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A Life Worth Living: A Doctor's Reflections on Illness in a High-Tech Era Hardcover – September 2, 2008


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Editorial Reviews

From Publishers Weekly

A physician, medical historian and bioethicist, Martensen pulls no punches: beyond the marvels of modern medical technology lies a treacherous morass of ethical, moral and spiritual dilemmas most of us are not ready to even consider: whether to opt for aggressive treatments, when to stop them, and how to die well. Too often the choice of aggressive treatment and heroic measures becomes an extended death by intensive care' in grim hospital units designed more like prisons than places of healing. Thoughtful and compassionate, Martensen narrates poignant case studies, such as that of Marguerite, who undergoes ineffective surgeries and drug trials for advanced breast cancer but has debilitating side effects. The author lays blame across the board, from patients with unrealistic expectations and doctors who don't explain treatment options fully, from profit-driven hospitals to an insurance bureaucracy that spurns routine health maintenance. Martensen makes his case with clear, compelling writing that never flinches from his conclusion that some things you just can't win the battle against; you can only hope for quality of life until the end. (Sept.)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From Booklist

Once a straightforward process, dying has become a minefield, despite—nay, because of—medicine’s best efforts to sustain life in the face of overwhelming odds. Thus, physician and bioethicist Martensen worries, many people diagnosed with a terminal illness may not be receiving all the information they need to make informed decisions. Indeed, they may not fully comprehend the hopelessness of their situations, either because they are not hearing or, more likely, because physicians are hedging the responsibility to tell the unvarnished truth. Consequently, what ensues is too often a painful and futile battle including unnecessary tests, interventions, and drug or device trials that make what is left of the patient’s life not worth living. Just where the balance point lies between hegemony and patient autonomy becomes murky at best when each participant in a patient’s final care is marching toward his or her own goals. An ever-compassionate Martensen makes it apparent that the thorny questions need asking, but even more apparent is that there are no easy answers. --Donna Chavez
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Product Details

  • Hardcover: 240 pages
  • Publisher: Farrar, Straus and Giroux; 1st edition (September 2, 2008)
  • Language: English
  • ISBN-10: 0374266662
  • ISBN-13: 978-0374266660
  • Product Dimensions: 0.9 x 5.8 x 8.3 inches
  • Shipping Weight: 12.8 ounces (View shipping rates and policies)
  • Average Customer Review: 4.9 out of 5 stars  See all reviews (16 customer reviews)
  • Amazon Best Sellers Rank: #921,486 in Books (See Top 100 in Books)

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Customer Reviews

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He said, "Well, if that eye goes, you'll still have one more."
Dr. Cathy Goodwin
As I am facing my own end of life decisions, I am inspired and comforted by Dr. Martensen's candor and common sense approach.
C. Edwards
It should be required reading for anyone middle-aged or older, or anyone with aging parents or ill family members.
maria dante

Most Helpful Customer Reviews

56 of 61 people found the following review helpful By Dr. Cathy Goodwin TOP 1000 REVIEWERVINE VOICE on March 15, 2009
Format: Hardcover
Martensen, a physician, dares to question the medical establishment's reliance on high-tech interventions, especially among the elderly. He shows that many of these interventions are unnecessary and even harmful.

On a broader scale, he reminds us that over 50% of our medical spending comes from the "public purse" in huge amounts, while every day people die because they can't afford basics like insulin. Most shocking: In 1600, if you made it to age 80 in Berlin, you could expect to live another eight years. In 1980, a study found that if you reached age 80 in the same city, your life expectancy was 88: just two more years (p. 79).

Martensen illustrates his points with stories taken from his many years as emergency physician and bioethicist. One of the most chilling accounts describes a woman who remained healthy and active through her seventies, when she began experiencing shortness of breath while enjoying her long walks. A cardio surgeon suggested an operation. The operation worked to restore the woman's breathing - but the woman now experienced dementia. She was afraid to go out and her quality of life deteriorated.

The woman's son asked Martensen about the possibilities of a lawsuit. Dementia is a known side effect of this type of surgery, so why hadn't the surgeon discussed it? Martensen warned the son, "You're in a field where you do a lot of negotiating. Your mother at the time ran her own craft business. The risks are here, buried in the fine print."

