There is no gainsaying the fact that modern medicine has brought tremendous progress to humankind. Many hitherto incurable maladies can now be cured. With all manner of technological breakthroughs, we are now able to push the limits of what is humanly possible across a range of activities. In particular, modern medicine is able to deal with a whole host of human ailments aggressively and thereby prolong human lives in ways that many would
have considered unthinkable even a few decades ago.
These positive aspects notwithstanding, the central claim made by Atul Gawande in this absorbing book is that, in its unrelenting quest to prolong the lives of the old and the terminally ill, modern medicine has paid little or no attention to the desires of the people whose lives are being prolonged. Specifically, death is not a question of if but when for the elderly and the terminally ill. Even though this point is widely understood, because modern medicine typically does not focus on the hopes and the wishes of terminally ill people, it does not adequately prepare such people for death.
The above points are developed by Gawande in some detail. This development makes great use of a variety of individual and personal stories to effectively drive home points about the practice of medicine in contemporary times. For instance, we meet the “spirited” and “independent minded” Alice Hobson who is 77 years old. Gawande discusses the causes of the downhill progression of Hobson from a state in which she lived independently in her own home with her own circle of friends to a state in which she became a frequently miserable resident of a high-rise senior living facility, with limited discretion over how to lead her own life.
Then there is the case of 87-year-old geriatrician Felix Silverstone and his wife, Bella. Gawande nicely delineates the trials and tribulations of this couple as they move from their home in New York to a retirement community in Canton, Massachusetts. Not only
does Felix have to accept his own decline, but in addition, he has to deal with the difficulties stemming from the trinity of ailments affecting his wife—complete vision loss, hearing loss, and memory impairment. A key point made by Gawande in the course of his discussion of the Silverstone couple is that although modern doctors are very good at “addressing specific, individual problems...” (p. 44), when these same doctors have too deal with “an elderly woman at risk of losing the life she enjoys” (p. 44), they frequently have no idea about what to do and sometimes make matters worse for the elderly woman in question.
A noteworthy motif in this book is that instead of focusing on how to make old people safe, modern medicine ought to spend more time focusing on how to make old age more meaningful. We learn that a different way to look at the same basic issue is to ask what a person’s doctor ought to do given that this person suffers from metastatic cancer or some similarly advanced and incurable condition. The author suggests that in these sorts of situations, instead of pondering the expenses associated with alternate actions, we ought to be thinking about how “we can build a health care system that will actually help people achieve what’s important to them at the end of their lives” (p. 155). In this regard, Gawande has praise for hospice services. He says that “[h]ospice has tried to offer a new ideal for how we die” (p. 165). This notwithstanding, he is aware that accepting this ideal “represents a struggle—not only against suffering but also against the seemingly unstoppable momentum of medical treatment” (p. 165).
Do people in general “care deeply about what happens to the world...” (p. 126) after they die? Second, is autonomy in one’s life an “empty and even self-defeating goal...” (p. 140) to live for? These are two examples of questions that are answered affirmatively but in too facile a manner by the author. Similarly, it is possible to fault the author for paying insufficient attention to the manner in which public policy would have to be changed if modern medicine were to be practiced along the lines suggested by him. These two caveats notwithstanding, I would be remiss in my duties if I did not point out that in general, Being Mortal is one of the most lucid, thought-provoking, and poignant books I have read in a while.