The reading assigned for today by Mary Jo DelVecchio Good looks at the political economy and culture of hope that serve as a legitimizing ground for what she terms the “biotechnical embrace”. She notes that even as the medical system promotes and naturalizes experimental treatments that have very low success rates, the same medical personnel that maintain public optimism are privately critiquing the practice. Here’s an excerpt from a resident:
“Being given high doses of chemotherapy and a bone-marrow transplant is not a natural event. Sometimes oncology in general kind of bugs me, in that it seems – especially for bone-marrow-transplant patients … I was feeling, Why are we doing this?
A recent article in the LA Times asks the same question. Even as the rates of Medicare patients who are choosing to spend their final days at home or in hospice are going up, an increasing percentage of these patients are spending all but their final weeks undergoing invasive, expensive and painful treatments. With the encouragement of both doctors and support groups, and an individualist and even moral discourse of “winning battles” and “never giving up”, Americans tend not to go gentle into that good night. And yet 9 out of 10 Americans say that when the end comes, they would rather die at home, with treatments focused on comfort rather than extending their lives.
There is one group that does not seem to buy into the ideology of hope for their own terminal care: doctors. A recent Radiolab episode explores the disparity between what we want doctors to do for us, and what they want done for themselves- see doctor’s responses below when asked what treatments they would want given a scenario of irreversible brain injury without terminal illness: