Saving Life... or Prolonging Death?

Saving Life...or Prolonging Death: Finding the Way in a World of Medical Technology (Erudite Medical Books, 2010).

Michel de Montaigne famously asserted that 'I want Death to find me planting my cabbages, neither worrying about it, nor the unfinished gardening'. Had he been a Charlie Corke case study, poor Montaigne would doubtless have found himself suddenly unable to do the gardening, in need of twenty-four hour care, speechless and incompetent and leaving his family with the difficult moral question of what to do next.

Charlie Corke's polemic Saving Life... or Prolonging Death: Finding the Way in a World of Medical Technology argues that, through an increase in what we might call 'end-of-life technologies', the question of how to die in a modern world has become newly important, 'because improvements in medical care mean that we can usually postpone death'. However, he caveats, 'in trying, we risk prolonging the dying process in ways that few of us would want'.

As his title suggests, Corke's book relies on an often-complicated distinction between when doctors are saving life and when they are prolonging death. Through a series of (often grim) case studies, and varying perspectives, ranging from the patient to the lawyer, he attempts to clarify this rather grey area.

Prolonging death, he argues, is when you allow extended or involved surgery, life support, dialysis and CPR, even though its purpose is unclear, and the chances of a full recovery 'unreasonable'. This has become increasingly common over the last fifteen to twenty years - with the result that most of us will now have to deal with the religious, ethical and personal questions it poses in our own lives. The stories he
offers to back up his points feature tales of family squabbles, doctors' egos, distressed partners and - in the midst of it all - the unconscious or incapable patient, silently suffering, with no clear directive to aid those whose decision their death has become.

In this world, the elderly finish their days in Intensive Care, hooked up to tubes, machines and technology and enduring stressful curative, rather than palliative, care, simply because no-one can bring themselves to admit that this process is no longer promoting any meaningful recovery.

Of course 'this world' is in fact this world, and the purpose of the book is primarily to encourage those who read it to make clear decisions about their end-of-life process - working on the assumption that they will probably be physically unable to enforce this decision themselves when the time comes. Here, Corke gives the example of the will, which he sees as an unpleasant but common part of most people's lives: like the will, he argues, the end-of-life plan will eventually become commonplace.

This may well be true. Certainly, anecdotal evidence seems to back it up - the uncomfortable question 'Would you want to be switched off?' is one I myself have heard in the pub (that well-known forum of moral debate). However, I find it more difficult to accept that the will has become an everyday part of family law: over 70% of Britons still die without one, and I would guess that this figure is repeated with little variety in most other Western countries. While the argument still stands that discussion of how we die will probably increase over the next fifty years (especially since people often make these decisions after seeing their own parents and grandparents experiencing a bad death), I wonder if Corke is not simplifying somewhat. In the main, people still don't actually make wills, any more than they actually make end-of-life plans: they are just vaguely aware that they should. I'm sure the 'living will' is soon to join the ranks of such uncomfortable tasks to be endlessly put off, but I imagine those who read this book will be, at least temporarily, disturbed enough to give it some serious thought.

"the purpose of the book is primarily to encourage those who read it to make clear decisions about their end-of-life process"

"While the argument still stands that discussion of how we die will probably increase over the next 50 years... I wonder if Corke is not simplifying"