UI  - 98007362
TI  - Reflections on death and dying.
AB  - Americans simultaneously worry about dying and about being tethered
      to machines that keep them alive beyond a point when life has any
      meaning. People living with terminal illness often feel isolated from
      life around them and a burden on those they love; they feel uncertain
      that their deaths will be relatively free of pain and suffering and
      that their dignity will be compromised as little as possible. These
      failings can be remedied. Traditional hospice care and integrating
      palliative care into the general medical setting are important, but
      they cannot alone occasion a better dying. The medical community must
      re-imagine dying and reflect about ways to transform image into
      reality in practice and in training colleagues and successors.
      Physicians and others know how to provide care and even improve
      living when cure is unlikely; the harder task is to respect such care
      as profoundly as curing. The exigencies of modern medicine, where
      time is a budgetable commodity, makes caring well for dying patients
      difficult. Medicine cannot have hegemony over dying and cannot
      singularly offer people a better death, but it cannot absent itself
      either. The almost single-minded focus on decision making that has
      infused conversations about dying and death may divert attention from
      the attentiveness and loving relationships that are as vital as
      life's end as at its beginning. Medicine has "colonized" death: It
      has transformed it into a place where progress in staving it off may
      appear to be unlimited, and thus it encourages forgetting that death
      is part of the human condition. The task before medicine, and
      academic medicine in particular, is to transform death back into a
      human scale. With all that is available to delay death--but not to
      make it optional--the most important task is to recover humbleness
      before an awesome moment and be with the patient, one human being to
      another, knowing that dying is not always open to solutions.