“Am I going to die?” Doctors are often uncomfortable with the question and generally respond with a variety of treatment options that ultimately may be ineffective, costly, and detrimental to the quality of a patient’s life.
Dr. Atul Gawande wants to change this. His new book, Being Mortal, identifies how the medical system fails the dying by not addressing what truly matters to the patient at the end of life. He writes, “Medical professionals concentrate on repair of health, not sustenance of the soul.”
“I am in a profession that has succeeded because of its ability to fix,” Dr. Gawande writes. “If your problem is fixable, we know just what to do. But if it’s not? The fact that we have had no adequate answers to this question is troubling and has caused callousness, inhumanity, and extraordinary suffering.”
Dr. Gawande recommends that families and health care professionals ask these key questions of someone with a serious illness:
- “What is your own understanding of your condition or your health?”
- “What are your fears and worries for the future?”
- “What are your goals if your health worsens?”
- “What are the trade-offs you’re willing to make in your life?” or “What outcome would be unacceptable to you?”
Understanding a patient’s answers provides guidance for what really matters to the person and how to move forward with a valuable treatment plan. Many of these questions are used by palliative care and hospice providers for people facing the very end of life. Dr. Gawande lobbies for asking these questions earlier in the healthcare process as a positive contribution toward patient care.
Dr. Gawande makes his point clear: “People with serious illness 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.”
A gifted storyteller, Dr. Gawande introduces readers to people in difficult, critical situations and invites us into the deeply personal discussions of navigating the road ahead. Through these real experiences, he shows us how we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of people’s lives.
Dr. Gawande concludes, “Our ultimate goal, after all, is not a good death but a good life to the very end.”
Atul Gawande does not write from a Christian world view, but we are recommending the book for nurses and other healthcare practitioners because of his practical and affirmative support of the dignity of human life and respect for each person in making decisions about medical treatment.