Medicine: Specialty for Losers

Trained to regard death as the enemy they must defeat at all costs, doctors regularly resort to heroic measures to keep their patients alive. Often they perform radical surgery or use complex machines to maintain a flicker of life in people so old or ravaged as to be beyond caring. But does death always represent defeat? No, says Dr. William Poe, a professor of community medicine at Duke University. Writing in the New England Journal of Medicine, Poe not only takes issue with the "winning psychology" of most medical specialties but suggests the creation of a new discipline, the practitioners of which would be willing losers.

Poe calls his new specialty "marantology" (from the Greek marantos, meaning withered or wasted). Marantologists would care for those whom no one else wants: the old, the incontinent and the incurable, those who have "committed the sin of remaining alive but not yielding to our manipulations." Those specialists, says Poe, would be taught to see their patients slip away without experiencing feelings of guilt or personal failure.

Like Jonathan Swift's A Modest Proposal, Poe's article is obviously intended more for shock effect than literal advocacy. But it does address a question that increasingly concerns physicians: How to deal with the hopeless case? Realistically, replies Poe, "Medicine should not use silly euphemisms such as rehabilitation and convalescence for its losing patients. A marantology service could be a place where a person could die in dignity without all the pother death engenders elsewhere."

Medical Restraint. A man with a self-described "penchant for reflection in the wee hours of the morning," Poe bases his case for what he terms "medical restraint" on a lifetime of observing the sick and dying. As a youngster in Roanoke, Va., he accompanied his father, a Baptist minister, on pastoral visits to the old and discouraged. "I'm pretty well steeped in the golden rule," he says, "and I'm old enough [53] to figure how I'd want to be treated some day. I don't want to be cycled and recycled to the doctor, to the hospital, to the specialist. I'm against the hauling and mauling of people who have no reasonable future."

Poe does not advocate euthanasia. "We are not supposed to shorten life," he says. "But there is a limit to what we ought to do to prolong it." The marantologist, he suggests, would not only recognize these limits but help the public do so as well. The result—peace, comfort and relief for the medically hopeless—would benefit both patient and physician. "Marantologists would not always look on death as an enemy, but often as a friend," concludes Poe. "They would have their vision extend beyond life into eternity."