Transcript DEATH & MEDICINE - Trinity University

DEATH & MEDICINE
Late modern societies’ frontline in
the war against death
MEDICINE TAKES CONTROL
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Reflecting on the successes
of the 20th century
Medicine inherits from
religion the cultural
responsibility to oversee
final passage
Death prevention as the
primary goal of medicine
Death-as-disease, death-asthe-enemy, death as result
of medical failure
Franz Glaubacker, “The Physician” (1923)
In 1163, the Council of Tours banned
the clergy from practicing surgery.
The shift in control from clergy to physician
can be argued to have occurred in 1879,
when it became mandatory that a doctor
certify death before a death certificate could
be issued.
Now that fewer people, especially those in the Western,
believe that life is a transitional phase leading to
immortality, they are left with nothing after death to
believe in. So their faith is placed in technology and
physicians who, ironically, have become decreasingly
equipped to deal with patients as humans.
The state protected professional titles
and markets while, in turn, the
professions undertook the provision of
welfare state services for citizens.
Public expectations about medicine’s
success in its war against death are
continuously fueled.
Modern Mechanix, February 1935
Scientists may have cured cancer last week. (February 1, 2007)
So, why haven't the media picked up on it?
Here's the deal. Researchers at the University of Alberta in Edmonton,
Canada found a cheap and easy to produce drug that kills almost all
cancers. The drug is dichloroacetate, and since it is already used to treat
metabolic disorders, we know it should be no problem to use it for
other purposes.
Doesn't this sound like the kind of news you see on the front page of
every paper?
The drug also has no patent, which means it could be produced for
bargain basement prices in comparison to what drug companies
research and develop.
Scientists tested DCA on human cells cultured outside the body where
it killed lung, breast and brain cancer cells, but left healthy cells alone.
Rats plump with tumors shrank when they were fed water
supplemented with DCA.
In November 2007, two
research teams reported
making ordinary human
skin cells take on the
chameleon-like powers of
embryonic stem cells. The
"direct reprogramming"
technique avoids the swarm
of ethical, political and
practical obstacles that
have stymied attempts to
produce human stem cells
by cloning embryos.
The biotechnology
company Tengion has
since 1999 been selling
new bladders made out
of the customer’s own
cells. From biopsy to
surgery, the process takes
six to eight weeks.
CONSIDER THE SUCCESSES
AGAINST CHILDHOOD CANCER
Reflecting on survival rates from childhood
leukemia, Dr. Robert Butler observed:
"In the 1960's and early '70's, cancer was a
death sentence. There was a 90 percent
probability that the child was going to die.
Now, there's about an 80 percent chance
that the child will be cured. It's turned
around practically 180 degrees.”
--Mary Duenwald and Denise Grady, “Young Survivors
of Cancer Battle Effects of Treatment,” New York Times
(Jan. 8, 2003)
FROM MORAL TO TECHNOLOGICAL
RITE-OF-PASSAGE
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More than half of attending
physicians & 70% of attending
physicians say they often
violate their own personal
beliefs and ignore requests
from patients to withhold life
support in cases of terminal
illness (Am J. of Public Health,
Jan. 1993, n=1400 from 5
major hospitals nationwide)
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According to Dr. Nicholas
Christakis (U. Chicago), 4070% of patients die in pain
(first phase study of Dying in
America)
There remains in the medical arts the
Cartesian model of man, which only
recently has been challenged by more
holistic conceptions.
In 1926, Fritz Kahn
illustrated man as a
working factory in his
famous poster, Man as
Industrial Palace. Tiny
guys in each body system
perform their own specific
job. A camera man
controls the eyes, groups
of thinkers sit up top, and
the guys at the bottom
handle the dirty work.
How the medical establishment
grew with the nation-state.
MEDICAL “GOOD DEATHS”
Contender for the 2010 Oscar for Best Animated Short
Film: “The Lady and the Reaper” (Spanish)
Chances that a U.S. adult does not
want to live to be 120 under any
circumstances: 2 in 3
--Harper’s Index, Jan. 2003; ABC News (N.Y.C.)
Thinking About Implications of
“Successes” in Cultural War
Against Death
PROFITING FROM THE
DYING PROCESS
In 2008, Medicare paid $50 billion just for
doctor and hospital bills during the last two
months of patients' lives - that's more than the
budget of the Department of Homeland
Security or the Department of Education.
--CBS “60 Minutes.” “Cost of Dying” (Nov. 22, 2009)
A study of nursing home patients, by Dr. Susan
Mitchell of Harvard and the Hebrew Rehabilitation
Home for the Aged, found that those with end-stage
Alzheimer's received more aggressive medical
treatment — including feeding tubes, intravenous
fluids and antibiotics and hospitalizations — than
cancer patients at the end of their lives.
--Gina Kolata. “When Alzheimer’s Steals the Mind, How Aggressively to Treat the
Body?” New York Times (May 18, 2004)
Thirty-four percent of US nursing home patients who suffer
from Alzheimer's disease and other forms of
dementia receive their food through a stomach tube, even
though the practice is of dubious medical value,
according to a study published in the Journal of the
American Medical Association.
