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

~ Robert Martensen (Author)
Key Phrases: elective choices, Life Worth Living, Baby Doe, Trials of the Body (more...)

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.)
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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: 8.3 x 5.8 x 0.7 inches
• Shipping Weight: 12.8 ounces (View shipping rates and policies)
• Average Customer Review: 4.4 out of 5 stars  See all reviews (9 customer reviews)
• Amazon.com Sales Rank: #62,947 in Books (See Bestsellers in Books)

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Customer Reviews

Most Helpful Customer Reviews

42 of 47 people found the following review helpful:

5.0 out of 5 stars Everyone should read this book, March 15, 2009

By	Dr Cathy Goodwin (Seattle, WA USA) - See all my reviews (TOP 500 REVIEWER)    (REAL NAME)

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.

7 of 7 people found the following review helpful:

5.0 out of 5 stars a groundbreaking, vitally important book, April 23, 2009

By	maria dante (boston ma) - See all my reviews

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.

4 of 4 people found the following review helpful:

5.0 out of 5 stars A must for anyone faciang end of life decisions!, May 23, 2009

By	C. Edwards (Tusa, OK) - See all my reviews (REAL NAME)

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.