A review by shoelaceofdoom
Being Mortal by Atul Gawande
5.0
If you are aging or know someone who is aging in America, you should read this book. Heck, you should read this book anyway. It is superb.
Gawande addresses what he points out to be medicine’s most financially and vitally costly failure— its inexorable focus on health over well-being. Modern medicine has, in his view, been dedicated to life-prolonging measures— treatments intended to push the brink of death further from where we stand now. But, he questions whether this is the appropriate goal of medicine in all cases, raising questions of medical futility and drawing the potent distinction between health and well-being. His arguments particularly concern our treatment of the elderly both societally and medically.
In more traditional societies, like the one where his own grandfather was aging, social structures revolve around the care of elders, enabling many elderly people to preserve their quality of life until their ends. Active until the very end, his grandfather died at 110 as the result of falling off a bus he was trying to ride into town for his business. While this is not necessarily the norm, one can appreciate the stark difference between this aging process and the one experienced by his wife’s grandmother, whose autonomy gradually diminished as she aged and fell multiple times in her home, was moved from her home into a care facility that did not provide for her psychosocial needs, and eventually died in a skilled nursing facility after less than a year of having lived there.
Ultimately if elder care facilities fail to cater to the needs of the population they intend to serve, it is because these institutions (as he says): “address any number of societal goals— from freeing up beds to taking burdens off families’ hands to coping with poverty among the elderly— but never the goal that matters to the people who reside in them: how to make life worth living when we’re weak and frail and can’t fend for ourselves anymore.” (p 77)
But an equally important problem he points to is that the medical profession does not train its constituents to face mortality. He describes the understandable discomfort he and his colleagues have felt in addressing mortality head-on with patients, particularly those who are young. Doctors feel pressured to understate the severity of a patient’s prognosis, perhaps for the simple reason that it is difficult to look at someone in distress and tell them that they will soon die. But the fortitude to be frank does not have to come at the expense of compassion, and in fact, he describes how often the compassionate thing to do is to recognize what truly matters to people in the end— being as comfortable as possible and surrounded by their loved ones.
Gawande addresses what he points out to be medicine’s most financially and vitally costly failure— its inexorable focus on health over well-being. Modern medicine has, in his view, been dedicated to life-prolonging measures— treatments intended to push the brink of death further from where we stand now. But, he questions whether this is the appropriate goal of medicine in all cases, raising questions of medical futility and drawing the potent distinction between health and well-being. His arguments particularly concern our treatment of the elderly both societally and medically.
In more traditional societies, like the one where his own grandfather was aging, social structures revolve around the care of elders, enabling many elderly people to preserve their quality of life until their ends. Active until the very end, his grandfather died at 110 as the result of falling off a bus he was trying to ride into town for his business. While this is not necessarily the norm, one can appreciate the stark difference between this aging process and the one experienced by his wife’s grandmother, whose autonomy gradually diminished as she aged and fell multiple times in her home, was moved from her home into a care facility that did not provide for her psychosocial needs, and eventually died in a skilled nursing facility after less than a year of having lived there.
Ultimately if elder care facilities fail to cater to the needs of the population they intend to serve, it is because these institutions (as he says): “address any number of societal goals— from freeing up beds to taking burdens off families’ hands to coping with poverty among the elderly— but never the goal that matters to the people who reside in them: how to make life worth living when we’re weak and frail and can’t fend for ourselves anymore.” (p 77)
But an equally important problem he points to is that the medical profession does not train its constituents to face mortality. He describes the understandable discomfort he and his colleagues have felt in addressing mortality head-on with patients, particularly those who are young. Doctors feel pressured to understate the severity of a patient’s prognosis, perhaps for the simple reason that it is difficult to look at someone in distress and tell them that they will soon die. But the fortitude to be frank does not have to come at the expense of compassion, and in fact, he describes how often the compassionate thing to do is to recognize what truly matters to people in the end— being as comfortable as possible and surrounded by their loved ones.