The seriously ill, the traumatized, and accident victims, strong in their common weaknesses, manifest their freedom with regard to what had previously put them in the category of subcitizens, those receiving assistance. They are fighting against the segregation that made them lepers, bearers of bad news. They are fighting to remain members of the human community.
The current case in the spotlight is Baby Joseph Maraachli. He suffers from a “progressively deteriorating neurological condition” of unknown origin and is in a permanent vegetative state. He is 13 months old. A court in Ontario ruled that the health center treating Baby Joseph could remove the breathing tube keeping him alive. The parents have transferred the child to a hospital in St. Louis, where he will receive a tracheotomy.
Thaddeus Pope quotes this sentence from a 1988 letter to the editor of The New England Journal of Medicine.
“It seems we have lost sight of the difference between patients who die because their hearts stop and patients whose hearts stop because they are dying.”
Today we no longer stop to make that distinction.
The New Yorker published a beautiful piece by Joyce Carol Oates on the death of her husband, Raymond Smith. Oates and Smith, who had been married 48 years, were in a car accident three years ago. The engine of their car was struck at high impact from the side, and their airbags inflated. Both Oates and Smith walked away from the scene, feeling lucky to be alive.
I tried to explain that my colleagues and I needed to know the cause of the accidents and the nature of the trauma. Then a bearded tall man approached me “ask me!” he said. I immediately recognised the “plainclothes”. “I wanted to know”, I began. He locked his intense hatred into my eyes. “You have no right to ask any question. At least if you don’t want to join them.” And he pointed to the line of the victims lying on the beds and on the floor.
It might be thought the height of poor taste to ascribe good fortune to a healthy man with a young family struck down at the age of sixty by an incurable degenerative disorder from which he must shortly die. But there is more than one sort of luck. To fall prey to a motor neuron disease is surely to have offended the Gods at some point, and there is nothing more to be said. But if you must suffer thus, better to have a well-stocked head.
In one of the best scenes of the episode, medical professionals are standing by in the operating room, ready to receive the organs that are about to be removed. Chief Resident Miranda Bailey — my favorite character (played by Chandra Wilson) — is emotionally distraught at the loss of George. She asks for information about the destination of the eyes, the liver, the heart. The details of the organ donations – the benefits they will bring to the particular children and adults who have been waiting and hoping for this opportunity – are quite moving.
The American Psychiatric Association (APA) is in the process of revising the Diagnostic and Statistical Manual of Mental Disorders (DSM) – the psychiatrist’s bible. Its last incarnation — known as DSM IV — was published in 2000. The new version will be DSM V. … One item in dispute is whether bereavement – the grieving process that follows the loss of a loved one – might qualify a patient for the DSM label Major Depressive Episode.
I have no idea where I’ll be next month. I could be silent. I could be dead. I could be exactly like this. I could be in a variety of stages. But I know, absolutely with certainty – within reason – that I’ll be dead in five years. And that reversal of consciousness means that I am very focused upon life in the next two weeks.
Between those late 19th century discussions of euthanasia as mercy killing and 1975, when Balfour Mount introduced the term palliative care, there was no name for supportive care of the dying. Without a name, there could be no specialists in the subject, no professors to teach it, no training for physicians. There was little discussion of the subject in medical schools. Without a name, the subject could not be indexed and researched in medical literature. There could be no advances in knowledge or improvement in techniques.
“Why is it that here in the United States we have such difficulty even imagining a different sort of society from the one whose dysfunctions and inequalities trouble us so?” he asked from his wheelchair.
The vocal muscle, for sixty years my reliable alter ego, is failing. Communication, performance, assertion: these are now my weakest assets. Translating being into thought, thought into words, and words into communication will soon be beyond me and I shall be confined to the rhetorical landscape of my interior reflections.
[O]ur responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come—and to escape a warehoused oblivion that few really want.
Considering the two wars were declared and waged with scant attention to their full costs, lawmakers add insult to injury by invoking budget concerns for the traumatic needs of actual warriors.
… “The real question is, why don’t we care anymore?”
There is a great injustice at the heart of the whole process of exploiting cheap labor to make the must-have googaws for the world’s affluent. Every suicide at a Chinese factory is an exclamation point at the end of that last sentence. Both the Chinese and international media know this, and so do Apple and HP and Dell and Foxconn’s top CEO, Terry Gou. It just doesn’t look good when your employees start jumping out of windows in steadily increasing numbers. It is a sign that something is very, very wrong in how humans are organizing themselves on this planet. We don’t want to think about it when we’re playing with our smart phones, or reading the new Wired app on our iPads, but it’s the truth, and it bears constant investigation.
There have always been people who wish they were dead, or who have thoughts about voluntary death. But nobody used to be directly encouraged to die. In conventional media, if somebody wrote or said: “I want to die”, the most probable answer was: “Hold on, don’t die!” On the contrary, in the Internet, everybody feels free to write whatever they please under a false name. The moment somebody mentions the intention of committing suicide, original words appear immediately and make their way to the suicide candidate. Horrible words and expressions such as “you are worthless”, “you are dead”, “you don’t deserve to live”, “the world is better off without you” start to appear. … In the Internet’s post modern world, words loose their link with the person responsible for them. … One of the most popular pages for the prevention of suicides had to lower the rule that users only could participate for a maximum 30 minutes, in order to prevent negative emotions from expanding.
