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A Philosophical Discussion on Death and Dying Mike Marschke, MD.

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1 A Philosophical Discussion on Death and Dying Mike Marschke, MD

2 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 TheCase for Mortality Leon Kass, M.D. in TheCase for Mortality

3 Immortality From Greek Mythology pondering immortality to Rene Descartes and Francis Bacon in the 17 th 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)

4 Immortality Imagine a world where no one died! 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 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? What if we still lived on average to mid-70s but are much more vibrant until the end?

5 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 Natures 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

6 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? 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? 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? 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? And what would happen with almost every cultures view of the promise of life after death?

7 The Stark Reality Cells and the human body have a limited life span; even disease free, a person is somehow programmed to die 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 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? 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?

8 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

9 What is Suffering? A very personal matter A very personal matter When an impending destruction of the person is perceived When an impending destruction of the person is perceived Extends beyond the physical to include the mind and spirit 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 Reductionalist modern scientific methods do not help us understand the nature of suffering in the WHOLE individual

10 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 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. 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 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…) Transcendence is a very powerful tool to help, allowing one to locate your person in a far larger landscape (religion, community, patriotism…)

11 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 Matt Stolick in Dying to meet you…

12 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 Matt Stolick in Dying to meet you…

13 Hope Hope is the expectation of something better to come in the future Hope is the expectation of something better to come in the future Its meaning is unique to each of us but Hope is common to all. Its 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. 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 Modern medicine focuses hope on prolonging life, on cures

14 Hope at the end of life? There can still be expectations of a positive future, even when medical science fails. There can still be expectations of a positive future, even when medical science fails. Hopes focus shifts – find more meaning in being in the moment, in family, in God Hopes 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. 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.

15 God never promised anyone tomorrow - Walter Payton, Hall-of-fame running back from da Bears


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