A new book published by best-selling author Atul Gawande presents a strident criticism of aged and palliative care in the US. In Being Mortal: Medicine and What Matters Most in the End, Gawande argues that US healthcare system is failing to provide ‘quality of life’ to patients receiving end-of life-care. The author, a Rhodes Scholar and one time public health advisor to the Clinton administration, argues that general medicine overlooks serious psycho-social issues facing elderly patients, prioritizing the provision of “treatments that addle [their] brains and sap [their] bodies for a sliver’s chance of benefit.”
There needs to be a paradigm shift, Gawande writes.
People with serious illnesses have priorities besides simply prolonging their lives. Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others and achieving a sense that their life is complete. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The question therefore is not how we can afford this system’s expense. It is how we can build a health care system that will actually help people achieve what’s most important to them at the end of their lives.
Gawande blends his professional expertise with personal experience, drawing extensively upon his experience of the passing of friends and family. He is not only a highly accomplished doctor, but also a talented writer.
“Being Mortal” is a valuable work, and a timely one. By 2044, there will be as many people in the world who are over 80 as there are under 50. Gawande reflects that, “It is not death that the very old fear ….It is what happens short of death — losing their hearing, their memory, their best friends, their way of life.” These are what matter in the end.
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