When should doctors stop saving lives?
TW: discussions about death and loss
To save lives, we prevent death.
But maybe it's time to reconsider that statement.
Modern medicine has evolved a remarkable ability to stave off death. Growing up healthy and fortunate, I rarely thought about mortality and fragility. Much to my parents’ dismay, I would eagerly wield butcher knives to slice watermelon, recklessly climb gnarly trees, and attempt new tricks on my bike. I knew that, should anything happen, the hospital would “put me back together”. I remember how my jaw hung agape when an older kid in elementary school told me about a classmate who had the tip of their finger reattached. Raised in a world with modern medicine, I assumed it held infinite solutions. Though I’ve since learned of its limits, I still occasionally catch myself holding onto this belief.
With the astonishing advances in medicine, it’s understandable why so many share this view. However, people with complex chronic conditions often know the limitations of modern medicine too well. In his 2022 book Death Interrupted, emergency and ICU physician Dr. Blair Bigham explores how our faith in medical technology is reshaping the way we die.
Dr. Bigham introduces a "death dilemma" he frequently confronts in his practice: When a patient's illness is severe, should families and healthcare teams persist with painful resuscitation efforts, or transition to comfort-oriented, end-of-life care (see Saray’s blog post on palliative care)? Drawing on historical archives and interviews with researchers, lawyers, bioethicists, clinicians, and advocates, Dr. Bigham seeks answers to this dilemma. He delves into how our definitions and attitudes towards death have shifted with medical advancements, and explores how factors like socioeconomic status, religious beliefs, legal considerations, family-physician dynamics, and the ethical complexities of organ donation complicate these decisions. For aspiring healthcare professionals, Death Interrupted provides an authentic, nuanced perspective on challenges they may encounter in practice.
The themes in Death Interrupted resonate strongly with those in Being Mortal by Dr. Atul Gawande, which Madison reviewed in a previous blog post. While Dr. Gawande emphasizes palliative care options, Dr. Bigham centers on the difficult choice between palliative care and resuscitation. Madison’s review highlighted how Dr. Gawande humanizes death by sharing his experiences as a family member supporting loved ones through terminal illness. In contrast, Dr. Bigham writes from a clinical lens, focusing on his interactions with families confronting the "death dilemma." His background as a paramedic, which led him to urgent care, perhaps explains why I—a young, healthy college student unfamiliar with death's harsh realities—found his at times dispassionate tone on death jarring.
Before reading his book, I heard Dr. Bigham discuss the death dilemma on Radiolab, my favorite podcast, where his narration sounded more raw and personal. (Link to the Radiolab episode below.)
Shortly after Death Interrupted was published, Dr. Bigham found himself on the other side of the death dilemma. His father was diagnosed with end-stage pancreatic cancer, and, despite his expertise, he clung to hope that modern medicine could offer a cure—that perhaps somewhere, a treatment awaited in a world-class hospital or emerging from a lab. Driven by both conviction and desperation, he reached out to renowned doctors, scoured journal articles, and consulted colleagues, searching for a way to improve his father’s slim chance of survival. At his father’s bedside, Dr. Bigham urgently fired off a list of potential options to the surgeon, only to be interrupted by his father’s gentle request, “I just want to be comfortable. We’re done here.”
Death Interrupted offers tools, if not answers, to help families, patients, and clinicians navigate the death dilemma, illustrating the importance of centering patient and family voices in care decisions. Dr. Bigham’s personal story demonstrates how crucial it is for clinicians to engage with narrative medicine to continue empathizing with patients through unrelenting crises amidst risks for burnout and desensitization. I am grateful to Dr. Bigham for sharing both perspectives of his journey through the death dilemma.
While we can objectively discuss quality of life and technology in medical decision-making, it is understandable to hold onto hope and resist grief when faced with a loved one's suffering. Authors like Dr. Bigham and Dr. Gawande encourage us to begin conversations about dying as a dignified and normal part of life—and about the types of lives we want to support with the resources and technology we have at hand.
By: Christina Zeng (she/her) | Blog Committee Member
