The Way We Die Now
by Seamus O’Mahoney, Head of Zeus, £14.99
Medical advances since the war have given Western populations unprecedented levels of health, cures for disease and longer life-spans. This is a good thing. But inevitably such advances bring with them new ethical questions for doctors and patients alike, such as when is further treatment useless, when should intervention give way to palliative care, and so on. O’Mahoney, a consultant gastroenterologist at Cork University Hospital, brings his own thoughtful and intelligent voice to this debate.
The author, born in 1960 and from a Catholic background (he mentions priests and nuns in the family), does not discuss his own faith. But he does acknowledge that the swift collapse of traditional Catholicism in Ireland has left a spiritual chasm in people’s lives. From being a theocracy in all but name, modern Ireland has become a “pleasure island”. Death is less of a spiritual event and “fear of death has replaced fear of God”; yet “our needs are spiritual”.
O’Mahoney is critical of the way modern medicine has turned doctors into “service providers” rather than professionals, who are afraid of possible litigation, angry relatives and patients who don’t want to hear the truth about their condition. As a doctor treating the dying (many of his patients are alcoholics, dying from cirrhosis of the liver), he believes it is his duty to tell them the truth with kindness and compassion.
Against him are all the treatments patients know about from the internet. In America, he points out, there is an insatiable appetite for medicine, scans, drugs, tests and screenings; yet it doesn’t make good medical sense to “offer every conceivable option to every patient”.
Cancer, in particular, seems to offer some people “a toxic combination of false hopes and a bad death” and chemotherapy “comes at a high price”. Tellingly, O’Mahoney states that doctors facing death usually reject the treatments they offer their patients.
The author informs us that 58 per cent of deaths in his country occur in hospital and only five per cent in hospices. He makes a plea for palliative care not to be the exclusive concern of specialists but to be shared and delivered “by a doctor who knows the patient”. Contrasting the Irish way of death with that of Britain, the author believes the former is better as it has not entirely discarded the old Catholic rituals attending the dying: the recitation of the rosary around the bed; the removal (where the body is placed in an open coffin at the undertakers, so that friends can pay their last respects and offer the family sympathetic words); the Requiem Mass; and the burial. Such rituals bring consolation that merely secular services conspicuously lack.
As the author notes, people don’t “die” any more; they “pass over” or “pass on”. The spiritual poverty of the age is often expressed in “bizarre modern fantasies about immortality”, whereas we need to help the dying to accept and understand their situation. O’Mahoney gives short shrift to the “death with dignity” euthanasia movement, commenting that it “coarsens society” by attempting to strip death of its “awesome grandeur” and to turn it into a process that can be managed, controlled and policed.
He widens his reflections by referring to the writings on death by Philippe Aries, Ernst Becker, Geoffrey Gorer and Ivan Illich, quoting approvingly Illich’s belief that pain, sickness and death are eternal human realities and that “we have lost our ability to accept [them]”.
At some stage in all our lives, we will fall sick and die. The themes of this book should concern us all.
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