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

Robert Martensen

Farrar, Straus and Giroux



Trade Paperback

240 Pages



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A Life Worth Living is a book for people facing difficult decisions while enduring a serious illness or watching a loved one endure such an illness. Robert Martensen, a physician, historian, and ethicist, draws on decades of experience with patients and friends to explore the life cycle of serious illness, from diagnosis to end of life. He connects personal stories with reflections upon mortality, human agency, and the value of “cutting-edge” technology in caring for the critically ill. Timely questions emerge: To what extent should efforts to extend human life be made? What is the value of nontraditional medical treatment? How has the American health-care system affected treatment of the critically ill? And finally, what are our doctors’ responsibilities to us as patients, and where do those responsibilities end? Using case studies he’s encountered, Martensen demonstrates how we and our loved ones can maintain dignity and resilience in the face of life’s most daunting circumstances.


Praise for A Life Worth Living

"When it comes to books about health and medicine, the biggest sellers tend to focus on the latest diet or exercise craze and new ways to restore youth and beauty . . . But the best books . . . [are] those that illuminated the experience of being ill in America today, from the perspective of both the patient and the doctor, and an easy-to-understand guide to the workings of the human body. Also moving [is] a view from the inside of a health-care system that, for all its flaws, continues to strive in the interests of patients . . . [A Life Worth Living offers] help in facing difficult decisions that come with serious illness, such as whether to continue life-prolonging treatment when there is no hope of a cure."—Laura Landro, The Wall Street Journal

“So packed with information and insight that it can change your life and the lives of those who seek your advice about caring for the critically ill.”—Diversion magazine

"Quietly compelling . . . It oversimplifies the theme of this book, but not by much, to say that it is about medicine as all of us—doctor and patients alike—want to see it in the 21st century as opposed to what it is."—U.S. News & World Report

"Partly because it addresses one of the most critical, complex, and controversial issues of our time, this is an important book. It is also a highly readable, informative, even entertaining one. The author describes it as first of all a sort of handbook for readers facing medical crises of their own or of people they care for, but it quickly becomes clear that A Life Worth Living is a book for any citizen concerned about the continued well-being of this country . . . [Martensen] has the eye for telling detail, the ear for dialogue, and the narrative drive of a good fiction writer; the scholarly judgment to put modern medicine in the context of a long and complex history; the professional experience of treating seriously ill patients; and finally a profound and compassionate understanding of what constitutes health . . . A Life Worth Living is a practical guide in the sense that it reminds the reader of the alternatives to expensive, painful, and too often futile contemporary medical care. A great many of the encounters Martensen describes between patients, their families, and medical professionals are of a different order, pointing to the subtle combination of skill, wisdom, and compassion that can serve to maintain or restore health or at least make final illness less painful for the individuals involved. But this reviewer is as struck as the good doctor by the fact that the medical profession no longer recognizes 'old age' as a legitimate cause of death—if the biomedical-industrial complex just tried harder and was given an even larger slice of the Gross Domestic Product, one of us would ever have to die at all."—William T. Hamilton, The Bloomsbury Review

"Dr. Robert Martensen paints a surprisingly sympathetic portrait of a noncompliant patient in his medical memoir, A Life Worth Living: A Doctor's Reflections on Illness in a High-Tech Era. Her name is Diana, and she comes into his emergency room blaming her blurred vision on 'nerves' brought on by an upcoming job interview. But after a more careful examination, Martensen concludes it's more likely the onset of multiple sclerosis. 'Noooo!' she screams at him. 'Some other . . . ER doctor told me that once. You're wrong!' Diana's refusal to listen to medical advice fills Martensen, a medical historian and bioethicist, with regret three decades after the encounter. But her predicament—and that of many of the patients he profiles in this compelling memoir—makes him understand her unwillingness to be 'medicalized.' Refusing to submit to her diagnosis, Martensen writes, 'likely meant that her sense of time—her time, her existence—would differ qualitatively from what she would experience if she participated fully in the rituals of chronic medical care.' Because the treatment for MS at the time did little 'to alleviate and nothing to halt or cure, why should she go down the orthodox path?' Questions like these will be painfully familiar to anyone who has faced a chronic or terminal diagnosis, or sat at the bedside of someone who has. Although medical science offers such patients more treatment paths and promises of hope than ever before, choosing among them, particularly in our strangely commodified role as 'health care consumers,' can seem more confusing than ever. 'Dying is not what it was in the 1950s or even the 1970s, as technology has transmuted the process from something that doctors and patients and their families could readily perceive into a range of contingent possibilities that often leave everyone in a quandary,' Martensen writes. Clearly an advocate for greater transparency between physicians and their patients, he collects case studies that suggest that's not always what we're getting . . . This thoughtful volume doesn't offer all the answers, but against the relentlessly upbeat marketing of high-tech medicine, it does provide a challenging second opinion."—Laura Billings, The Star Tribune (Minneapolis)

