Atul Gawande, Being Mortal: Medicine and What Matters in the End
Length: 263 pages (plus endnotes)
Summary: Modern medicine has significantly extending the average human lifespan, a positive change which also engenders complications and novel questions. How can the elderly best navigate the physical and mental decline of advanced years? What do we want a person’s last few weeks to be like? How do we evaluate the comparative worth of duration of life versus quality of life? Gawande, a surgeon from Boston with three previous popular books about medicine to his credit, has written an extremely wise and compassionate volume.
Due to its great achievements, modern medicine thinks in terms of fixing people but not in terms of helping them in a broader sense. As a result, it often tries invasive surgeries and treatments even when the chance of success is quite negligible and the side effects render patients’ final few months painful and devoid of the things most precious to them. Another result is doctors avoiding geriatrics where complete cures are a rare commodity. However, a sensitive physician can make a huge difference in a patient’s last years.
Doctors need to gently inform patients of the reality of their limited remaining time, dialogue with them to discover what the patients most care about, and help select a choice of treatment that maximizes the possibility of those experiences.
Gawande also emphasize the importance of enabling ongoing autonomy. We should recall that even though we prioritize safety for others, we tend to prefer independence for ourselves. This realization promotes assisted living over nursing homes or hospitals where the patients lose the ability to decide what to wear, eat, and the like. It also leads to a preference for hospice care with the advantages of spending one’s last days at home and not in a hospital.
Other important topics include the relationship between doctors and patients in decision making, an analysis of assisted suicide, and the human need for some meaning that transcends the self.
“Compounding matters, we have no good metrics for a place’s success in assisting people to live. By contrast, we have very precise ratings for health and safety. So you can guess what gets the attention from the people who run places for the elderly: whether Dad loses weight, skips his medication, or has a fall, not whether he’s lonely” (p. 105).
“…our elderly are left with a controlled and supervised institutional experience, a medically designed answer to unfixable problems, a life designed to be safe but empty of anything they care about” (p. 109).
Published on Aug 1, 2019
This is the third installment in TraditionOnline’s “The BEST” column, exploring exemplars of the best culture has to offer thinking religious people—click here for the column introduction.