Being Mortal Illness, Medicine, and What Matters in the End

A must read for seniors.

Anyone who has ever had to care for and manage the end of life treatment of a loved one or relative will appreciate this book and wish they had read it before experiencing the numerous medical, emotional and financial crises and issues that always arise. Doctors and health care professionals could also benefit greatly from the perspective in this book; that sometimes quality of life as defined by the patient is the most important factor, not prolonging life at any cost. Dr. Gawande reviews the history of care for the sick and aging from time when most people lived in multi-generational households to the present day when assisted living, nursing homes and hospice prevail. He tells the stories of several patients and their families dealing with terminal illness, including his own father, also a physician. Through these stories he examines questions such as: How much treatment is too much? What and how much information should doctors give patients about their conditions? Should patients just be given information about various treatment options and be allowed to decide on their own or should doctors take a more proactive role in guiding the patient? Can we evolve away from a medical model where extending life is paramount toward a more holistic approach driven by how the dying want to spend their remaining time? Many people understandably do not want to think about these questions until it is too difficult to actually make the best decision. I read this after I read "Can't We Talk About Something More Pleasant?" by Roz Chast which is an up close and personal graphic memoir of an adult child facing the end of life issues of her elderly parents. The two books make good companion pieces on this topic.

Well written, informative for all who are entering senior years of their life. IMHO a must-read.

This book is wonderfully written, pleasantly entertaining, but most importantly gives an Eagle eye view into the aging process, thoughtful insight into options for living arrangements as we age, Palliative care as a viable option for mindfully living and hospice…the compassionate care provided when a terminal illness is diagnosed and making the most of every moment is more valued than aggressive treatment—respecting each persons right to choose! Gawande shares intelligent, compassionate, and thoughtful wisdom on the bodies natural aging process and making rational decisions for making the most of every moment of life!

Depressing but informative. Good guide to age gracefully

Must read if you are a caregiver for a terminally ill parent, child, or friend.

My whole family read this book and it has changed each one of our perspectives on aging and elder care. I highly recommend it to anyone dealing with elderly family members or dealing with aging themselves. It has been life changing.

I and my spouse used this book as a self-reflection tool to delve into what we might be needing to address at the end of our stay here on earth. We are both about to enter into our 70's and so these issues begin to take on greater significance than in previous periods of time. The end of life happens to all of us and to deny that the moment will come and do nothing to prepare for it I think is irresponsible to those that you care about and that care about you. It was a good read.

As all of Dr. Gawandes' books and articles this is an amazing and captivating read, although this book is in my opinion his masterpiece (at least so far). A book that everybody should read, especially medical professionals.

Un'ottima lettura, su un argomento su cui tutti dovremmo fermarci a pensare (è possibile che non lo facciamo abbastanza). Scritto in maniera piacevole, con un inglese non troppo complesso. Notavo, in ogni caso, che è disponibile anche la traduzione italiana.

Being Mortal is a no holds barred realistic yet compassionate consideration of what it is like to get old in North America. Dr. Atul Gawande deserves a Nobel Peace Prize, or some equivalent recognition, for his insightful observation of even his own profession being in need of improvement regarding the needs of the older population. His appeal seems to be for the medical profession to waken up to the fact that we are all mortal and are going to die. Some medical conditions indeed cannot be "fixed" no matter how hard doctors may try to do so. Perhaps what is needed is for those in the honourable calling of medicine to give greater regard to deeply compassionate care of people especially when there is nor cure. Even when there is no cure there is always care! Dr. Gawande is to be highly commended for the courage, integrity and courage he exhibits in this wonderful book!

We are all going to die. Hopefully, we will live a long and healthy life first. But the fear is always of a slow, lingering, undignified death. In this deeply moving and thought-provoking book, physician Gawande demonstrates why modern medicine is not set up to cope with the inevitability of death. Much medicine is about heroic acts that, through strict treatment regimes, violent surgery and toxic drugs, make us better, after we have suffered through the warfare between illness and cure. Death is failure. But people who are nevertheless dying will not get better: medicine offers only the debilitating warfare, with no peaceful recovery after. All pain, no gain. Only failure. Is there an alternative to the standard end-of-life route of incarceration in a nursing home, made subject to loss of independence and an infantalising regime of “doctor knows best”, accompanied by ever more violent interventions, culminating in dying in a sterile hospital bed while attached to tubes and beeping machines? Gawande describes his discovery of this alternative: patient-centric palliative care, carefully discovering what the patient wants from their remaining time, and ensuring they get that: time at home, time with family, time to enjoy what time is left, medical care appropriate to that, and, if it is what is wanted, further interventions. And the consequences of this approach, of providing the patients what they want, of not insisting on providing the fullest medical interventions possible, are possibly counter-intuitive: "those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives—and they lived 25 percent longer". So end-of-life medicine needs to change to incorporate quality of current life, not just quality of later (here, non-existent) life. And quality of life nearly always means independent living, and dying, at home. We need to move from second stage medicine to third stage: "as a country’s income climbs to the highest levels, people have the means to become concerned about the quality of their lives, even in sickness, and deaths at home actually rise again". Gawande, with a combination of heart-rending, and heart-warming, case studies, and hard medical data, argues convincingly for this change, and for an extension of the palliative care approach. It is more humane, it improves quality of life and lifespan, and, if more argument is needed, it is cheaper. Some may be concerned that allowing people to choose not to undergo medical procedures might lead to people feeling they have to choose this route so as “not to be a burden”. But many of the people Gawande spoke to who had chosen to go the route of more interventions, had done so not because they wanted to, but because of pressure from their families who, understandably, didn’t want them to die. This is an important book that should be read by all people involved in delivering medical care, all involved in medical policy, and all who will one day be at the end of their own lives.

A thoughtful and compelling read. It essentially outlines the end for the very elderly, coping with the loss of independence and serious terminal illness, and to a lesser extent fatal illness for those who are not old. Information regarding the creation of independent living residences for seniors in U.S. was quite interesting. There were so many worthwhile nuggets of information; for example, how checking out old people's feet provides a quick window in to their ability to care for themselves. The book talks about important life / death issues and is a must read.