A Life Worth Living: A Doctor's Reflections on Illness in a High-Tech Era

I first heard of A LIFE WORTH LIVING wheb Dr. Martensen was interviewed on the Diane Rehm Show. As I am facing my own end of life decisions, I am inspired and comforted by Dr. Martensen's candor and common sense approach. I ordered two copies of the book--one for myself and the other to share with family members and friends.

A Life Worth Living is powerful book which can inspire a broad readership of general public, health professionals, and those in positions of effecting health policies. Like Dr. Martensen,I have had long career in health care. I believe he was right on point with many of the complex health issues facing individuals and families. He cited examples of dilemmas faced by adults with sick children, middle-aged and older adults facing chronic disease and/or end of life issues. His case examples represented the poor, affluent,disabled, persons young and old and the quality of life during illness and in the face of death. He wrote with humility with respect for science and for the individual "person." His account of his father's death showed that families and friends can be an advocates while grieving. He stressed how important it is to identify and articulate our wishes and the importance of communicating with those who may be faced with participating in making decisions on our behalf. This is a book which inspires the reader to take personal action. Martensen has shared historical, ethical, personal and instructional information. When a book has the capacity to change behavior, mine and others, I believe that it is a book well written. Heather Losee, RN, MPA

Great food for thought and action regarding hospital care for those entering their "golden years" and also for children of aging parents and parents of children with terminal illnesses.

Where to start? I read this book in two days, although it's not my usual fare. I had heard Dr. Martensen discuss his book on NPR, and thought it sounded interesting. I had no idea how much I would learn from it (and I consider myself an educated, well-informed person). I think many of us have anxieties about being trapped in the bureaucratic labyrinth of contemporary medical care--personally I've always dreaded dealing with hospitals and doctors far more than I've feared being ill. The book confirms one's worst fears about the inhumane (though often well-intentioned) treatment critically ill people receive at the hands of today's medical-industrial complex. Martensen negotiates (but doesn't over-simplify) the ethical minefield that patients (or consumers? another question the book raises), doctors, and families must tread in attempting to make medical decisions for themselves and others. He writes compassionately about the value (as opposed to mere length) of life for all people, including the aged, indigent, and genetically compromised. He examines these questions as they affect individuals and reflect social/economic priorities. He asks why, when medical care is more expensive than ever, it has become increasingly inhumane. He questions the need for more high-tech, highly-specialized treatment centers in an era when an increasing number of citizens lack any health care insurance. He explores the economic reasons for this seeming paradox, and the phenomenon of for-profit hospitals. I was chilled to hear some of his anecdotes about organ donation, and the pressure put on grieving families to help hospitals make money. It was almost like something out of that old novel/movie, Coma. I hasten to add, however, that there is nothing sensationalizing or sentimental about this book. It is lucid (I'm not a medical expert, but found it wonderfully accessible), compassionate, factual, and just plain riveting. Some of the personal stories he tells will stay with you long after you put the book down. It should be required reading for anyone middle-aged or older, or anyone with aging parents or ill family members. Elegantly written, persuasive, and most of all, timely.

Martensen, a physician, dares to question the medical establishment's reliance on high-tech interventions, especially among the elderly. He shows that many of these interventions are unnecessary and even harmful. On a broader scale, he reminds us that over 50% of our medical spending comes from the "public purse" in huge amounts, while every day people die because they can't afford basics like insulin. Most shocking: In 1600, if you made it to age 80 in Berlin, you could expect to live another eight years. In 1980, a study found that if you reached age 80 in the same city, your life expectancy was 88: just two more years (p. 79). Martensen illustrates his points with stories taken from his many years as emergency physician and bioethicist. One of the most chilling accounts describes a woman who remained healthy and active through her seventies, when she began experiencing shortness of breath while enjoying her long walks. A cardio surgeon suggested an operation. The operation worked to restore the woman's breathing - but the woman now experienced dementia. She was afraid to go out and her quality of life deteriorated. The woman's son asked Martensen about the possibilities of a lawsuit. Dementia is a known side effect of this type of surgery, so why hadn't the surgeon discussed it? Martensen warned the son, "You're in a field where you do a lot of negotiating. Your mother at the time ran her own craft business. The risks are here, buried in the fine print." My own view is that the surgeon should still have gone out of her way to warn about risks, especially such serious risk. I would have encouraged them to sue (if they had means ) to teach the surgeon (and other surgeons) a strong lesson. Doctors tend to see risks abstractly. I once expressed concern about an eye problem to a doctor who seemed fairly sensitive. He said, "Well, if that eye goes, you'll still have one more." I'm still blown away. In all fairness, there was very little likelihood I would lose vision, but statistics feel different when they're about you. Finally, Martensen talks about the uncertainties of high-tech medicine. We know that a certain percentage of people with certain conditions will recover, but we don't know which episode will be fatal and which episode deserves a high-tech response. At the end of life, UCLA patients spend three times more days in the ICU than UCSF patients, with no increase in quality or length of life. This book should be required reading for everyone. We need to recommend this book to our legislators and take a copy when we visit medical practitioners. This book will be especially helpful to readers who have aging parents or who are aging themselves, because we need to set up safeguards to avoid useless, invasive end of life "care." The author's own father was saved from a painful death only because family members had the paperwork in hand when the father went to the emergency room. Most of us wouldn't be so lucky.