Being Mortal: Medicine and What Matters in the End
Doubleday Canada, 2014
Reviewed by Chris Eagle, MBA, MD
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As of the day I am writing this review, there are 4306 reviews of the hard cover version of Being Mortal on Amazon’s website. Clearly, this book has had impact, both deep and broad. Is there more to this than Gawande catching the crest of the wave of aging boomers looking nervously into the mirror of mortality? The answer is yes.
In brief, the book explores a number of themes about aging and dying in modern societies. It brings with it the author’s personal experience and insights gained from his patients and those who are close to the business and practice of aging and dying. As usual, Gawande uses his medical perspective to add depth, but also critical perspective.
The book is a careful mix of personal insight and philosophical and cultural reflection. It is an uncomfortable thesis about western culture’s and western medicine’s medicalization of aging, dying, and death, and their ultimate failure to deal with the consequent issues. It leaves a very unsettling picture, even for those who have become inured to the status quo.
Numerous examples are given where minor changes in the environment of the aging have made differences, to both quality and length of life. The point is that we do have options about how we support our families and ourselves in the final years of life. Top
Gawande talks about the “dying role.” “People want to share memories, pass on wisdoms, settle relationships, establish their legacies, make peace with God, and ensure those who are left behind will be okay. They want to end their stories on their own terms.” This perspective holds true for the elderly dying in nursing homes, for patients dying from terminal cancer, and for those dying in intensive care. The key is to “help people with a fatal illness have the fullest possible lives right now.”
As caregivers, we need to focus on extending life while holding close an appreciation of the quality of the life we are extending. When is enough truly enough? Increasing specialization of care, with the numerous caregivers all contributing a part, does not make this conversation any easier to have. Our minds are full as we plan a technical plan of care. We must focus on the needs of the person as well as the body.
This has been said many times before. What Gawande brings and what is refreshing is the candor of his vision. It is a clear and direct challenge to health care providers and institutions. We can go further with those at the end of life, and that journey can start with small steps.
Chris Eagle, MBA, MD, FRCPC, is a professor in the Department of Community Health Sciences at the University of Calgary.
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