Death Valley, Nevada
A good death
As all rivers flow to the same home, the sea, all lives reach the same end, death. But in a modest residential neighbourhood south of the Thames,
Dr. Cicely Saunders and her colleagues at St. Christopher's Hospice in London are demonstrating that some ways of dying affirm and enhance life.
Saunders is nurse, social worker, physician, and founder of St. Christopher's. As a hospice it provides care to terminally ill patients and their loved
ones. Its primary purpose is to alleviate chronic pain. Families are treated as units and are cared for in bereavement.
Perhaps not until this century did the average visit of a patient to a doctor do more good than harm. But now medical proficiency, while making
living better, is making dying more problematic. Medicine should prolong life, not the process of dying. There comes a point in a degenerative
disease when further "aggressive" treatment would intensify the patient's suffering without substantial benefit.
Then concern for the patient should become concern for a dignified death, for palliative care for symptoms and needs.
This point is difficult to determine because much is unknown about the behaviour of advanced malignant diseases. But the point must be determined.
Saunders believes that doctors treating terminal cancer frequently are concerned too much with the disease process and too little with the patient as
a person. It is not always obligatory to use every medical technology as long as possible. For example, doctors should "consider what has been done
to a patient who dies in the isolation of a laminar flowroom, perhaps unable to touch another person's hand for the last weeks of his life". At some
point in terminal cases such measures as chemotherapy, radiation and surgery could be described as treating the doctor, not the patient. Before
recent medical advances, doctors had little technology to give, so they gave much of themselves at bedside. Today, when mistakenly prolonged
attempts at cures are at least abandoned, many doctors desert the dying, who are left unsupported at the most demanding point of their illnesses.
Dying of a prolonged disease is less an event than a difficult process which, like birth, requires understanding help. But understanding is scarce, not
only because death is a mystery from which people flinch, but because it is a reality with which people are no longer acquainted.
Until recently, death was woven into the fabric of life. A rural death was a village affair, and the impersonality of cities was tempered by large
Victorian homes where grandparents died with grandchildren at bedside. One reason why people had large families was that many children died
of diseases no longer feared. Today life is healthier, families are smaller and dispersed. And death is too remote to be readily conceivable.
Saunders speaks of "positive achievement in dying" when terminal illness is " a time for reconciliation and fulfillment for the patient and his family,
and may well be the most important period they spend together". Remember, she is a professional, not a sentimentalist, and she has earned the
right to speak of dying as she sees it daily. Aside from sophisticated pharmacology, St. Christopher's speciality is simple words and gestures. The
dying, and those who attend them, struggle, Saunders says, to make what T. S. Eliot called "a raid on the inarticulate".
Patients' needs, she says, are summed up by the words "watch with me", meaning "be there".
The hospice is a therapeutic community within the community, helping the dying to live until they die and helping families to live on. St. Christopher's
staff generally has the placidness of a gentle river which, over time, cuts canyons in granite.
St. Christopher's is not just for the dying (there is a wing for the frail elderly) but ninety percent of those admitted do not go home. The mean length of
stay is twelve days. All but about twenty of the six hundred persons who died there in 1977 died of cancer. St. Christopher's is also a teaching and
research facility in the field of terminal care.
Its premise is that no patient must remain in chronic pain. its purpose is efficient loving care, hard medicine with a humane dimension in the treatment
of all aspects of pain, physical, social, emotional and spiritual. Hospices here and the U.S. are an answer to demands for euthanasia.
Support for euthanasia legislation derives, in part, from the mistaken fear that doctors are obligated to prolong life with all available technologies,
however severe the ordeal and cost, and the mistaken fear that unremitting pain in terminal diseases, especially cancer, is unavoidable.
Without hospice care as an alternative, legalization of euthanasia would exert vicious pressure on people who are old and frail and believe society
does not think much of them. When incurably ill, such people would think of an administered death as the only alternative to terrible suffering
for themselves and terrible cost to their families, so their "right to die" would seem like a "duty to die".
(about 825 words)
from : NEWSWEEK, January 16, 1978, p. 5
1.1. Explain what St. Christopher's hospice is and summarize its aims.
1.2. What are the problems of modern medicine as far as death is concerned?
1.3. Show the two attitudes to death mentioned in the text and explain briefly which attitude St. Christopher's favours.
1.4. In what way is St. Christopher's an alternative to euthanasia?
2. Analysis and discussion
2.1. Comment on the structure of the text.
2.2. Why can't we call the text a scientific article although the author uses many technical expressions? Give examples for your opinion.
2.3. Compare death at St. Christopher's with death as shown in Huxley's "Brave New World".
2.4. Discuss some advantages and disadvantages of modern medical progress.