Whose Life Is It Anyways

I am going to allow myself to deviate from my general style of writing which focuses on a medical issue and then technological solutions. In what I am about to describe, there is a slight mention of technology. But, I am writing this as a response to a blog post I just read that deals with end-of-life issues.

It is no surprise to anyone that end-of-life issues are an incredibly sensitive topic. There are religious and cultural overtones that can wreak havoc for the individual who is ill and for the individual’s family and friends. But as medicine improves and doctors succeed in keeping people alive for decades, despite painful and incapacitating disease, everyone needs to overcome their anxiety and fear, and deal with this issue. Otherwise, the results may be disastrous for all involved.

The following is the response that I wrote to a blog post author. As always, I welcome comments and  opinions. This is far from a black-and-white issue, and I respect the fact that my personal opinions and prejudices cannot guide the care of others in an end-of-life situation. I do not give a link to the blog post because I do not want, in any way, to offend the blog author.

“To the blog post author,

Here’s a thought. Have the AMA (American Medical Association) along with its lawyers craft a living will that is 20 pages long and takes into account 99% of possible end-of-life scenarios that occur. Then, have this converted into a website whereby an individual can answer a set of questions for each of these scenarios. For argument’s sake, let’s say there are 75 scenarios within this document. A person would go online, read the scenario and answer a standard question for each scenario, such as:

(a) use heroic measures
(b) provide only pain control
(c) remove all supportive measures
(d) if I am in a state that allows for euthanasia, euthanize me.

Once all of the scenarios are answered, the individual can print the document and sign it.

No document is perfect. Children, who for various reasons (perhaps selfish), are unwilling to respect their parent’s wishes despite their parent’s suffering, will always be able to contest any document. This can be partly dealt with by having all potential legal guardians sign the same document.

This would unquestionably take a serious amount of time and effort. But people spend months, if not years, planning a wedding. Even if it takes a month to review this form, fill it out, and get all the necessary signatures, that is a small price to pay relative to the pain and agony that a person can suffer in an end-of-life scenario.

People don’t like to think about their own death. Doctors need to speak to patients and explain to them that we live in a new reality where people can live decades in a dramatically reduced state of health. I am quoting older people I have met when I say that being 90 years old is no blessing, when every moment of your day is filled with pain.

If you wish, this could even be a new niche for a group of doctors and lawyers, offering end-of-life consultation both from a medical and legal point of view. Such a service could assist the patient with the document I mentioned above, and make sure that all of the necessary signatures are in place. More so, as a service, you could video the entire interaction so that there is no question as to the intent and state of mind of the person signing the document. This same service would keep a copy of all documents and videos, which would be accessible under the necessary circumstances.

I would even imagine that insurance companies would foot part of the bill [if not all of it]. The last few months of a person’s life tend to be incredibly expensive for medical insurance companies. If such a document can reduce overtreatment in a patient at the end of his or her life, this would translate into huge savings for the insurance companies. If the service charges a reasonable amount for everything I have described, I suspect that this could become a win-win situation for everyone involved.

Don’t be a victim. Don’t  wait to deal with these issues. Both the general public and physicians should be extremely proactive in this entire issue.”

I have spoken often of the possibility of intelligent machines replacing the vast majority of what doctors do. When the day eventually comes, when cancer and heart disease and all of the other maladies that are common causes of death, are easily treatable with a single injection or pill, the whole concept of disease will change. The doctor-patient relationship will not have a chance to form, not because of lack of time, but because all disease will have become nothing more than a nuisance.

But until the day comes that we can block death itself, there will be a need for a medical professional to sit and talk with a person to help that person decide on how to manage end-of-life issues. Emotion and empathy will take a very long time to virtualize and implant in a robot or computer. It will be a long time until we can emulate the human soul in silicon. Until that day, medical professionals who understand the medical world, disease and treatments, will be needed to have a soul-to-soul discussion about life and death and the manner of death.

In our present world, we achieve immortality by having or adopting children and then raising them with our set of values. But there are other ways to achieve an equivalent form of immortality. We can write, teach, share our experiences, contribute to others who we know and don’t know. In this type of immortality, our names may be forgotten. But our actions will live on, reflected in the souls of our children and their children and/or everyone we have met.

I have made my end-of-life wishes very clear to my wife [who is in fact an excellent lawyer]. My children who are all now adults also understand my wishes. Take the time to share your wishes with the people who need to know them.

All the best to everyone, have a happy and healthy new year, and most of all …

Thanks for listening.

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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