David Brooks, the New York Times columnist, in an op-ed titled Death and Budgets that ran on July 14, 2011, observes that our refusal to face death may break the federal budget. Brooks discusses how Dudley Clendinen faced his diagnosis of Lou Gehrig’s disease with the calm resolve to live out the remaining days of his life as well as he was able, without resorting to extraordinary measures to keep his “skin bag” alive:
“When the music stops — when I can’t tie my bow tie, tell a funny story, walk my dog, talk with Whitney, kiss someone special, or tap out lines like this — I’ll know that Life is over. It’s time to be gone.”
But it’s also [Cleniden’s attitude] valuable as a backdrop to the current budget mess. This fiscal crisis is about many things, but one of them is our inability to face death — our willingness to spend our nation into bankruptcy to extend life for a few more sickly months.
The fiscal crisis is driven largely by health care costs. We have the illusion that in spending so much on health care we are radically improving the quality of our lives. We have the illusion that through advances in medical research we are in the process of eradicating deadly diseases. We have the barely suppressed hope that someday all this spending and innovation will produce something close to immortality.
In other words, we believe that doctors save lives. This is not so. Every patient of every doctor ultimately meets the same fate. Just as no priest or preacher has ever saved anyone’s soul, no doctor has ever saved anyone’s life. God, for the spiritually inclined (or the individual, for those less so inclined) saves souls. Doctors, at best, can only extend life.
The question then becomes, is the extension of life made possible through medical advancements worth the cost of doing so? Is the cost of extending life always exceeded by its benefits? Obviously, the answer is no. No one would propose that spending a million dollars a day to keep an old man dying from cancer alive for so long as medical technology was able would be a good way to employ societal resources, no matter how important the old man had become in life.
But that’s an easy case, and not one likely to bankrupt the fisc one way or another. The harder case is whether to spend thousands of dollars to try to treat a relatively young person (e.g., under seventy) whose body is hopelessly, incurably riddled with cancer, the treatment for which is doomed to fail. That’s my mother.
She has stage-four pancreatic cancer. It has enveloped her liver and gotten into her lymphatic system. There is no cure, and the treatments may or may not extend her life by a few weeks; a couple of months at most. Nothing of the cost of treating her was discussed when it was decided that she would attempt chemotherapy. And for good reason. The state, i.e., the government in all its various forms, was picking up the tab. Would the decision have been different had the cost of treatments been paid by the family? Though my parents are financially able to pay for the treatments, they didn’t get that way by investing in losing causes. I believe they would have foregone treatment had they been the ones forking over the money. That cost never even factored into their decision calculus is a poignant example of why, as Brooks observes, the aging and dying baby boomer generation is the true fiscal time bomb, never mind debt ceilings and military adventurism.
Mom’s cancer was discovered through a CAT scan when she was admitted to the hospital after an X-ray revealed tiny blood clots in her lungs. The cancer was inoperable, but since she decided to do chemotherapy, she had to undergo surgery to put in a port. The complications from this relatively simple surgery kept her in the hospital another ten days or so. That was two months ago. She has never really recovered from the surgery, and the few times she’s felt well enough to go for chemo, the treatments knock her down some more. She might have had a couple of good months left had she foregone treatments. As it is, she’s hardly had a good day since her surgery, and she’s not getting any better. And all because the financial cost of treating the cancer was effectively zero. In effect, the availability of Medicare made Mom’s remaining days worse, and it’s not even clear that the thousands of dollars spent to date for her treatments will extend her life, such as it is, even one single minute. They may even shorten her life, and have certainly ruined its quality.
In a culture founded on materialism, as is American capitalism, it is no surprise that the most sought-after material good is the continuation of the body’s existence. Americans like to claim that theirs is a pious culture, founded on the principles of Judeo-Christianity, but Christ instructed his followers in Matthew, “Do not store up for yourselves treasures on earth.” What is this worship of the continuation of the material body’s existence except an attempt to store up treasures on earth? Yet it is the most pious (such as my parents) that stubbornly refuse to embrace the fact that every life comes with a death.
American capitalism that depended for its expansion and success upon creating new and insatiable material desires in its populace is now threatened with demise because it so successfully inculcated the idea that more is always better (cars, houses, life itself) that its elderly refuse to die, no matter how terrible is the quality of life that is extended. The selfishness and greed upon which the culture depended now threaten to destroy it, because unlike houses and cars, etc., there is practically no need for the individual to consider the costs when deciding to purchase an extension on life.
In another op-ed article in the New York Times, Does Philosophy Matter?, Stanley Fish argues that philosophy is irrelevant (particularly regarding whether one is a moral relativist or absolutist) in making day-to-day decisions that have moral implications. To be sure, I don’t pull out Spinoza’s Ethics when confronted with a decision on whether or not to speed through a yellow light. But Fish misses the point. It is exactly because so few have a philosophy (or theology, if you prefer) of existence animating their understanding of reality and how their lives fit within that reality that the hard choices about life’s continuation become impossible to make, which ultimately yields reversion to the default choice that more is always better.
Dealing with the inevitability of death and the temporality of life is the whole point of philosophy and theology. Life is a conundrum. Its purpose is necessarily its continuation, else human beings would not long continue to exist, but for the individual, life’s indefinite continuation is impossible. As John Mayer laments in Edge of Desire, “All of that striving; we still end up dying; how can it be?” When is it okay to quit all of that striving and let death wash over you? It seems a delicate balance. Yet somehow, I believe most people know, if only they would listen to the murmurings of their soul.
By the time my son’s leukemia relapsed, and I was faced again with the very real possibility that his earthly existence would soon cease, I had spent countless days and months in the eight years since his first diagnosis wrestling with the temporality of existence. I found solace in philosophers and theologians ancient and near, but one particular ancient, St. Augustine of Hippo, seemed to speak directly to my heart about the temporality of life and of the vulgar state of American materialism with this passage, from On the Free Choice of Will:
All wicked people, just like good people, desire to live without fear. The difference is that the good, in desiring this, turn their love away from things that cannot be possessed without the fear of losing them. The wicked, on the other hand, try to get rid of anything that prevents them from enjoying such things securely. Thus they lead a wicked and criminal life, which would better be called death.
Of all the things that can not be possessed without the fear of losing them, the continuation of one’s earthly existence certainly reigns supreme. Death is inevitable. Fear is not. Embracing the inevitability of death, of either one’s own life or that of a loved one, is the only way to ever truly live a good life.
For that reason, I was internally conflicted about whether or not we should attempt another bone marrow transplant (though, obviously, the decision was not mine alone to make). My son was young enough that, if successful, a transplant might buy him several more years, but if it failed, we would have mortgaged his remaining days for a hollow promise. Though he survived and is now doing fairly well, I still don’t know whether the year and a half he spent in hell with the transplant will prove to have been worth it. Because I had done all I could to turn my love away from things I could not possess without the fear of losing, I did not automatically believe that every potential “life-saving” procedure was worth undertaking. I had already turned my love away from the continuation of his earthly existence by the time of the relapse. My philosophy of existence made the decision harder, but only because it was better informed.
There is great freedom and peace to be found in turning one’s love away from things that can not be possessed without the fear of losing. It means refusing to love money, honor, status and all the other material trappings of society, but it mostly means refusing to worship the continuation of one’s material existence. It places one’s life in the proper context. We will all be dead for a great many more years than we will have lived, no matter how long we manage to survive, which is as true of individuals as it is of empires and civilizations. Augustine’s admonition and my son’s leukemia helped immensely along my way of struggling to see things as they really are.