Quality of Life or Quantity of Life?

Quality of Life or Quantity of Life?

I was spending the summer training as a hospital chaplain, and felt I had been given one of the “easy” floors to serve.  I was on a general medicine floor that mostly saw older patients.  I was relieved to have somehow avoided an assignment in another area of the hospital, like pediatric intensive care or the ER.

But one day, I walked into a room, and met a couple.  A woman, probably in her seventies, was lying on the bed, and I saw her husband awake, aware, and attentive to her needs.  While his wife slept, IVs in her arms, machines beeping, I drew him into conversation.

He had brought his wife into the hospital that day, as he had a number of times before.  His wife was suffering from an untreatable form of cancer, and the disease would eventually lead to a long, protracted, most likely painful end.  She also had a chronic hyper-calcium condition which had periodic flare-ups and could be treated.  But that treatment needed to be administered early in the flare-up stage — if the symptoms of the condition were not quickly recognized, and she was not brought immediately to the hospital, it would be only a very short time before she would die.

The husband was struggling.  He knew the signs of her flare-ups very well; better than she did, in fact.  Even the slightest change in her condition and he could recognize what was happening, and get her to the hospital in time.  But he also did not want his wife to suffer, and knew each time he brought her to the hospital, he was assuring that the cancer and its drawn-out agony would one day “win.”

He asked me — what was the right, the ethical thing to do? Should he ignore his wife’s symptoms and let her pass quickly, without pain?  Or, should he continue to bring her in each time for care, knowing he was condemning her to an extended, lingering, terrible and painful death?

I had no real answer to give. He felt he was playing God; I could not fully contradict him.  Was he saving a life each time he brought his wife to the hospital? Was he putting a barrier before death, and not letting the inevitable occur?  Was he required to do everything possible, regardless of the later consequences?

In the 21st century, particularly, as our scientific knowledge and our medical technologies continue to grow, we are able to save many more people than in the past.  Machines keep us alive, when in former ages we would have “known” someone was dead. New treatments can potentially alleviate pain.

But not always.

And so we need to ask some very hard questions. Do we have a responsibility to keep people alive at all costs, even if they are in great pain? How do we navigate the tension between “quantity” of life and “quality” of life? As medical technologies advance, ethical challenges like this one will only increase.

As I left the hospital room that day, my mind kept circling around a rabbinic story of the 2nd century sage Rabbi Yehuda haNasi.  As he lay on the edge of death, struggling painfully through his last moments of life, his disciples had gathered around his bed, praying for him to remain in this world.  Rabbi Yehuda haNasi’s servant saw his suffering, and realized that the fervent prayers of his students were preventing him from dying.  She knew she had to act, and threw an earthenware jug off the roof, smashing it, startling the disciples.  In that millisecond when their attention was distracted, the rabbi’s soul peacefully departed.

I felt like I was supposed to be like that servant, seeing the big picture, knowing what to do, knowing the right answer to give.  I felt that my training as a rabbi was to bring a religious point of view to circumstances, and I had interpreted that as having and giving answers.  I was unsettled and upset for not having an, let alone the, answer to give.

Over time, my chaplain supervisor helped me realize a different point of view.  We tend to think that religion, morals and values, give a clear bright line on all of life’s questions.  In reality, that is not always so.

I struggled then to understand this, and it still is not fully comfortable to me even now years later, but I came to see that as a religious person, my role that day was not to tell the husband what to do.  Religion is much more than saying, “do this.”  Rather, the religious role is often just to be there, to be present for the other.  To share our common humanity and frailty, and our lack of clear knowledge.

Even though I didn’t know it at the time, that day, I realize now that I “simply” needed to listen to the husband.  To sit with him through his questions.  To take his hand in his anguish and grief.

And now I recognize that together, in our brief interaction, we helped comfort each other.

(This post is part of the Sinai and Synapses Discussion Forum, a collection of perspectives on specific topics. It is part of our series, “Are We Using Technology, or is Technology Using Us?“)


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