Death by intensive care. Last week I went through a surgery, never mind which one in particular, it doesn’t matter for the course of my current thoughts. What does matter is the fact that I’m seventy years old, and that my DOD (date of death; drop on dead) is much close than my DOB (date of birth; drop on by). Am I afraid of death? Well, actually, I am not ready to answer that question. On one hand, I look back on the seventy years of my life with some rejoice: I’m pleased with the most of my life achievements, socially and professio-nally, and, more importantly, people around me show some genuine respect. I don’t think I need more years either to prove myself or to enjoy the life. On the other hand, day after day I am becoming aware of something I can’t do any more or I can’t do as well as I used to do. It is the deterioration of my physical and mental capabilities I’m afraid of. And if that decline is perceived as an early phase of dying, then my answer should be ‘yes’, I’m afraid of death. I’m afraid of the health care in a prolonged period of decline and dependence (also called 'death by intensive care’).

The matter gets murkier upon the three deviations of our present society: (i) medicine as a science, (ii) health care as a business, and (iii) absence of a clear religious and/or moral guidance in an aging society. Our technological civilization has built a cult of knowledge, and scientists who are paid and honored to find out what could be done (and who almost as a rule have high but rather narrow education) too often are in position to decide what should be done. Technical and phar-maceutical advances in medicine are staggering but who decides what is applied to those with treatable illnesses and accidental body damages as compared to the inevitable body and mind erosion due to advanced age? We, the elderly, we are so attractive field of research with almost limitless erosion possibilities. And hospitals, they are not health care institu-tions, they are health care businesses: they like us, aging people, we come regularly for the service and repair, not like those young people coming only after car accident or sport injury. Of course they are pushing my life expectancy (length of survival, by definition, not a span of life!), it’s in the base of their business. And with whom can I discuss topics like this? Such thoughts are rarely shared, because prevalent etiquette discourages.

Lorenz Phryesen (c.1480-1532): Spiegel der Artzney, 

 Ralph H. Major: A History of Medicine..