A Philosophical Discussion on
Death and Dying
Mike Marschke, MD
“Why should we die? Why should we, the flower
of the living kingdom, lose our youthful
bloom and go to seed? Why should we grow
old in body and mind, losing our various
powers – first gradually, then altogether in
death?”
Leon Kass, M.D. in
“The Case for
Mortality”
Immortality
From Greek Mythology pondering immortality to Rene
Descartes and Francis Bacon in the 17th century
seeking immortality
To 1980s when the National Institute on Aging added
in its mission statement to “control aging”
To at least 14 modern societies world-wide trying to
solve aging (including Amer. Academy of Anti-aging
Medicine, Amer. Academy of Longevity Medicine,
and the World Academy of Longevity Medicine to
name a few)
Immortality
Imagine a world where no one died!
– What would society look like?
– What would everyone do?
– Would society continue to perpetuate as it is, with the
young replacing hope, freshness, bold new ideas ?
– What would be better - adding years to life or life to
years?
What if the average life span increased to 90, but we
still deteriorate and decline?
What if we still lived on average to mid-70s but are
much more vibrant until the end?
Mortality
“I notice that in proportion as I sink into sickness, I
naturally enter into a certain disdain for life… When
we are led by Nature‟s hand down a gentle and
virtually imperceptible slope, bit by bit, one step at a
time, she rolls us into this wretched state and makes
us familiar with it; so that we find no shock when
youth dies within us, which in essence and in truth is
a harder death then the complete death of a
languishing life or the death of old age.”
- Montaigne in “That to
Philosophize is to Learn to Die”
Mortality
Does not our limited days on Earth allow us to
appreciate life more? Does not accepting this allow us
to care for the well-being of our souls and not just
on our mere existence?
Would immortality greatly intensify the fear of a
violent death? Or even if we added more life to years,
would not death be more of an affront on our person
and more of a shock to family?
If we were immortal, why have children to perpetuate
our species?
And what would happen with almost every cultures‟
view of the promise of life after death?
The Stark Reality
Cells and the human body have a limited life
span; even disease free, a person is somehow
programmed to die
Death is the only 100% in life
If this is so, why in modern medicine do we
focus so little attention on the relief of
suffering and instead focus on prolonging life?
Suffering
“a modern paradox: even in the best settings and with
the best physicians, it is not uncommon for suffering
to occur not only during the course of a disease but
also as a result of its treatment.”
“The relief of suffering is considered one of the primary
ends of medicine by patients and lay persons, but not
by the medical profession. Little attention is
explicitly given to the problem of suffering in medical
education, research, or practice.”
- Eric Cassel, MD, in “The
Nature of Suffering and the
Goals of Medicine”
What is Suffering?
A very personal matter
When an impending destruction of the person
is perceived
Extends beyond the physical to include the
mind and spirit
Reductionalist modern scientific methods do
not help us understand the nature of suffering
in the WHOLE individual
How is suffering ameliorated?
The only one who knows if something is causing suffering is
that person, so ASK! Try to understand that person as a whole.
The ability to recover from this injury to the integrity of your
„person‟ can actually be good and help one grow = this ability
to rebound is called resiliency, allowing one to structure your
personhood in a new manner. Physicians can lend strength
and guidance to this process.
Assigning a meaning to the destructive part of the personhood
can also ameliorate the suffering
Transcendence is a very powerful tool to help, allowing one to
locate your person in a far larger landscape (religion,
community, patriotism…)
“Considering how you would have someone appreciate
you and respect you as a unique individual, with a
unique style, while in a hospital room penetrated
intermittently by strangers, is an exercise that
promises to teach caregivers about the import of
attending to the unique characteristics of each
patient, a lifetime of events that reflects a unique
style of another human being lying under a
bedsheet.”
Matt Stolick
in “Dying to meet
you…”
“Not only are we human beings essentially
mortal, we are not medical creatures; we live
our dying process as existing human beings in
charge of our own meanings.”
Matt Stolick
in “Dying to meet
you…”
Hope
Hope is the expectation of something better to
come in the future
It‟s meaning is unique to each of us but Hope
is common to all.
Hope gives strength and courage to battle
illness but also wisdom to find meaning in life
and death.
Modern medicine focuses hope on prolonging
life, on “cures”
Hope at the end of life?
There can still be expectations of a positive
future, even when medical science fails.
Hope‟s focus shifts – find more meaning in
being in the moment, in family, in God
Redefining hope at the end of life is crucial to
help one go on and not give up. It gets very
hard to do caught up in the vortex of the
science world of the hospital.
“God never promised
anyone tomorrow”
- Walter Payton, Hall-of-fame
running back from da Bears