Michael de Ridder, the head of the emergency ward at a Berlin hospital and author of a new book on dying, discusses how modern medical advances are making death more complicated for patients with little hope of living. His book makes a plea for doctors to allow people to die with greater dignity.
SPIEGEL: Mr. de Ridder, as an emergency physician, you fight to save lives every day. Which makes it interesting that you, all people, are now calling for a new definition of death in an era of high-tech medicine. Isn't that a contradiction?
De Ridder: In my field in particular, I see how the limits of life are constantly expanding, without regard for the well-being or will of the patient. In some emergency rooms, half of all admissions now come from nursing homes. If someone who is chronically ill has a heart attack or gets pneumonia there, the most sensible thing to do is to make sure that they don't suffer, and to refrain from doing anything else. But this is all too rare. Instead, old people, who are dying, are torn out of their familiar surroundings, rushed off to hospital in an ambulance, resuscitated and given artificial respiration. If they're unlucky, they die in the elevator. These are horrible, undignified situations.
SPIEGEL: Why does it happen like this?
De Ridder: Dying a simple death is no longer an option in our society, even in places where one might expect to. Hardly anyone dies without an infusion or artificial feeding. For a long time, dying has not been natural.
SPIEGEL: What do you consider "natural death"?
De Ridder: I'm reminded of a woman in her late 80s who was still very vigorous. Her daughter brought her to our emergency room with massive intestinal bleeding. A colonoscopy showed that it was caused by a tumor. The bleeding could only have been stopped with an operation. She didn't want it. She said that she had lived a full life and now preferred to die rather than embark on an indefinite path of suffering. The daughter agreed, and the woman died that same day. It was a totally plausible decision that no one could object to, particularly as bleeding to death is a gentle way of dying. But the doctors felt snubbed. There were bitter discussions over whether this should even have been allowed to happen.
SPIEGEL: But don't doctors see themselves as guardians of human life?
De Ridder: The mandate to heal is primary, of course. But the mandate to allow someone to die well is equally important in terms of ethics. In reality, however, the chain of resuscitation and treatment often takes on a life of its own. The person who is supposed to benefit from it, with his or her individual ideas about living and dying, is no longer relevant. Here's a classic example: A doctor arrives here with an old man from a nursing home. After having a stroke two years ago, the man stopped eating, could no longer communicate and seemed to have lost all interest in life. He had now contracted a serious case of pneumonia, and the people at the nursing home didn't want the responsibility. Just as the doctor was transferring him into the emergency room, he went into cardiac arrest. Her automatic response was: intubation, oxygen, ICU! I said to her: "Slow down. This man is dying, and now we are going to allow it to happen."
SPIEGEL: In the past, doctors had no other choice. It was said that pneumonia was the old people's friend.
De Ridder: And rightly so. Because it allows the patient to slip away quickly and, for the most part, without suffering.
<SNIP>
http://www.spiegel.de/international/zeitgeist/0,1518,685426,00.html
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