In this month’s Atlantic, Jonathan Rauch profiles Dr. Angelo Volandes’ work to change the way Americans approach death. After realizing that most people facing end of life decisions did not really understand what various treatment options or conditions looked like, Volandes embarked on a mission to produce short, brutally honest films that he could show his patients. Dementia, artificial nutrition and hydration, heart disease, cancer, emergency CPR. . . If we really knew, Volandes believes, we would forgo a lot more end of life care that can make dying inhumane. Unwanted care is, in his view, the most urgent issue facing medicine today. This is why he interrupted medical school to learn film-making:
“Videos communicate better than just a stand-alone conversation. And when people get good communication and understand what’s involved, many, if not most, tend not to want a lot of the aggressive stuff that they’re getting.”
Volandes attempts to make his videos as objective and dispassionate as possible. He says wants to inform patients, which will improve The Conversation (or conversations) that must eventually take place near the end of life. But he sees this work as “subversive,” in that it has the potential to fundamentally change the way we approach end of life care.
Interestingly enough, Volandes is not invested in changing laws or policies. A doctor who uses his videos says, “The changes will come locally, not nationally.” According to Rauch, Volandes has “entrepreneurial obsessive-compulsive disorder: the gift, and curse, of unswerving faith in a potentially world-changing idea.” But that idea involves change that comes not from above but from below. With a stronger sense of reality, more people will be empowered to make better choices. This will mean better dying for them and huge cost savings for the healthcare system (though the latter is not the main emphasis of the project).
Is information enough to affect change? I don’t think so. Rauch highlights the example of his own father, who was not given the opportunity for The Conversation. He says,
“The momentum of medical maximalism should have slowed long enough for a doctor or a social worker to sit down with him and me to explain, patiently and in plain English, his condition and his treatment options, to learn what his goals were for the time he had left, and to establish how much and what kind of treatment he really desired.”
Of course, Rauch is right.
But along with good information, we need a way to assess the morality of various choices. Rauch himself wonders if doctors are up to this task. The Catholic tradition can be incredibly helpful here. Our ways of talking about end of life care are sophisticated, nuanced, and accessible. Ideas like double effect, distinctions between extraordinary and ordinary means, between killing and allowing to die, are incredibly helpful, and still, as far as I can tell, relatively unknown to the broader public. Beyond that, there is a long tradition on virtuous dying (cmt.com’s own Chris Vogt has a wonderful book on the subject.) that has yet to be tapped.
My hope is that as Volandes and others make more information available, Catholic theologians, health care workers, social workers, and family members will bring the reasoning of the tradition into many conversations about death. Sitting between the extremes of vitalism and an ethical egosim that can too easily justify asssisted suicide, the Catholic tradition rightly understood seems to provide a way to talk about all of the many conflicting values at stake in any decision about end of life care.
