A Review of "Being Mortal: Medicine and What Matters at the End"

I began this book with great enthusiasm, and closed it after 282 pages stirred by many of Gawande’s insights:

1.    The failure of the institutions of modern medicine and healthcare to focus on enhancing quality of life at every step of the way;

 2.    In the case of serious, incurable conditions, it is essential to know when it is time for ‘medicine’ to resist using every possible intervention at the cost of great pain and only prolonging the dying process.

3.    We want to control our lives, to “remain the writers of our own story.”

Gawande repeatedly makes the very central point that what is essentially important in life for us now will remain important regardless of our age. The dream and hope is that we will be allowed the autonomy necessary to “remain the writers of our own story.”

Just a few choice quotes that reflect these important insights?

From pages 140 – 141:

All we ask is to be allowed to remain the writers of our own story. That story is ever changing. Over the course of our lives we may encounter unimaginable difficulties. Our concerns and desires may shift. But whatever happens, we want to retain the freedom to shape our lives in ways consistent with our character and loyalties (loyalties meaning ‘purpose’ here).

. . . . “Sickness and old age make the struggle hard enough. The professionals and institutions we turn to should not make it worse. But we have at last entered an era in which an increasing number of them believe their job is not to confine people’s choices, in the name of safety, but to expand them, in the name of living a worthwhile life.”

Gawande speaks of “the dying role.” It is a concept we should think more about, I believe.

Page 249

“Technological society has forgotten what scholars call the ‘dying role’ and its importance to people as life approaches its end. People want to share memories, pass on wisdom and keepsakes, settle relationships, establish their legacies, make peace with God, and ensure that those who are left behind will be okay. They want to end their stories on their own terms.  This role is, observers argue, among life’s most important, for both the dying and those left behind. And if it is, the way we deny people this role, out of obtuseness and neglect, is cause for everlasting shame.”

This book is worthy of reading, reflecting on, underlining, and even dog-earing the special pages, Each of us mortals should discuss these concepts of what makes life good, what we want – beyond medicine and the institution – at the end with those we appoint as our medical power of attorney.

For those of us who work in the field of aging services, this book and its grandly human view and articulation of what we want “at the end” merits discussion in staff meetings accompanied by serious evaluations to assure that our policies and day-to-day operational activities reflect and implement these humanizing concepts for those we serve.