Presentation on theme: "DEATH & MEDICINE Late modern societies’ frontline in the war against death."— Presentation transcript:
DEATH & MEDICINE Late modern societies’ frontline in the war against death
MEDICINE TAKES CONTROL Reflecting on the successes of the 20 th century Reflecting on the successes of the 20 th century Medicine inherits from religion the cultural responsibility to oversee final passage Medicine inherits from religion the cultural responsibility to oversee final passage Death prevention as the primary goal of medicine Death prevention as the primary goal of medicine Death-as-disease, death-as- the-enemy, death as result of medical failure Death-as-disease, death-as- the-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 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) 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) According to Dr. Nicholas Christakis (U. Chicago), % of patients die in pain (first phase study of Dying in America) According to Dr. Nicholas Christakis (U. Chicago), % 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.Fritz KahnMan as Industrial Palace
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, …”Medicaid
Apple’s Steve Jobs had a liver transplant in 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, Death- with-Dignity Movements 1990 merger between Concern for Dying & Society for Right to Die 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 Derek Humphry’s Final Exit reaches top of New York Times best-seller list in 1991 Media attention given to Jack Kevorkian Media attention given to Jack Kevorkian The rise of hospice The rise of hospice Growing public support for euthanasia Growing public support for euthanasia
In 2008 the city council of Salford, Lancashire, UK printed these wallet "right-to- die" 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 ( ), Nancy Cruzan ( ), and Terri Schiavo ( ).Karen Ann QuinlanNancy CruzanTerri Schiavo
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.
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) HOSPICE
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 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)
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 “Democrats make their own lumpy bed.” (Aug. 24)Democrats make their own lumpy bed Beliefs about government death panels
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, 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?”“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 studyHealthGrades
In Europe, where hospital surveys have been conducted, Gram- negative 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”? Cell death is a part of life; apoptosis 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.” 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) 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 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 American tissue banks American tissue banks How should scare organs be allocated? How should scare organs be allocated? Why in the state of Texas can corneas of the deceased by harvested without family permission? 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 people be allowed to sell their organs to the highest bidders? Should organs of executed prisoners should be available to those in need? 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 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 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 Hill
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.
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)Reuters
The Emergence of Death Tourism Exit Deutsche Schweiz