Lisa Adams, a 37-year-old mother of three, is suffering from cancer, but has the seeming temerity to talk about her struggle and offer encouragement to others on Twitter. Some people, such as former NY Times editor Bill Keller and his wife, Emma, find this offensive, and so they are now waging a campaign in the pages of the Guardian and the NY Times essentially to shame Adams into quietly foregoing treatment so that she will die, and to stop encouraging others to fight cancer.
First, we have Emma Keller, in the Guardian. (Un)fortunately, we cannot excerpt her comments in full, as the Guardian has pulled her post pending further investigation (good for them!). However, she did have this to say,
I felt embarrassed at my voyeurism. Should there be boundaries in this kind of experience? Is there such a thing as TMI? Are her tweets a grim equivalent of deathbed selfies, one step further than funeral selfies? Why am I so obsessed?
So, instead of sharing her personal journey and encouraging others to fight the good fight, Lisa should just go away and die quietly, as though somehow her struggle is in any way offensive? Is this how people are supposed to live?
Then we have her husband, Bill, writing in the NY Times,
In October 2012 I wrote about my father-in-law’s death from cancer in a British hospital. There, more routinely than in the United States, patients are offered the option of being unplugged from everything except pain killers and allowed to slip peacefully from life. His death seemed to me a humane and honorable alternative to the frantic medical trench warfare that often makes an expensive misery of death in America.
Among doctors here, there is a growing appreciation of palliative care that favors the quality of the remaining life rather than endless “heroic measures” that may or may not prolong life but assure the final days are clamorous, tense and painful. (And they often leave survivors bankrupt.) What Britain and other countries know, and my country is learning, is that every cancer need not be Verdun, a war of attrition waged regardless of the cost or the casualties. It seemed to me, and still does, that there is something enviable about going gently. One intriguing lung cancer study even suggests that patients given early palliative care instead of the most aggressive chemotherapy not only have a better quality of life, they actually live a bit longer.
He goes on to write,
Steven Goodman, an associate dean of the Stanford University School of Medicine, said he cringes at the combat metaphor, because it suggests that those who choose not to spend their final days in battle, using every weapon in the high-tech medical arsenal, lack character or willpower.
“I’m the last person to second-guess what she did,” Goodman told me, after perusing Adams’s blog. “I’m sure it has brought meaning, a deserved sense of accomplishment. But it shouldn’t be unduly praised. Equal praise is due to those who accept an inevitable fate with grace and courage.”
In short, while being unwilling to second-guess her personal decision, he would prefer that she just went away and died, without receiving any more medical treatment, and he is worried that her Tweeting about her struggle will encourage others to fight, and therefore “waste” a lot of money.
Before going any further, let’s first stipulate that Keller has muddled the issue. When doctors talk of heroic measures to save a person’s life, they are generally not talking of people who at a minimum have years, months, or even weeks to live. They are talking of people who are in the ICU on life support.
For a person who is quite elderly, otherwise frail, comatose, and already on life support in an ICU, if the kidneys fail, for example, while there is a theoretical possibility of the person surviving if “heroic measures” are taken, in practice the person will almost certainly die within a few days if not a few hours. A large percentage of medical costs in the US are incurred during these final few hours or few days in exactly this kind of situation, when there is little or no hope. There is a case to be made that if treatment will only prolong the life and agony for a few hours, that treatment should be withheld, especially for elderly patients who were frail and in poor health before they entered the hospital, as their hope for long-term survival may in fact be non-existent once they reach the ICU. This is not the same as saying that life support should be turned off, IVs should be ripped from the arm, or a pillow should be placed over the patient’s face. It is to say that all hope is lost, and that everyone needs to make their peace with that fact.
While apparently Lisa Adams’ circumstances have taken a turn for the worse, she is certainly not in that category. She is in no need of “heroic measures” to stay alive. Indeed, she has been enrolled in a research program at Sloan-Kettering for new treatments for her kind of cancer and, as Keller admits, people willing to enroll in such programs are actually in short supply. While Keller notes that this is good for Sloan-Kettering, he is unwilling to admit that her enrollment in the program is good for other cancer patients. Indeed, from his article he appears to think that research into new treatments constitutes “heroic measures” and therefore is just costing us money that could be better spent elsewhere.
Yes, medical treatment can at times be expensive, especially for cancer patients, and especially if they are researching new treatments and medicines (which will become part of a normal treatment regimen if they are successful). However, Keller’s goal is to simply save money on the backs of cancer patients, because he feels that it is not worth the expense and trouble. If it is not worth the trouble to try to save the life of someone who is young and has cancer that might well be cured, why not just advocate shooting people? A bullet in the head is surely the cheapest option.
Rude? Uncalled for? Not really. While it is held that the first person to invoke the Nazis on the Internet automatically loses the argument, it is hard to differentiate Keller’s brand of liberalism from the progressive mindset of the Nazi party. Just take a look at Nazi rhetoric and substitute “cancer patients” for “Jews”, and you get the picture. Of course, there is one big difference between the Nazis and Keller: The Nazis were motivated by an unreasoning hate for one ethnic group, while Keller is motivated by an unreasoning hate for the human race.