My own view is that the surgeon should still have gone out of her way to warn about risks, especially such serious risk. I would have encouraged them to sue (if they had means ) to teach the surgeon (and other surgeons) a strong lesson. Doctors tend to see risks abstractly.
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13 of 13 people found the following review helpful By maria dante on April 23, 2009
Format: Hardcover Verified Purchase
Where to start? I read this book in two days, although it's not my usual fare. I had heard Dr. Martensen discuss his book on NPR, and thought it sounded interesting. I had no idea how much I would learn from it (and I consider myself an educated, well-informed person). I think many of us have anxieties about being trapped in the bureaucratic labyrinth of contemporary medical care--personally I've always dreaded dealing with hospitals and doctors far more than I've feared being ill. The book confirms one's worst fears about the inhumane (though often well-intentioned) treatment critically ill people receive at the hands of today's medical-industrial complex. Martensen negotiates (but doesn't over-simplify) the ethical minefield that patients (or consumers? another question the book raises), doctors, and families must tread in attempting to make medical decisions for themselves and others. He writes compassionately about the value (as opposed to mere length) of life for all people, including the aged, indigent, and genetically compromised. He examines these questions as they affect individuals and reflect social/economic priorities. He asks why, when medical care is more expensive than ever, it has become increasingly inhumane. He questions the need for more high-tech, highly-specialized treatment centers in an era when an increasing number of citizens lack any health care insurance. He explores the economic reasons for this seeming paradox, and the phenomenon of for-profit hospitals. I was chilled to hear some of his anecdotes about organ donation, and the pressure put on grieving families to help hospitals make money. It was almost like something out of that old novel/movie, Coma. I hasten to add, however, that there is nothing sensationalizing or sentimental about this book.Read more ›
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7 of 7 people found the following review helpful By Heather Losee on May 22, 2009
Format: Hardcover
A Life Worth Living is powerful book which can inspire a broad readership of general public, health professionals, and those in positions of effecting health policies. Like Dr. Martensen,I have had long career in health care. I believe he was right on point with many of the complex health issues facing individuals and families. He cited examples of dilemmas faced by adults with sick children, middle-aged and older adults facing chronic disease and/or end of life issues. His case examples represented the poor, affluent,disabled, persons young and old and the quality of life during illness and in the face of death. He wrote with humility with respect for science and for the individual "person." His account of his father's death showed that families and friends can be an advocates while grieving. He stressed how important it is to identify and articulate our wishes and the importance of communicating with those who may be faced with participating in making decisions on our behalf. This is a book which inspires the reader to take personal action. Martensen has shared historical, ethical, personal and instructional information. When a book has the capacity to change behavior, mine and others, I believe that it is a book well written.
Heather Losee, RN, MPA
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4 of 4 people found the following review helpful By John Thorndike on January 25, 2011
Format: Paperback
A book about care at the end of life, particularly that medical care that extends lives that to many of us (perhaps from a safe distance) seem hardly worth living.

The most moving parts of the book, to me, were the stories of individuals facing a difficult end. Not knowing, of course, when death would come, but dealing with it and making crucial decisions about how much care they wanted.

We've all thought about this, haven't we? At one end of the spectrum is that misleading line, "If I get to that state, just shoot me." No one is going to shoot us. At the other end of the spectrum is the bad fall we might take one day when we are deep into our own dementia. A telephone call is made by whoever is looking after us, the squad arrives and swings into their normal, predestined mode: Take care of the patient.

Martensen imagines how the death of his own father might have been prolonged (for better or worse) if the paramedics had arrived to find him unresponsive and not breathing. "Whether or not [his wife] told them of his Do Not Resuscitate status, the paramedics would likely have put in an artificial airway--an endotracheal tube--and begun ventilating him. They would have done so because he possessed vital signs--a pulse and blood pressure--and emergency field protocols specify ventilatory support when they are present, regardless of the circumstances."

You can have your DNR tattooed on your forehead, but this will not necessarily change the paramedic practices. Then, in the ER, you will almost certainly be put on a ventilator, and admitted to the Internal Care Unit. Once the ventilator is installed, it's not easy to get it taken out--and so the patient finds himself, if conscious of his own condition, in a state that he worked hard to avoid.
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