Since the Enlightenment, we’ve favored science over intangibles like wisdom and art. This belief in science gives us the illusion of control but even science has its limits. Our dependence on scientific evidence has come at the cost of losing common sense, especially in the practice of medicine.
While medicine was once seen as both an art and a science, our focus evolved and today, medical school teaching is based almost exclusively on scientific principles. The impact on medical education has been both beneficial and profound but it has diminished the important role of art in medicine.
Until the middle of the last century, it was not uncommon for doctors in this country to forge a personal bond with their patients. Many MDs were general practitioners who treated and knew virtually every member of the family.
Now, technology plays the dominant role in the diagnosis and treatment of patients, even those who are dying.
Don’t get me wrong. The shift toward specialization and science in medicine has brought undeniable benefits such as the miracle drugs and sophisticated treatments we have developed for diagnosing and curing the sick and the injured. However, there is
a downside, particularly when it comes to providing artful and compassionate end of life care. Too often we try to keep dying patients physically alive by using advanced medical techniques despite the impossibility of their ultimate recovery. Instead of calling on science to artificially extend their lives, we should be using our basic human decency and common sense—the artful side of medicine—to help them die naturally.
While we invest generously in medical technology, we don’t fund critical, non-medical support like homecare, which is especially important for the frail and elderly. We also fall woefully short in providing palliative and hospice care to terminal patients who would prefer to die at home rather than in a hospital.
By relying almost exclusively on procedures and tests in our treatment of dying patients, we take the art and humanity out of medicine. Our scientific approach overwhelms spiritual and psychological considerations such as the emotional well-being of the patient.
The Hippocratic approach to medicine called on physicians to be “very kind to the patient.” The approach specified gentle treatment and “emphasized keeping the patient clean and sterile.”
This kinder, gentler approach to medicine, employing empathy and intuition, is especially important in treating patients in the last years of their life. By connecting personally with their patients and granting them the dignity and respect that they deserve, doctors can do more to ease their dread and discomfort than any inanimate machine no matter how sophisticated or efficient it may be. The more machines dying patients are hooked up to, the lonelier, more hopeless, and more isolated they are likely to feel in their final hours and days.
There are patients who will not want to give up the fight for life and that is their choice. Might their choices change if they had data that informed them of likely complications from certain treatment options?
If, for example, as an older patient you knew that you were at increased risk for reduced cognitive and physical abilities and greater risk for nursing home placement following successful medical treatment for a heart attack, would you feel the same way about receiving that care? Providing older patients with this kind of data can help them make more informed choices about their EOL care. Medicine can save your life, but it can extract a heavy toll, too.
Through the synthesis of science and art we are more likely to find a good death. What might the therapeutic art of medicine look like in the dying process? How do we wish to face death? This is a humanitarian – or “art” - question more than a scientific one.
Our cultural bias toward science has deprioritized the hospice care option. Hospice is a humanitarian and not a science-based model. Selecting hospice means the patient or his or her representative is letting go of further medical treatments. While it can be hard to make the decision to let go, research has documented that life expectancy is just as long, if not longer, in hospice care.
This research reminds me of a blunt quote from a physician advising her patient about a chemotherapy regime: “You probably have six months left to live. You can take chemotherapy and you will suffer through those six months, or you can go into hospice and spend that time putting your affairs together with your family.”
The point here is that death involves making complicated personal and clinical choices. Do we want chemotherapy, or do we want hospice? Such dilemmas would benefit from a therapeutic perspective and humanitarian reflection – in other words, a balance of art and science.
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