Futile care and a time for dying

The Lancet Oncology Commission, ‘Delivering affordable cancer care in high-income countries’, looks fascinating and necessary. I was particularly drawn to the discussion of ‘futile care’, chemotherapy for individuals who are, in truth, living with dying, rather than living with a hope of recovery, or even much more time.

It reminded me of conversations I’ve had about how difficult it is for health services to find a place for death amidst the effort to sustain life. There are honorable reasons for this, and less honorable. But it seems that when death is not allowed to be part of life, the attempt to hold onto life can become desperate. Futile care, that is also unsustainably expensive, cannot be checked. Whether or not to administer a drug is left to brutal financial calculation.

This doesn’t help the dying and, I suspect, doesn’t help those who have more life yet to live. Might a good death be defined as one in which the dying are helped and allowed to depart in such a way that they become peaceful, benign energies in the lives of the still living? The living, in turn, can say to the dying, we will grieve, we long for you not to go; but we will join you in time, and in the meantime, will live as well as we can remembering you.

Something like this is behind many of the rituals of death, from lighting candles to laying places at the meal table for the recently departed and praying for them. I wonder whether a lack of such rituals in a secular world compounds the problems that organisations like health services face; might be another way in which hospital chaplains could save money?

It’s a tricky balance, of course, because today’s futile care might lead to tomorrow’s happy cure. But still, death needs a place in life. Then it might be less feared, in a flurry of medical activity, and might be embraced as part of a whole or flow that is bigger than both life and death.