Customer Reviews

A Life Worth Living: A Doctor's Reflections on Illness in a High-Tech Era

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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. I once expressed concern about an eye problem to a doctor who seemed fairly sensitive. He said, "Well, if that eye goes, you'll still have one more." I'm still blown away. In all fairness, there was very little likelihood I would lose vision, but statistics feel different when they're about you.

Finally, Martensen talks about the uncertainties of high-tech medicine. We know that a certain percentage of people with certain conditions will recover, but we don't know which episode will be fatal and which episode deserves a high-tech response. At the end of life, UCLA patients spend three times more days in the ICU than UCSF patients, with no increase in quality or length of life.

This book should be required reading for everyone. We need to recommend this book to our legislators and take a copy when we visit medical practitioners. This book will be especially helpful to readers who have aging parents or who are aging themselves, because we need to set up safeguards to avoid useless, invasive end of life "care."

The author's own father was saved from a painful death only because family members had the paperwork in hand when the father went to the emergency room. Most of us wouldn't be so lucky.

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. It is lucid (I'm not a medical expert, but found it wonderfully accessible), compassionate, factual, and just plain riveting. Some of the personal stories he tells will stay with you long after you put the book down. It should be required reading for anyone middle-aged or older, or anyone with aging parents or ill family members. Elegantly written, persuasive, and most of all, timely.

I first heard of A LIFE WORTH LIVING wheb Dr. Martensen was interviewed on the Diane Rehm Show. As I am facing my own end of life decisions, I am inspired and comforted by Dr. Martensen's candor and common sense approach. I ordered two copies of the book--one for myself and the other to share with family members and friends.

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

I teach medical ethics at a community college to prospective nurses, bio-technicians, and other allied health concentrators; consequently, I read "A Life Worth Living", a Christmas gift from a friend, a nurse who confronts ethical dilemmas on a daily basis, with the hope of procuring some value, some insight that would be enlightening for me personally, and professionally. I am pleased to report that my aspirations have been met; this book has significant merit.

As an emergency room doctor, Robert Martensen is in a unique position, like a career soldier fighting an interminable battle, recounting his experiences and perceptions to the majority of us who get to face similar situations only at specific points in life - those times when health and end-of-life decisions affect us, or love ones. Since we cannot escape the existential reality of sickness and death, Dr. Martensen, through his book, invites us to reflect on those very issues, the Hobson's choice scenarios that disquiet our spirit, but are inevitable.

The following list delineates some of the essential questions and concepts addressed by Dr. Martensen in his book, "A Life Worth Living" - stuff that should inspire internal discussions:
- When is enough, enough? (...forgoing aggressive treatment for palliative care...)
- Should therapeutic privilege (paternalism) ever trump a patient's autonomy?
- Should children have a voice in their health care?
- When is a person not a person?
- Advanced directives are essential. (Let people die of old age again...)
- Critical illness drains personhood,
- Should exceptions to the "whole-brain" definition of death be permitted?
- Baby Doe Regulations: Our history of denying treatment for Down's babies with duodenal atresia.
- Arthur Imhof's compelling research involving life expectancy beyond 80 years of age.
- When is a ventilator an appropriate choice?
- Health care is big business.
- Principle of double-effect: "A fig leaf for euthanasia".
- Hospice: death with dignity.
- Ethics committees / boards should be empowered.
- Need more general practitioners ( communication / coordination); need to improve community-based health
infrastructure (... treating our most vulnerable...).
- To be compliant or non-compliant; and, the importance of control and resiliency.

I enthusiastically recommend this book to everyone... ( I am grateful to my friend...)

My wife has Altzheimers, and the book gave me some new insights on her care.

Great food for thought and action regarding hospital care for those entering their "golden years" and also for children of aging parents and parents of children with terminal illnesses.

A sincere and serious book about the end of life. But this is not at all depressing - the doc shares very real experiences with a variety of people in their last stages of life, including his father. It's worth reading and will make you think about the options we have.

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. Living wills and notarized DNR documents to the contrary, it's easy to wind up in an ICU with machines extending one's life in a way the patient had tried to prevent, back when he was hale and articulate.

Among the penetrating stories in the book is one of a doctor diagnosed with cancer in his forties, and who eventually withdraws from all medical treatment, feeling stronger because he has withdrawn from "the system." He gives up Phase II cancer drug trials, he gives up repeated CAT scans to follow the progress of the cancer. The added months of life such treatment might give him--or perhaps it would only be days, or perhaps no time at all---are not worth as much to him as his own sense of empowerment and freedom.

The author cites studies that support his personal view that when it comes to late-life care, "more usually means less. Specifically, sick elderly people who endure the aggressive treatments that our "best" medical centers routinely administer near the end of their lives tend not to survive any longer than those who avoid such treatments."

If I were diagnosed tomorrow with cancer, I'm sure I'd head straight for an oncologist and whatever treatments she recommended. But I imagine that somewhere closer to the end I'd give it up and accept my coming demise, and try to avoid the extensive, futile medical endeavors designed to keep me living another few days or weeks.

But I'm also aware that many have thought this and later changed their minds. I might too. Who can say what we're going to do when we're actually looking death in the eye? Martensen leads us, over and over, to consider the question.

By telling stories about his patients and or friends Dr. Martensen brings up issues that many of us may have to think about when dealing with the impending demise of a loved one or of ourselves. Modern medicine can sometimes do miraculous things for sick folks. When the result is complete recovery or a life worth living than the cost (in suffering and dollars) is worth it. But what about if treatment only prolongs suffering? There's no easy answers (and to his credit Dr. Martensen doesn't supply any) but after reading this book, at least one will be armed with a few questions and ideas to start a dialogue with a loved one or with their or your doctor. This is a thoughtful and thought provoking book that will stay on my bookshelf unless I lend it to a friend.