Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.
Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.
Full of eye-opening research and riveting storytelling, Being Mortal asserts that medicine can comfort and enhance our experience even to the end, providing not only a good life but also a good end.
When our days are limited, medical priorities may not align with what matters to us most, says surgeon Atul Gawande.
Medicine is grappling with what is ultimately an unsolvable problem. I never felt I had good answers for people who were facing death; when do we push ahead with treatments and when do we not? It wasn't until I connected with experts working in palliative care that I began to gain a sense of how you can unravel these problems. At the centre of the issue is the difference between the medical priorities of health, safety and survival, and an individual's priorities for well-being.
We make trade-offs every single day. For my patients in nursing homes, often their biggest struggle is with things being taken away from them, in the name of health, that they care deeply about. You'll see people with Alzheimer's who want nothing more than a cookie, but are given only pureed food because they might choke. We do these things in the name of health, but there's a larger idea about what makes life worth living that we're not serving. That comes to bear most obviously at the end of life.
I think the big change has been the family. My grandfather lived in a village in India and died at the age of 108. He spent the last decade of his life needing substantial help to live, but it didn't require him to be in an old age home. It worked because he was surrounded by family who would take care of him -- but that only worked because young women were more or less enslaved to the task.
The success and growth of our economies have come from giving young people the freedom to choose the work they want and where they want to live. Pensions have been important in giving older people the financial independence to live without family; the problem comes when you can no longer take care of yourself. We've decided that this is a medical problem, but the medical focus is on health and safety -- not on what people might see as their most important priorities.
We see failure on multiple levels. One is the sheer amount of suffering endured by people in institutions such as old age homes or intensive care units. On another level, you are admitted into these institutions and no one knows who you are; no one recognises the arc of your life and the things that have been important along the way. The most important thing about you is that you are diabetic, and you have some problems walking and swallowing -- that's who you are.
But there are other approaches. For instance, one major study in cancer patients found that people who receive early palliative care choose less chemotherapy, spend less time in hospital, and start hospice care earlier. And the result? They have less suffering, lower cost, and they live 25 per cent longer on average. This suggests we've just been making bad decisions.
"Being Mortal" by Atul Gawande raises many important discussion points for you, your family, and physicians. If you are interested in further study or resources, these library resources can help. You will just need your library card number and PIN to access: