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As recently as the 1960s, “medicine did not routinely stave off death among the very old,” journalist Katy Butler points out in Knocking On Heaven’s Door, her new book about modern medicine’s tendency to overtreat, particularly at the end of people’s lives. Butler chronicles the deaths of her parents—her father’s slow decline after a debilitating stroke and her mother’s refusal to succumb to “Hail Mary” surgeries—and in so doing offers an unflinching look at the “perverse economic incentives” that reward doctors for procedures over humane care.
An expansion of Butler’s 2010 New York Times Magazine piece about her family’s attempts to get her father’s pacemaker turned off after a stroke leaves him increasingly incapacitated, the book deftly toggles between her family’s relationships and end-of-life struggles, and the history of our shifting attitudes towards death and rise of technologies that are meant to extend life but often lead to suffering. Butler also offers an antidote of sorts—a Slow Medicine movement that emphasizes “care over cure.” I caught up with the author to talk about her daughterly regrets and tackling a subject that most of us would rather to avoid.
Mother Jones: People are often told they should have these conversations about how they want to die before they are medically incapacitated. But what if they change their minds after the fact?
Katy Butler: I don’t think people ever were free of fear of death, but clinging to life and being so unprepared for it is a modern experience. Our ancestors actually read books about how to prepare for death. It was considered your moral obligation to be prepared for your deathbed and to able to face it with equanimity. We offer such false hopes to people that every medical problem can be fixed even when you’re starting to deal with an 80- or a 90-year-old body that is breaking down in multiple ways and doesn’t have that resilience. And so it doesn’t surprise me that someone who is completely unprepared for death may say, “Doc, do everything.”