Not only have our causes of death dramatically changed in the past century, but our places of death have changed as well. In 1900, only about 30 per cent of us died in medical institutions. According to the Centers for Disease Control and Prevention, in 2010 roughly 70 per cent of Americans died in hospitals, long-term care facilities or nursing homes. We have medicalized our last days. We’re also living longer. In 1900, life expectancy was about 49 years, while a person born in 2015 is expected to live to be more than 80 years old. Advances in medicine, science and technology have made it possible to keep people alive well beyond what was possible only a few generations ago.
Amidst celebrations over our abilities to extend life, we seem to have forgotten to ask what it means to actually live in our final days. As a result, we’re only now coming to terms with what it means to be mortal in an age where survival at all costs appears to be driving so many of our health care decisions.
In Being Mortal: Medicine and What Matters in the End, Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston and author of two widely read books on the state of contemporary medicine, wants to help us make sense of the struggles we face when our biological limits encounter medical science’s power to push against these limits in ways that were, even recently, unimaginable. Instead of focusing on dying a good death, he wants us to consider what it means to live well while being mortal.
Gawande is brutally honest about the current state of medical science when it comes to dying. On the less serious side of things, geriatric clinics have been renamed “centres for older adult health” because the term geriatric carries such negative connotations for society. On the much more serious side of things, medical schools are closing geriatric divisions because they are too costly. These closures are shocking because they are made in spite of strong evidence that elderly clients who are treated by geriatric teams are 25-per-cent less likely to become disabled and 40-per-cent less likely to require home health services. Gawande’s point is sharp — medical science is more invested in keeping people alive than in ensuring a good life as we draw nearer to death.
The stories Gawande tells are the kind that will remain with you — an elderly former physician and his ailing wife trying to remain independent as their health deteriorates, a middle-aged couple and their children trying to manage life with an elderly parent living under their roof and a hospice nurse trying to overcome the very real perception that hospice care is the end of the line and that all hope is gone.
But it is the story of Gawande’s own father as he battles the medicalization of death that eventually overwhelms the reader. His father wants no more pain, no more hospitals, but only to live well in his final days. His father’s death isn’t particularly heroic. He experiences fear and anxiety, and at times he just wishes he could sleep through it all. But in spite of the physical and emotional challenges he is facing, he enjoys his food and he longs for his family to be nearby — in other words, the same things that had contributed to a life well lived.
So much of Gawande’s book reminded me of a challenge put by a Catholic ethicist a number of years ago. “Imagine a 300-bed Catholic hospital with all beds supporting persistent vegetative state patients maintained for months, even years, with gastrostomy tubes … An observer of the scenario would eventually be led to ask: Is it true that those who operate this facility actually believe in life after death?”
Gawande offers us a welcome departure from overly politicized and usually far too shrill arguments about the right to life and the right to die. Being Mortal is, ultimately, a careful meditation on mortality that will appeal to many readers, and especially those of us who will soon be faced with the declining health of our parents.
(Ethicist Kline is an associate professor of religious studies at St. Jerome’s University in Waterloo, Ont.)