Being Mortal: Illness, Medicine and What Matters in the End – by Atul Gawande
Despite its sombre black cover with Golden lettering — which I personally find very beautiful — this is not a morbid book about death, as such, but rather the latter moments/years of life and the quality of those years.
Being Mortal’s main focus is on how medicine and medical care has maybe skewed our perception on what it means to live. Does the quality of the life we have at the end often get overshadowed by a focus of extending our life — even if this extension comes at the cost of stripping our final days of everything that gives meaning to a definition of “Life”.
The book begins by investigating the kind of care that is offered to our culture’s elderly; a care that can, more often than not, remove as much of their autonomy and dignity as possible in favour of safety. The latter half of the book then moves into discussing the kind of medical direction that is adopted with/by those who are diagnosed as terminally ill.
In both cases, Dr Gawande, eruditely and with much sensitivity, proposes that a better kind of end-of-life-care would be given, and a better quality/freedom of life would be had, if we moved our focus away from trying to ward off the inevitable and placed it instead on assisting and cultivating what life there is remaining. Gawande’s proposition is for a more considered medical approach towards those facing the final chapter of their story; one that would allow people to maintain as much control of their life as possible. In such cases the question is not a matter of “would we like to live or die”, but what quality of life would we like to have available to us prior to the end, and what levels of quality are we prepared to “trade” in order to extend what little time we have left? The concern of medicine and care would therefore be more inclined in providing the patient with an attainable desired life and not putting them through unnecessary cycles of treatments which, inevitably, erode what quality of life could be had whilst giving so little time (if any) back in return. In such an application, the “well-being” (physically, mentally and emotionally) of the patient would be more important than treating the incurable.
In short, could our current medical practice (along with our own expectations of what medicine is for/about) be failing those who are facing death by preventing them from experiencing as much life as is possible in their final moments?
Such an approach does require us courageously accepting our own mortality; which is a modern challenge in the technological age we live in, and something our ancestors never really struggled with. But this acceptance would lead us towards embracing a life we can have now instead of forfeiting this for something that, sadly, lies beyond our reach.
At this point, some may be thinking that Being Mortal is about Euthanasia. Although this highly complex ethical issue is briefly discussed within the book’s eighth chapter (entitled Courage), the context of the book is not arguing for prematurely bringing someone’s life to close (“assisted dying”), but improving the quality of life for those who are terminal, and helping them to best prepare, both emotionally and physically, for this end. In other words, this book is arguing for “assisted living”. That said, I’m certain that both sides of the Euthanasia debate would find much food for thought within Dr Gawande’s writing, along with examples that could be taken to both strengthen and challenge their held positions. Personally, I’m not sure whether the topic under discussion within this book would fall under the header of Euthanasia; it could be argued that prolonging treatment to fight a terminal illness that has already won, could lead into an earlier death.
I found this book extremely fascinating, poignant and sobering. I’ll admit, at the age of thirty-five, the quality of life I would desire at my own end isn’t something I’ve given much thought to. I have now. Reading this book will certainly have that affect on you. But the book has also made me think a lot about others, especially the elderly I know and love.
Death, and preparing for it, is such a difficult topic to discuss. So I admire Dr Gawande’s courage and compassion as he navigates this issue; and he navigates it very well. To help him in this task, many personal stories from those who have faced this natural crisis have been used; even Atul’s own moving description of his father’s last years. At first, I found some of the core issues raised by these stories repetitive; wondering whether they could have been condensed together. However, with the hindsight that birthed when I was about three quarters of the way through this book, I became very grateful for every syllable. These personal words help to enlarge our perception of what it means to live; they enable us to grasp how universal our hopes and fears are when it comes to preparing for the end of our own tale.
It is — though it may seem a very awkward thing to read in public — an excellent book. One that maybe we all should read.
Tristan Sherwin is the author of Love: Expressed, available now.