yours! I wanted to let you know about an online journal at UVA called Hospital Drive, which can be found at http://hospitaldrive.med.virginia.edu/. I think you and your readers would really enjoy reading and perhaps even submitting material to the journal. Happy Reading!

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