"Being Mortal"

Massachusetts surgeon, Atul Gawande, writes a timely book about end-of-life medical issues. “Being Mortal: Medicine and What Matters in the End” addresses the decisions that have to be made due to the constraints of human biology; the limits set by genes, cells, flesh and bones. Medical science has provided the knowledge to press biological limits, but Gawande looks at the damage doctors perpetrate when they do not acknowledge the finiteness of the human body.

The two traditional tasks of the medical professional have been to ensure health and survival, but the author insists that in the current medical environment it has to be more than that. He asserts the task of today’s medical profession has to include enabling comfort and wellbeing.

When they are discussing serious medical issues with patients, this surgeon believes doctors need to ask the patient critical questions: “What is your understanding of the situation and its potential outcomes?” “What are your fears and what are your hopes?” “What are the trades-offs you are willing to make and not willing to make?” “What is the course of action that best serves this understanding?”

Especially when serving the very old, Gawande contends it is not death the aged fear; it is what happens short of death— losing their hearing, their memory, their best friends, their way of life. Aging involves a continuous series of losses. The doctor’s proposal challenges the reader to look at new ways to live with, and manage, these losses.

He asks the reader to answer the question, “What is most important to you?” He then encourages the reader to have that hard conversation with family and caregivers. This conversation should determine a choice of future protocols. For example, the patient may prefer procedures that do not include health and survival at all costs, but provide quality time with loved ones for as long as life lasts.

Gawande is a strong proponent of palliative care for seriously ill and dying patients. He contends that caring professionals and institutions ought to assist people in their struggle with biological limits. He argues that medical interventions are only justified if they serve the larger aim of the person’s life. When medical professionals forget that their job is to help people coping with their finiteness, the suffering they inflict may be barbaric, but when they remember this goal, the results may be amazing.

While directed primarily toward medical professionals, “Being Mortal” is written with a vocabulary and style that makes it accessible to the average reader. His case studies bring the theoretical down to earth. It is an excellent book for a discussion group, or a jumping off point for a conversation with the person you have assigned to implement your advanced medical directive.

Atul Gawande is a surgeon at Brigham and Women’s Hospital in Boston, a professor at Harvard Medical School and the Harvard School of Public health. He is chairman of Life Box, a nonprofit organization whose mission is to make surgery safer globally. Gawande is eminently qualified to write on this subject. This is his third book on medical issues; the first two won national awards.