Being Mortal: Medicine and What Matters in the End (Kushiel's Legacy), by Atul Gawande

I would never have chosen to read Being Mortal: Medicine and What Matters in the End (Kushiel's Legacy), by Atul Gawande (2014).  Books about death don’t interest me.  Let me qualify: fictional books about death do not bother me.  Non-fictional books, about the inevitability of death, the processes of death, don’t interest me.  It’s not just disinterest.  It’s that I do not wish to confront or consider the subject.  Right now, my plan is to continue living and not to think about the end result. Such a delusion that may be.

Being Mortal is beautifully written.  It moves back and forth from discussions of attitudes towards death at various times in history, to the development of approaches to “handling the elderly” through nursing homes, assisted living, independent living, hospice care, and so on. One of Gawande’s main concerns is the fact the developing technology has greatly extended the lifespan of human beings and enables doctors and others to cure or treat diseases that in the past would have led to early death.  The unwanted effect of such life-extending technology is that the body continues to break down.  Dementia, Alzheimer’s, various ailments and products of the aging process can leave the elderly in an unhappy state—blind, unable to care for themselves, unaware, in pain, separated from loved ones and familiar environments.  He makes note of the considerable costs of life-extending technology that allows the dying to survive into such a miserable state.

Gawande uses various examples from his practice as a doctor to illustrate the development of his attitudes over his career to death.  His main example is his father, also a medical doctor. The account of his father’s decline and ultimate death is moving.

Gawande believes that as much as possible the elderly and the dying should be empowered to take control of their own mortality.  If they want life extended as much as possible, even though that may end in a coma, unable to communicate with loved ones and others, he supports that wish.  But if they want to maintain a quality of life up to the point of death, relatively free of pain, able to continue living and enjoying family and friends, he supports that too.

The book is informative and compassionate and though I still hate the subject I am glad I read it.