The Importance of Mortality

Irecently attended a presentation given by a ministerial colleague about the benefits of being mortal. We usually don't think about mortality in this way. Traditionally, the medical field and many parts of our society view mortality as either an error or a failure, certainly not as a natural outcome or as a “good thing.” What would you do if you were given the opportunity to live forever? A hospice social worker I worked with would ask audiences if they would like to live forever. He proposed a hypothetical situation guaranteeing good health and financial security for them and their close family and friends. Interestingly, no one wanted to live forever. What would you say? My ministerial colleague asked a youth group the question, “Suppose that at this moment you knew, for certain, that you shall all live forever. What might you do next?” The participants did not jump around joyfully, as if liberated. On the contrary: They stumbled around aimlessly. They had discovered the meaning of life. If life has no boundaries, and no closures, we become like zombies. Because without death, without deadlines and without closures, nothing really matters much.

Mortality gives structure and meaning to life. In this issue, authors Chochinov, McClement, and Hack, et al., describe a tool, the Patient Dignity Inventory, used to identify sources of distress commonly seen in patients with terminal illness. ¹ In Dignity Therapy clinicians help patients generate a document that can be passed on to loved ones by recording a patient's life story and then transcribing the patient's words. This document usually contains the details of a patient's life, lessons the patient has learned, and declarations of affection towards loved ones. ² Without mortality, the things we did and the choices we made wouldn't matter.

Mortality gives us timelines and deadlines and these make us more aware and appreciative of the remaining time that our patients and their families have. The finiteness of death makes Drs. Wong, Soh, and Yuen's article, Targeted Therapy at the End of Life in Advanced Cancer Patients even more poignant. ³ We think of the number of people receiving chemotherapy near the end of their lives and worry about increased physical and psychosocial suffering frequently experienced by patients and their families. We wrestle with the quantity versus quality of life debate. These timelines and deadlines make what we do so important.

We recognize that life is precious, unique, and finite. We recognize this when we are asked to see a new patient and his or her family, when we attend a memorial service, or read a case study in the literature. We are advocates for our patients and their families. Authors Alt-Epping, Stäritz, Simon, et al., in the article What is Special About Patients with Lung Cancer and Pulmonary Metastases in Palliative Care? Results from a Nationwide Survey, describe the high symptom burden experienced by this population and call for for early recognition of dyspnea and confusion and encourage additional research into pathophysiology of these symptoms. ⁴ The article entitled Determination of Cutpoints for Low and High Numbers of Symptoms in Patients with Advanced Cancer is an example of how we can quantify symptom burden in order to improve quality of life as soon as possible. ⁵

Mortality facilitates change. Values and expectations change as players on the field change. New ideas gain support and a larger following. This is happening in our field. Consider the following paradigm shift. In medical school I was taught that children don't experience pain. On my pediatric rotation it was explained that babies cried while being circumcised because “they didn't like being tied down to the papoose board.” Seriously, that is what I was taught and I believed it – just like all the other students on the rotation did. That was quite a few years ago and look how far we have come. Now we are reading articles like the one by Drs. Ameringer, Fisher, Sreedhar, et al., evaluating the effectiveness of a web-based pediatric pain management module on knowledge, confidence, attitudes, and self-reported skills in medical students. ⁶

Maybe it's time to view mortality somewhat differently. What would our lives be like if we weren't mortal?