Presentation on Nuland’s Chapter 4, Doors to Death of the Aged

by poolerm …

This passage essentially describes the process of aging,  and the diseases that come with it which will eventually carry you on.

In this excerpt, I feel that Nuland focuses way too much on what could be classed as the ‘cellular level’ of death. I found that he did not deal in this chapter with the emotional side of the death of an elderly person, and for me, this level of detachment was startling, given that the author himself is a doctor, supposedly a person who is humane and compassionate.

I feel that the main issue raised in this chapter is accepting that ageing is the gateway to death, and raises the question should we push the limits when natural life has begun to fade? He appropriately voices this question in the phrase on page 70 ‘It lies in the power of man, either to permissively to hasten, or actively to shorten, but not to lengthen or extend the limits of his natural life’.

I think this is important because it is saying, in my opinion, that age is a natural process which we must all endure, and death is its final stage. I feel that trying to lengthen the life of an elderly person if the methods used will only cause more pain, or be detrimental in some other way, is pointless. It is trying to fight against nature’s plans for us. Death is an inevitable process, and I think it is ethically wrong to try to extend a person’s (be they elderly or young) life. Life’s natural course has been run, and the priority of physicians, in my opinion, should be to make sure that death occurs with dignity.

I feel that in this chapter, Nuland tries to offer some guidance on the topic of death, and tries to shed some light on the process itself. I think for the best part, he means well, but essentially, he is saying that death can never be the easy, painless affair we all hope for. He says that eventually, we will all be carried off by one of the seven horsemen of death, which include pneumonia. I find this to be quite unsettling, and strange that in certain literary reviews,this book has been recommended for reading by terminal patients. Personally, I think that knowing so much about your death and how it (according to Nuland) probably will be, only increases fear of death.

Nuland also raises the point that death is necessary for the progression of life and our species. The replacement of each generation is a natural process, which ultimately leads to the improvement of our race, as new knowlegde is obtained by new generations, etc. Death is essential for the growth and prosperity of new life.

I know that some of the group found the amount of detail included to be useful and interesting, and while from the point of view of a medical student I do agree, but if you were a lay person reading it the level of detail would put you off. That is one of the things I did not like about this particular extract.

Please feel free to leave your own comments on what you thought about the chapter!!!

And here are some of the points we raised in the discussion, if anyone would like to comment/tweet on those too!!!!


Does advancement in medical sciences make us fear death more?Ignorance is bliss?

Is it wrong for society to sustain life when it’s course has been run?

Should we as doctors prolong treatment when the patient is over 85?

Euthanasia: Should it be allowed or not??

And, if it were legallised, would it be abused by those who were not terminally ill?


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