The fundamental expectation of medical care is to keep the body healthy and to prolong life. Preserving life in this sense means to prolong or extend the duration of life. Extending the duration or lifetime gives to medicine the mandate to do what is needed to allow a treated individual to have more time. The concept of hope for more future time is often the main aspiration of those seeking medical care. In palliative care the focus of care is shifted from life-prolonging treatment to efforts to maintain comfort and quality of life.
The efforts of palliative care suggest there is another way to see the goal of preserving life. In its Medieval Latin roots, “pre-servare” has two principal meanings. One is to make sure that something lasts, in the sense of keeping something protected from anything that would cause its current quality or condition to change or deteriorate. In another sense, it means to guard beforehand, protecting somebody or something from literal or symbolic danger. With these definitions, preserving life takes on more meaning.
Certainly, terminal illness and the dying process cause the body to change and deteriorate. As one patient recently put it, “It's not so much the cancer that bothers me, but the fact that when I look at myself in the mirror I don't recognize myself anymore. I lost so much weight, and my skin looks green. I just don't see me in the mirror, and this is very distressing. I feel that life is literally slipping away from my body.”
As we help patients process the grief related to the loss of their body image, we also help them get in touch with elements of their identity and sense of self that can still allow them to feel congruent with their self-image. In psychotherapy we can “preserve life” by helping patients maintain a sense of connection with at least some of the values, roles, beliefs, or even fantasies that have supported them during their life. In this context, psychotherapy with terminal patients preserves life by supporting all that has sustained life. Psychotherapy can be applied to protect patients' core values and sustaining values from deterioration. So it “preserves life” by “allowing something to last” and “guarding beforehand,” helping patients to continue to recognize the essential aspects of their personhood so that they can say “I am still me” and experience a sense of congruence in the midst of the chaos of the illness and death narrative.
This aspect is especially important when patients experience anxiety related to fear of annihilation (emotional, existential etc.), what Nietzsche described as “the hollowing of our highest values.”
Duration of life can then become complemented with preservation of life. As such, the focus on preserving life is to be directed toward maintaining those core meanings of life for each individual. To preserve life, then, requires knowing what “life” means for each individual and safeguarding the expression of that experience.
When hope for the indefinite prolongation of life no longer exists, the focus of hope can be shifted to an expectation for preserving what is meaningful in the experiencing of life. This is the result of a temporal shift in the dimension of hope, bringing it closer and closer to the moment of experience. And preserving the opportunity for fulfillment in the moment of being is preserving life in that moment. Hope can then be about the positive experience of the present moment. This quest for the experience of life can be compelling, fulfilling, and “life preserving.”
This temporal shift in the dimension of hope creates a focus on the appreciation and creation of a positive experience in the present.
Mathematicians have developed The Calculus as a tool for understanding the role of the moment in the course of time and dimension. The Calculus allows a continuous event to be sectioned into smaller and smaller fragments until it is a sequence of points. The arc of an event in time and dimension becomes a sequence of discrete moments. Perhaps The Calculus of time creates the impetus for keeping attention to the moment, allowing the accumulated moments to create the arc of life.
