Through the Valley of the Shadows
Living Wills, Intensive Care, and Making Medicine Human
The first living will was introduced in 1969, and it was a breakthrough for patients and their families, promising them control over the very difficult decisions being made at the end of life. In the wake of the Nancy Cruzan and Karen Ann Quinlan cases, holding on to the right to “pull the plug” provided comfort and a sense of personal autonomy.
Unfortunately, as Samuel Brown describes in Through the Valley of the Shadows: Living Wills, Intensive Care, and Making Medicine Human, the living will has let us down. An intensive care physician, Brown has become a champion of changing how the medical system works for people for whom death may be near. Though we hold onto the hope that “advance directives” will give us the ability to navigate difficult decisions at life’s end, they have fallen far short, too often leaving patients, and doctors, in limbo. In part, this is because advances in medicine have complicated the choices people must make – the living will was designed to avoid a situation that today rarely presents itself: being kept alive in a prolonged comatose state. Further, while 80-90% of very sick patients once died despite intensive care, now about 80% survive. The ICU experience has been transformed, but the living will has not kept up with that reality.
In this thoughtful and cogently argued book, Sam Brown proposes a new approach to decision making in the ICU, one that supports patients, families, and medical professionals. The ICU is rightly celebrated for healing bodies, but it has done little to care for the while person. Dr. Brown believes intensive medicine has as much responsibility, and as much potential, to care for hearts, minds, and spirits.