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Doctor, Allow Us to Die: Reimagining End-of-Life Care

I am going to tell you the story of my grandmother's experience in the ICU of a hospital. Her problems started when she could no longer eat solid foods. She said that there was some obstruction in her food pipe, the esophagus. So she lived on fluids for a long time. She was old and had become very weak without enough food. Over time, she could not swallow fluids either. So she was admitted to a hospital. I was a student then.

The doctors said that there was a cancerous growth in the esophagus. The oncologists and surgeons felt that the tumor should be surgically removed. But it was risky given her age and health condition. They asked my grandmother for her opinion. She said, "You are the best judge. You do what is best."

So she underwent surgery. They had to cut open her chest, cut a few ribs, and enter the thorax. The lump was quite deep inside. The surgery went on for eight hours and was not successful. The surgeons saw that the tumor had spread to all the neighboring organs and it was too risky to remove it. So they closed the wound and sutured it.

This left her further weakened, debilitated, and more pathetic. She developed other complications as well. Though the doctors knew that she would not recover, they continued their regimented treatments like ventilator, oxygen mask, digoxins, and stimulants, etc. They would not give up.

My grandmother used to beg them, "Doctor, allow me to die." But they were reluctant. And she died in the ICU after a month-long suffering of pain and loneliness. She said that loneliness was more painful than cancer.

This is a very old story and now I am myself very old. But the picture of the treacherous and dictatorial treatment given to her lingers in my mind as if it is quite fresh.

Now I have come to see what aging and growing old really are. While we grow older, all the parts of the body gradually shrink and lose their weight. All the functions decline and slow down as we age. This downhill journey is natural, painless, and ends in a pleasant death.

Look at your teeth for example. Though a tooth is the hardest substance in the body, it wears out over time. It shrinks and becomes brittle, no matter how much you brush it with the best toothpastes. The jaw and the tissues in the mouth lose their mass and strength to bite hard stuff. You cannot rebuild it. It is final and irreversible.

This is my story as an old, aging man. But as a doctor, I have a different story. We, doctors, don't know about aging and natural death. Our medical textbooks nowhere mention how to assist the elderly or help people face a natural, inevitable death.

On the contrary, we are trained to save lives and fight death. Giving life is a victory for us, and not being able to do so is a failure. If a patient dies, it is seen as our failure somewhere. We hate death and aging. Therefore, doctors are very unprepared to help a dying person.

Fifty years ago, people died in their own homes, and their families knew how to deal with death. Now, most people die in hospitals, at the hands of doctors and other staff who are not trained in this area.

Now let's take a look at the patient's story. Patients in their old age often live in a delusion, believing that their life can be prolonged, their health regained, and their youthfulness regained. And they believe that doctors will do that. Doctors also live in this same delusion. They don't know that it is impossible to reverse aging. It is impossible to conquer death. They are in a system that is dedicated to curing illnesses, whether it is cancer or a coma. Their job is to cure. Doctors often go to extreme lengths with treatments like ventilators and pacemakers. So they have to put the patient locked in an ICU and start fighting death.

This mindset has created a lot of inhumane acts, callousness, and unspeakable misery for the patients. It would be welcome if doctors would take the time to look at the reality of a terminal illness with an open mind. And allow them their freedom to choose a painless natural death.

Patients do not know but doctors know that they are going to die anyway. Our people live with self-respect, dignity, and honor when they are healthy. I wish they would die with the same dignity and honor. Why should they die like a victim in an ICU, cursing their fate? Why should they take the punishment of living with an oxygen mask? Why should they be deprived of dying at home assisted by loving family members?

So, however hard it appears, people should choose to die at their own homes in the midst of family members with all dignity and honor. One must die like a Buddha, isn't it!

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