For last week’s Jerusalem-Tel Aviv commute, I opted for mass transit. As customary, on the hour, the bus driver turned up the radio volume so that we passengers of Egged 480 could hear the news.
Together, we learned that Ariel Sharon’s condition had become critical due to acute renal failure.
As we marveled at the breathtaking views along Highway1, our collective “Tsk, tsk, tsk” implied, “What a shame that Arik’s health has deteriorated,” but in fact, the former Israeli prime minister has been lying in a vegetative state since his series of strokes in 2006. For the past eight years, healthcare workers and laymen, alike, have understood the 85-year-old’s condition to be, as they say, “terminal.” Yet how often do we, either as individuals or collectively as a society, choose to dodge the end-of-life questions that Sharon’s condition prompts us to consider? Writing for the AMA Journal of Ethics, Dr. Kenneth Prager points out that advances in biomedical science make it increasingly difficult to die in an intensive care unit. While sophisticated machines allow doctors to make heroic “saves,” the same technologies can prolong the dying process for patients with incurable disease.
Although Sharon did live to be transferred out of the ICU, some might consider the life-prolonging treatment to be an inappropriate and misguided exercise in what many professionals call “medical futility.” Prager emphasizes, however, that the word “futility” has no meaning out of context. Particularly with human life involved, establishing such context requires clearly defining goals.
If the goal was to restore Ariel Sharon to full consciousness, perhaps even political function, then medical treatment might be deemed futile. However, what if Sharon’s sons, Gilad and Omri, wished to keep their father alive because they believe in the sanctity of life and want to be near the dad who raised them? Probably they would consider his treatment effective rather than futile. Should society find such preferences reasonable or selfish, if not immoral? It is impossible to create absolute definitions of “futile” and “reasonable” because each of us is driven by a very personal set of values. It is quite plausible, though, for individuals and families to arrive at their own contexts and priorities.
Recently, our organization (Life’s Door – Tishkofet) made arrangements to bring “The Conversation Project” (www.TheConversationProject.org) to Israel. This important tool will be made available here in Hebrew, Russian and Arabic. By reflecting on some simple questions with loved ones regarding priorities during life and at life’s end, clear goals can be established and uncertainty as well as regret can be minimized.
The Conversation Project questions are straightforward but provocative: If you have a serious illness, do you worry that you won’t get enough care or that care will be too aggressive? Would you be willing to receive potentially toxic treatments if the interventions might extend life and increase chances of reaching important milestones such as birthdays and graduations? Are there circumstances (e.g., dependence on a breathing machine or a feeding tube) that you consider worse than death? Last week, Yair Shamir, current minister of agriculture, attended ceremonies dedicating a high school in memory of his late father, prime minister Yitzhak Shamir. It’s common, in fact, to link names of deceased Israeli prime ministers to public works projects. On the vast roads of our country, for example, we commemorate the names of many leaders – Golda Meir, Yitzhak Rabin, Menachem Begin. Who knows, maybe a great boulevard will bear the name of Ariel Sharon someday.
If so, Highway 1 would certainly be a good choice since our number one priority – if we are to genuinely extend Sharon’s legacy beyond that of military hero or statesman – will be to honor the starting point of an important form of communication that we failed to have during his lifetime.
The author is chair of the Institute of Radiotherapy at Tel Aviv Medical Center and the co-founder of Life’s Door-Tishkofet.