Book Review: Being Mortal by Atul Gawande

If you are a “Baby Boomer,” you probably have parents who are dealing with end-of-life issues. You may be thinking about these issues for yourself. Atul Gawande, a surgeon, has written an amazing book to help us navigate this phase of life that we might prefer to deny. 

Have you talked to your parents about their wishes? Or, have you talked to your children about your wishes? Many families avoid these difficult conversations at their peril. Gawande takes us through a number of case studies from his practice. Families that don’t talk about it until the end, or who make the mistake of thinking modern medicine can always save their loved ones, do much worse than families who communicate and are not afraid to face reality:

People who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation and to spare their family anguish.

Gawande addresses the various choices we have as we exit this mortal coil. Palliative care and hospice are at the top of his list. He is all about humanizing the end rather than the all-too-common  choice of “warehousing” the aged in inhumane places where, lashed into their wheelchairs, they are left in the dayroom to watch meaningless TV all day long.

He tells a great story of Dr. Bill Thomas  who helped to humanize the entire industry by introducing living things for his patients to care for: cats, dogs, parakeets, and even house plants. People who’d been mute began to talk; people who’d been bed-ridden began to walk. In their declining months, the elderly patients found new meaning by caring for a living thing.

Gawande’s critique of our current system of dying includes issues of cost: 

Doctors everywhere become all too ready to offer false hopes, leading families to empty bank accounts, sell their seed crops, and take money from their children’s education for futile treatments.

In the United States, 25 percent of all Medicare spending is for the 5 percent of patients who are in their final year of life, and most of that money goes for care in their last couple of months that is of little apparent benefit.  

While I enthusiastically recommend this book, I have serious problems with Gawande’s near omission of “aid in dying” as a viable option. He is all about hospice and palliative care, but scarcely mentions the “right to die” choice that is taking hold across the country. Study after study shows that around 70% of Americans want to be able to determine when and how they die. 

Gawande mentions one African tribe that solves the problem of old age by having the elderly–who are no longer contributing members of the tribe–dropped off in the jungle as dinner for the animals. Now that may be a bit extreme for us. I do like the idea that when I am no longer able to care for myself and become a physical and financial burden to society and to my family, I can, as Mitt Romney said in explaining his position on the undocumented immigrant problem, choose “self-deportation.”

Yep, that’s for me. Self-deportation at a time and place of MY choosing–not my doctor’s, not the government’s, and most certainly not the church’s. While hospice and palliative care are fine as far as they go, I believe people who are of sound mind, should be allowed to check out when they are ready. Call it the “self-deportation” option.

Other than that, this excellent book is worth your time. You may find that it will give you tools to think about how you want to take that final swan dive. It may also help you broach this difficult topic with your family.