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mercredi, 14 janvier 2015

Accepter de vivre et de mourir

Sur son blog Slate Star Codex, Alexander Scott, médecin psychiatre à l'hôpital, aux États-Unis, évoque la mort inhospitalière à l'hôpital. Il rappelle que beaucoup de médecins sont moins jusqu'au boutistes lorsqu'ils sont eux mêmes malades que lorsqu'ils doivent soigner les autres. Un choix fait en connaissance de cause, une connaissance très professionnelle.

Voici un extrait de son article Who by very slow decay, un titre extrait de la chanson de Leonard Cohen Who by fire.

"I was sitting in an ICU room yesterday where a patient’s body had just been brought out after their death. My attending was taking care of the paperwork in the other room, and I was sitting there reflecting, and I started thinking about what it would be like to die in that room. There was a big window, and it was a sunny day, and although I mostly had a spectacular view of the hospital parking lot, a bit further in the distance I could see a park full of really big trees. And I knew that if I were dying in that room my last thought would be that I wanted to be outside.

I think if I were very debilitated and knew I would die soon, I would want to go to that park or one like it on a very sunny day, surround myself with my friends and family, say some last words, and give myself an injection of potassium chloride.

(this originally read “morphine”, but just today the palliative care doctor at my hospital gave an impassioned lecture about how people need to stop auto-associating morphine with euthanasia, because it makes it really hard for him to offer morphine painkillers to patients who need them without them freaking out. So potassium chloride it is.)

This will never happen. Or if it did, it would be some kind of huge scandal, and whoever gave me the potassium chloride would be fired or something. But the people dying demented and hopeless connected to half a dozen tubes in ICU rooms aren’t considered scandals by anybody. That’s just “the natural way of things”.

I work in a Catholic hospital. People here say the phrase “culture of life” a lot, as in “we need to cultivate a culture of life.” They say it almost as often as they say “patient-centered”. At my hospital orientation, a whole bunch of nuns and executives and people like that got up and told us how we had to do our part to “cultivate a culture of life.”

And now every time I hear that phrase I want to scream. 21st century American hospitals do not need to “cultivate a culture of life”. We have enough life. We have life up the wazoo. We have more life than we know what to do with. We have life far beyond the point where it becomes a sick caricature of itself. We prolong life until it becomes a sickness, an abomination, a miserable and pathetic flight from death that saps out and mocks everything that made life desirable in the first place. 21st century American hospitals need to cultivate a culture of life the same way that Newcastle needs to cultivate a culture of coal, the same way a man who is burning to death needs to cultivate a culture of fire".


Who by very slow decay, par Scott Alexander. L'article entier est sage, intéressant et invite à la réflexion. Le blogueur nous invite ensuite à lire l'article How doctors die, sur la manière dont les médecins eux mêmes font face à leur propre fin.


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