Timothy G. Ihrig, Chief Medical Officer, Crossroads Hospice and Palliative Care
At the intersection of medicine and technology lies a fulcrum upon which healthcare can reconnect to a broader sense of the human condition beyond its own or drift further away from what it means to truly care for others. At this epicenter are driving forces, conscious and unconscious, potentiated by the linear algorithmic world of medical education and practice, which preclude true informed consent and thus empowering patients and caregivers to live pursuant to what they hold sacred.
Influenced more and more by technologic advances, an inherent fear of life’s ambiguity (lacking a realistic understanding of the true physiologic arc of life manifest as fear of clinical failure due to limitations of medical education/ training), and economic pressures, medicine faces the atrocity of undermining the principles of non-maleficence and beneficence. Reclaiming or losing our own humanity depends on whether we acknowledge the need to change how we perceive life and the delivery of medical care throughout its entirety.
If we step away from acknowledging this, even for an instance, we are likely to lose sight of what it means to be human. If we portend to believe that technology without rigorous moral and ethical scrutiny against perhaps the greatest frailty of humankind – the desire for absolute certainty or, put another way, fear of the unknown and living in a world of ambiguity (which is truly what life is), – if we enter that realm, then technology will falsely appear to approach the impossible of being able to overcome and even control the very nature of life itself.
Unfortunately, the practice of medicine emphatically touts clinical paths and outcomes are “unknown.” Guised as a fear of “stealing hope”, “the patient is not ready to hear the truth” and many more. These excuse us from fulfilling our fiduciary responsibilities, and in truth, are a false manipulation of the clinical narrative.
Such a path is not to dissimilar to others throughout history that decomposed the fabric of society by excluding individuals from living, loving, learning, growing and supporting each other. Within the medical world this is an insidiously iatrogenic path compared to the atrocities of the last century. I offer however, it is no less significant with respect to interrupting the common fiber which binds us all. Doing things to people rather than with and for them results in unwarranted suffering, decreased quality of life and even death. Loss of freedom of choice is what manifests when we cease or fail to engage with the truth and embrace life’s ambiguity rather than manipulate it with fixed-false beliefs entrenched in our linear clinical algorithm. If we do not change,dehumanization becomes an interwoven thread of clinical practice. I would argue it already has.
Death is inevitable. Its relevance comes only after the last exhalation of breath. As such the conversation need not be about dying and death. Focusing on how one wants to live - whether it be for ten minutes or ten years - transforms the narrative from transactional to translational. This empowers hope and freedom and a greater sense of control regardless of diagnosis.
Realizing, accepting and communicating that there is no true unknown is the key to reclaiming our humanity. We know with absolute certainty where every journey leads. To a great extent we also know what the journey’s duration and course are as well. We must find a path of actualization that leads to obtaining the courage to tell the truth.
I urge us to seek new ways of thinking and practicing which can elevate what is possible in healthcare and beyond. Deepening our understanding of life, as opposed to fearing death or thinking of it as failure, we transcend medicine and come closer to what it means to be a true caregiver in the modern age.
Hesham Abboud, MD, PhD, Director of the Multiple Sclerosis and Neuroimmunology Program and staff neurologist at the Parkinson’s and Movement Disorder Center at University Hospitals of Cleveland, Case Western Reserve University School of Medicine
Health Sciences Associate Clinical Professor, Dept of Pediatrics - University of California- Irvine, Director CHOC Comprehensive Epilepsy Center Pediatric Neurology & Epilepsy , Children's Hospital of Orange County