The Royal College of Physicians has suggested that doctors should learn to talk to patients about death. But talk about what, precisely? The medical diagnosis? Matters spiritual? Philosophical?
In a play about his fate, Prometheus, the mythical champion of mankind, said that he had benefited mortals by preventing them from foreseeing their death. Asked how, he replied ‘I lodged blind hopes in them’. This reflected a school of medical thought which took the view that offering the patient encouragement could prevent them ‘giving up on themselves’ and actually keep them alive.
Not everyone took that approach. In a world where anyone could become a doctor (we hear of 18-year-olds starting to practise), it was vital to maintain one’s reputation. So doctors were advised to steer clear of treating the dying. Those observing the ‘scientific’ teachings of Hippocrates (5th century bc) simply confined themselves to ‘rational’ assessments of whether a patient would improve or survive. The famous doctor Galen (2nd century ad), accurately describing the slow decline that we still recognise today (pre-senility, senility, last days), did alleviate the early signs, but agreed that the time came when one had to walk away.
The ancient philosophers filled the gap with sage observations: ‘we are dying every day’, ‘Are you lengthening your living or your dying?’, ‘Should you obey Nature or Nature obey you?’ But one wonders what purpose that served. In that world, a third of children would be dead before their first year, a half before their fifth: every child who made it to five would have had first-hand experience of the death of many siblings. Only 8 per cent would make it to sixty. Reflections about death carved on epitaphs often record some comfort in it.
But in today’s world of advanced medicine and virtual (how virtuous!) reality, the natural world seems far away. Can doctors, then, bent on frustrating nature, make the best comforters or philosophers?