The study suggests the economics of Medicaid
reimbursements favor the potentially harmful practice
and that large, for-profit nursing homes were more likely to
use the devices. In addition, the study found
that nonwhites were more likely to be given feeding tubes
than whites.
--James Collins. “Study links Medicaid fees, use of feeding tubes- Financial incentives for
nursing homes seen Boston Globe (July 2, 2003)
Medical costs exacerbates the
inequalities of death
“Effective at the beginning of October, Arizona stopped financing certain transplant
operations under the state’s version of Medicaid. Many doctors say the decision amounts
to a death sentence for some low-income patients, …”
Apple’s Steve Jobs had a liver transplant in
2009. The billionaire’s story became a parable
of class privilege and the inequities of the
nation's transplant system. Jobs relocated from
his home in California to Tennessee, where
there is much less competition for vital organs.
Avastin, which costs about
$100,000 a year, was in 2008 one
of the most popular anti-cancer
drugs in the world. Studies showed
that it extends life by only a few
months.
On the Rise of the Right-to-Die, Deathwith-Dignity Movements
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1990 merger between Concern for Dying &
Society for Right to Die
Derek Humphry’s Final Exit reaches top of New
York Times best-seller list in 1991
Media attention given to Jack Kevorkian
The rise of hospice
Growing public support for euthanasia
In 2008 the city council of
Salford, Lancashire, UK
printed these wallet "right-todie" cards. They're freely
available in pubs, banks,
hospitals, libraries, and other
public places. They're sort of
like a living will combined
with an organ donor card. If
you don't have the mental
capacity to tell doctors how
far they should go to save
your life, this card lets them
know you've already planned
ahead for just such a
situation.
Though most euthanasia cases involve the elderly, it is
interesting to note how often the right-to-die campaign has
been dramatized in the cases of brain-damaged young
women: Karen Ann Quinlan (1975-1985), Nancy Cruzan
(1983-1990), and Terri Schiavo (1990-2003 ).
Unlike the young women who had
become the poster children of the
right-to-die movement, in the Fall of
2009 the focus shifted to a 76-year-old
retired truck driver from Billings,
Montana. Now, in death, Mr. Baxter
could make Montana the first state in
the country to declare that medical aid
in dying is a protected right under a
state constitution. His claim is that a
doctor’s refusal to help him die
violated his rights under Montana’s
Constitution
According to a Pew
2005 survey, 35% said
they've given their
end-of-life medical
wishes a great deal of
thought and 36% said
they've given it some
thought. Only 27%
said they have put their
wishes in writing and
29% said they have a
living will.
HOSPICE
After Congress passed a measure allowing
Medicare coverage of hospice care, the number
of programs increased from 1,500 in 1985,
taking care of about 160,000 people, to 3,300
hospices in 2005, annually caring for some
950,000 people. One quarter of Medicare
expenditures go to people in the last year of life
($25,000 average per person in 1999)—the
same proportion as before hospice coverage.
--Robin Marantz Henig, “Will We Ever Arrive at the Good Death?”
New York Times (Aug. 6, 2005)
The National Hospice and Palliative Care
Organization reported that 1.3 million patients
received care from one of the nation’s 4,500
hospice providers in 2006. This represents a
steady increase of more than 100,000 patients
than the previous year. Approximately 39
percent of all deaths in the US were under the
care of a hospice program in 2008.
Advance Directives
(and whether they are honored)
Researchers at the Dana-Farber Cancer Institute in
Boston interviewed 603 patients with advanced
cancer. They asked the patients, who had about six
months left to live, whether their doctors had
discussed their wishes for end-of-life care. The
majority — 69 percent — said those conversations
had not taken place. And in their last weeks of life,
those patients who had talked with their doctors
wound up with medical bills that were on average 36
percent lower — $1,876 compared to $2,917 — than
those of patients who did not have end-of-life
conversations with their doctors.
--Maggie Jones. “At the end of life, denial comes at a price.” New York Times
(April 3, 2009)
Beliefs about government death panels
In 2009, 36 percent of seniors thought that the health care bill
would allow "a government panel to make decisions about
end of life care for people on Medicare," according to a Kaiser
Family Foundation poll. Another 17 percent weren't sure.
Once the bill became law, the right’s propaganda campaign
faded and public support for the legislation steadily rose. July
2010, it stood at 50 percent, according to a recent Kaiser poll.
More importantly, only 27 percent of Americans want the law
repealed right away.
--Froma Harrop. 2010. “Democrats make their own lumpy bed.” (Aug. 24)
EUTHANASIA & PAS
• the Netherlands experience
• Kevorkian controversy
• support in U.S. over time
• status of the Oregon
physician-assisted suicide law
A feeding tube was removed
from Terri Schiavo, the
severely brain-damaged
Florida woman, after her
husband won a court ruling
allowing her to die, despite her
parents' plea to continue life
support, October 15, 2003.
