Sunday, December 11, 2011

Of Beginnings and Ends

We talk much in medicine about the end of life. How do we know when it will end (prognosis)? How do we prevent death (treatment)? How do we comfort those in their last days (palliation)? But what do we really know about these questions of beginnings and ends?

I notice that many of our discussions focus on the “end of life.” As if life has an end. In all of history, what religion or culture has said that this moment of last breath was the complete end? All connect the life to the living that remain, or those who have “gone” before. Or adding hereafter, look also to that same life going on unseen elsewhere. Who has not been affected by those whose lives are over? Those loved ones we carry with us. Or even the multitude we have not met who impact our lives now in one way or anther: Plato, Freud, Stalin, Jesus? Their lives are “over,” but are they? When did we adopt terms better used in the lab or the courtroom for thinking about the “end” of life when it comes to meaning, being human, or making decisions about “end of life care.” (there we go again)

And for that matter, what does the “beginning” of life mean? Knowing now what the ancients did not, that if you look at a sperm and an egg under the microscope, they have a set time of fusion; does that mean we have defined the beginning of life? How has even the Christian Church been so quick to adopt this moment, ignoring the stories of life formed from dirt, from ribs, at the indefinable “beginning” of time, from a God with life, no beginning and no end?

And as for science, what have we as moderns added with our great stores of knowledge? We still use a beginning and end in the same simplistic way, throwing away what we know to again adopt words from the courtroom or the congress such as autonomy and individual. What of mitochondria that span thousands of generations, truly tying us all together with a single mother of yore. What of Lucy the transitional, of stone tools and an iron age, can we truly say with any authority that my life began with me? What of my own tail that was resorbed, my blastocyst stage (when I was more pond scum than biped)? Or what of toilet training, adolescence, are not those beginnings and ends as well?

So the complexity grows and the discussion could continue as well, encompassing all. Let us, as doctors and otherwise, take off our shoes and bow our heads when we approach issues of beginnings and ends of life. It was wisdom, not foolishness, that made the ancients call in holy men and women at these moments. And if we find ourselves there for reasons of science or otherwise, whether it be the delivery room or the palliative care room, or for that matter the classroom of discussion, may we foster things like silence and awe in ourselves and others and not be limited to only procedures and check boxes. And may we realize how limited we are and how we limit our understanding of life with this vocabulary of beginnings and ends.

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