A Life Worth Living is a deeply engaging book. It can be read as a self-defense manual. In fact it should be read by, say, anyone over forty-five because we are all destined to do battle with the medical industrial complex . . . Martensen, who is both an M.D. and an historian of medicine, gracefully illumines the problems we all face.”—Jim Harrison, author of Returning to Earth

A Life Worth Living is a treasure. Robert Martensen tells compelling stories of people who are at once remarkable and familiar, and distills practical wisdom for living with serious illness. Their experiences illuminate common dilemmas and difficult decisions and shine a light on the wondrous and perilous world of contemporary medicine. Martensen writes with the insights of an experienced clinician, the perspective of a historian, and the voice of a close friend.”—Ira Byock, MD, author of Dying Well and The Four Things That Matter Most

“This book looks straight in the eye at uncomfortable truths, yet it does so in an intimate, almost caressing way. The results provoke and make this book one of the few that may change how we see the world, and how we think.”—John M. Barry, author of The Great Influenza

“Once a straightforward process, dying has become a minefield, despite—nay, because of—medicine’s best efforts to sustain life in the face of overwhelming odds. Thus, physician and bioethicist Martensen worries, many people diagnosed with a terminal illness may not be receiving all the information they need to make informed decisions. Indeed, they may not fully comprehend the hopelessness of their situations, either because they are not hearing, or more likely, because physicians are hedging the responsibility to tell the unvarnished truth. Consequently, what ensues is too often a painful and futile battle including unnecessary tests, interventions, and drug or device trials that make what is left of the patient’s life not worth living. Just where the balance point lies between hegemony and patient autonomy becomes murky at best when each participant in a patient’s final care is marching toward his or her own goals. An ever-compassionate Martensen makes it apparent that the thorny questions need asking, but even more apparent is that there are no easy answers.”—Booklist

“A physician, medical historian and bioethicist, Martensen pulls no punches: beyond the marvels of modern medical technology lies a treacherous morass of ethical, moral and spiritual dilemmas most of us are not ready to even consider: whether to opt for aggressive treatments, when to stop them, and how to die well. Too often the choice of aggressive treatment and heroic measures becomes an extended death by intensive care in grim hospital units designed more like prisons than places of healing. Thoughtful and compassionate, Martensen narrates poignant case studies, such as that of Marguerite, who undergoes ineffective surgeries and drug trials for advanced breast cancer but has debilitating side effects. The author lays blame across the board, from patients with unrealistic expectations and doctors who don't explain treatment options fully, from profit-driven hospitals to an insurance bureaucracy that spurns routine health maintenance. Martensen makes his case with clear, compelling writing that never flinches from his conclusion that some things you just can't win the battle against; you can only hope for quality of life until the end.”—Publishers Weekly

Reviews from Goodreads



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A physician, historian, and bioethicist, Robert Martensen has held several professorships. Recently he joined the National Institutes of Health as director of its Office of History and Museum. In 2002 he received a Guggenheim Fellowship.

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  • Robert Martensen

  • Robert Martensen is a physician, historian, and bioethicist, and has held several professorships. Recently, he joined the National Institutes of Health as director of its Office of History and Museum. In 2002 he received a Guggenheim Fellowship.