She had been in a vegetative
state since 1990, when her
heart stopped because of what
doctors said may have been a
chemical imbalance. Photo
by Reuters
When a person has a disease that cannot be cured, do you think
that doctors should be allowed by law to end the patient’s life by
some painless means if the patient and his family request it?
Do you believe that one has the right to end own
life if he or she has an incurable disease?
There are problematic cases of
involuntary euthanasia
London—January 13, 2004
Britain's most notorious serial killer,
former family doctor Harold Shipman,
has been found hanging in his prison cell
after an apparent suicide.
Shipman. known as “Dr. Death,” was
serving life imprisonment for murdering
15 elderly women with lethal doses of
heroin. A subsequent judicial inquiry
found him responsible for another 215
deaths over a 24-year medical career in
Britain's north. A further 45 patients died
in “suspicious” ways.
MEDICINE AS CAUSE OF DEATH:
ON IATROGENIC DISEASE
"A doctor can bury his mistakes, but an architect can only
advise his clients to plant vines." - Frank Lloyd Wright
According to the most respected
medical publication in the world, The
Journal of the American Medical Association,
the third leading cause of death in the
US after heart disease and cancer is
doctor-induced or iatrogenic.
--David Phillips, “Doctors: the Third Leading Cause of Death in the
US?”
"The United States loses more American
lives to patient safety incidents every six
months than it did in the entire Vietnam
war. This also equates to three fully loaded
jumbo jets crashing every other day for the
last five years."
--The 2004 HealthGrades Patient Safety in American Hospitals study
In Europe, where
hospital surveys have
been conducted, Gramnegative infections are
estimated to account for
two-thirds of the
25,000 deaths each year
caused by some of the
most troublesome
hospital-acquired
infections, according to
a report released in
September 2009 by
health authorities there.
What is “death”?
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Cell death is a part of life; apoptosis
Somatic death: heart and breathing stops and
anoxia (tissues become oxygen deprived) sets in.
“Point of no return.”
Clinical death: heart and lungs stop but vital
organs not yet damaged (~ 6 minutes)
Brain-stem death: begins about 2-3 minutes after
somatic cessation; potentially stoppable and
reversible; has replaced somatic death as
definition of death
Globalization of Death Avoidance: The
International Body Parts Market
The first successful organ transplant took place on Dec. 23,
1954, when Richard Herrick received a kidney from his healthy
identical twin brother, Ronald. Richard survived for eight years
until the original kidney disease struck again.
HUMAN RECYCLINGS
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American tissue banks
How should scare organs be allocated?
Why in the state of Texas can corneas of the
deceased by harvested without family
permission?
Should people be allowed to sell their organs
to the highest bidders?
Should organs of executed prisoners should
be available to those in need?
Over six years, a UCLA medical school
official sold 496 cadavers for $704,600,
according to invoices that provide the first
evidence of the scope of the scandal in the
school's body donor program.
--Charles Ornstein and Richard Marosi. “$704,600 Billed for Cadavers.” Los
Angeles Times (March 9, 2004)
A 2008 investigative story of the Los Angeles
Times reported on how four members of the
yakuza, the Japanese mafia, received liver
transplants at the UCLA medical center between
2000 and 2004. Two of the four men later gave a
$100,000 contribution to the medical center.
A Peruvian gang operating out of Huánuco allegedly killed people
and drained fat from their corpses. The amber liquid, worth up to
£36,000 a gallon, was exported to Europe as anti-wrinkle cream.
26 Feb 2008.
Republican former South Dakota lieutenant
governor and potential Senate candidate Steve
Kirby made his fortune running a scandal-wracked
business that harvested collagen from corpses
donated for medical research and using it for
cosmetic products and penis-enlargements.
Kirby’s niche industry had proven financially
lucrative. Collagenesis could take the skin off one
cadaver and convert it into $36,000 of a gel injected
to smooth wrinkles and inflate lips. Its lone
competitor, a firm called LifeCell, estimated its
potential revenues from such skin at $200 million a
year — 10 times what it would earn if it focused on
life-saving burn applications instead of cosmetic
surgery.
--Markos Moulitsas. “GOP’s flesh-eating zombie candidate.” The Hill
(Feb. 26, 2008)
The tsunami that hit South Asia in
2004 left many destitute, including
thousands Indians. As many as 150
women near Chennai are known to
have sold one of their kidneys for a
large sum of money.
--Randeep Ramesh, “Indian tsunami victims sold their kidneys to survive,”
Guardian Unlimited, 13 April 2007
<http://www.guardian.co.uk/tsunami/story/0,,1992965,00.html>.
Farhat Moazam of the Sindh Institute of
Urology and Transplantation in Karachi,
Pakistan, said "There are villages … in
the poorer parts of Pakistan where as
many as 40 to 50 percent of the
population of the village we know only
has one kidney.“
--Laura MacInnis. “`Transplant tourism’ on rise due to donor
shortage.” Reuters (March 30, 2007)
Transplant Tourism
The Emergence of Death Tourism
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