Matters of Life and Death
CDH Physician Co-authors Book Exposing the ‘Real Costs’ of End-of-life Care
Dr. Lindsay Rockwell, a medical oncologist and hematologist at Cooley Dickinson Hospital, says societys concept of dying has been altered by life-saving technology, and not always for the better. In a book she co-authored, Rockwell argues that the medical system has fallen off course by refusing to embrace the natural course of life in the name of delaying death at all costs.
She calls it the the medicalization of dying.
Thats the phrase that Dr. Lindsay Rockwell, a medical oncologist and hematologist and member of the staff at Cooley Dickinson Hospital, along with co-author Dr. Kenneth Fisher, put out for discussion in their book In Defiance of Death: Exposing the Real Costs of End-of-Life Care.
The terminology is used by the two physicians to summarize how they believe that the medical system has fallen off course, as Rockwell puts it, on the matters of death, and the technology that can delay it.
By taking a historical look at death and how we die, we notice that technology has removed us from the natural process of dying by, in some cases, prolonging life, Rockwell told BusinessWest, adding that this is not a recent phenomenon, per se, but it has been heightened by advances in science and medical treatment.
Summarizing the books basic thesis, Rockwell said she and Fisher, a nephrology consultant for the Borgess and Bronson Hospital in Kalamazoo, Mich., contend that, in too many cases, physicians tend to equate death with failure when, in some cases, it should not be considered that.
We have, as a medical culture, moved away from being able to differentiate when it is time to allow the bodys natural process of death to occur and when it is appropriate to intervene and sometimes that line becomes blurred, she explained. So much of our training as a physician is in keeping people alive because, well, life is good.
Sometimes, the appropriateness of that gets lost or obscured in the context of thinking that death is a failure because life is better, she continued. So much of our society views death as something to be avoided, rather than as something that can be embraced as much as any other part of life.
Physicians get caught up in all this, especially the notion of death as failure, she said, and thus she believes they have a large role in somehow changing this perception when it is appropriate.
I really dont think doctors are bad people I dont think they mean to do things to make money and prolong suffering, she explained. But the I think the system has so much momentum that the physician gets lost, and the physicians ideals and priorities get lost amid the momentum of that machine.
Rockwell said she hopes the book, published by Praeger Publishers and now available on Amazon.com, will generate a dialogue within the medical community, but also outside it, involving the public, business leaders, government, and religious leaders.
In this issue, BusinessWest talks with Rockwell about what prompted her book, and what impact she hopes in can make with regard to matters involving life and death.
By the Book
Rockwell says she took a rather circuitous route to her work as an oncologist.
Intrigued by science and medicine, she took a job during high school as a research assistant at Memorial Sloan-Kettering Cancer Center in New York. I was on my way to medical school, as far as I was concerned, she said. I was interested in doing very benchy, molecular stuff, but then I spent a month in a lab and became quite disheartened; I spent that time injecting animals with DNA samples and killing them. So I said to myself, no, I dont think this is what I want.
So instead of medicine, Rockwell went into the arts, specifically work in theater in choreography, and stayed in that realm for 15 years. But then her closest cousin died of leukemia.
That had a huge impact on me we grew up together, she explained. And that brought me back to my original dream of doing cancer work, so I decided to try again. She attended the University of New England in Maine and its College of Osteopathic Medicine. And it wasnt long before she identified her intended specialty oncology.
While in residency, Rockwell wrote several papers on the issues surrounding death and dying, and one of them was published in the Journal of Clinical Oncology. It was this piece that she took to the Harvard Physician Writers Conference a few years ago, where she met Fisher and was ultimately put with him for a larger examination of the subject.
We went to the conference with the intention of writing essentially the same book, only we didnt know it, she explained. We were in a small writers group together, and when Prager heard about my work and then heard about his work and ideas, they said, you need him and he needs you.
They collaborated on In Defiance of Death: Exposing the Real Costs of End-of-Life Care, a title that really hits at their basic premise that Americas defiance of death, as the authors call it, is simply too costly.
And there are many different costs associated with defying death and extending life, she contends, noting that there are financial costs that must be borne by everyone, and, in many cases, quality-of-life issues facing those who see their lives extended by science.
As our technology has become so amazing, we are now more seduced by the ability of that technology to prolong life, said Rockwell, when in fact the life that were prolonging is a life without quality or a human being behind it.
The question is where and how do we differentiate between prolonging life and prolonging suffering?
When asked about who has the ultimate responsibility for determining when death should come meaning the physician or the patient Rockwell acknowledged that this is a hard question, and that, ultimately, both parties have, or should have, definitive roles. And the assignment for the physician, she continued, is to inform the patient, be honest, and explain that, sometimes, death isnt a failure or something to be defied.
The root of the word doctor comes from teacher, she explained. The physician is a resource for the truth concerning the medical condition of a patient; he or she is obliged to say what the outcome will if this choice is made, as opposed to that choice, based on ones best estimation.
People always ask me, how long do I have to live? she continued. And the first thing I say is, its not my charge; its not up to me.
Turning the Page
The book will hopefully generate what Rockwell calls improvement in end-of-life care, because while the present situation poses problems for the health care community and society in general, the future prompts even greater concern, as science continues to advance and the huge Baby Boom generation ages.
I hope this book is a catalyst for an open dialogue between the medical community, legislative leaders, and spiritual leaders, she said. And the discussion has to be about how we take care of people at the end of life, from a physiological, medical, and biologic perspective, from an economic perspective, and from a spiritual perspective.
Were on a wheel that has its own momentum, she continued. In order to stop that, we need to bring some awareness to the matter of what will happen if we stay on that wheel.
George OBrien can be reached at[email protected]