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Book Review: Being Mortal
Advances in science and technology have led to the development of skills and mechanisms through which human health can be sustained and recovered from most known illnesses. This has led to the growth of the notion that medical care can heal anything and that death is mortality is as a result of medical failure. But as Atul Gawande writes in Being Mortal, death, frailty, and aging are all part of nature. Atul also indicates that the medical profession has little to offer to patients who are nearing the end of life. This essay reviews Being Mortal by Atul Gawande and seeks to establish the importance of changing the medical philosophy around death and aging.
Dr. Gawande is a surgeon like his father before him, has an interest in geriatrics and hospice care (Sutton 1). With this background, Atul uses experiences as well as interviews with patients, their families, as well as caregivers who are involved in the difficult conversation involved in assuring patients that peaceful death is not the ultimate goal. Rather, the goal is to live a good life up to the end with respect to each individual’s autonomy, joy, and dignity. Atul laments that since we have medicalized aging a lot, medical professionals treat frailty and aging as if they are clinical problems to be overcome. However, there is more than medicine as the body begins to decline, and the process should involve providing the person with a full life with meaning.
To provide adequate care to a patient who is nearing their end, it is important that we can honestly examine this experience of dying. Failure to do so has resulted in neglect for the basic comforts of people at the end of their lives, instead choosing to put the old in nursing homes and ensure that the nursing homes offer patients the best quality of care they can afford. In the experiences of the author’s father in India (Gawande 15) and as an American treating Alice, Atul shows that traditional cultural societies have a way to take care of their old with respect when compared to developed societies where patients do not live with their families but are relegated to nursing homes. Rather than ensuring the survival of their patients, the medical profession needs a philosophical change to allow them to enable the wellbeing of their patients.
As we age, we are exposed to the problems of aging, with a frail body that is not as strong as it used to be. At this point, we begin to lose teeth, become weaker and brittle, and handicaps start to affect us. For a society that values being independent, it gets to the age where such independence is not possible. When medical care can no longer assist us in living better lives, it is important that we can reckon with the reality of the body’s decline and switch to think about what matters to patients at this point and how we can adapt the medical profession and the society to provide these needs.
For nurses and physicians, the importance of offering patient-centered care cannot be overstated. Care should always be based on the unique individuality of every person as well as the unique needs that guide their lives. Nursing home patients are regarded as feisty and resistant when they do not want to be restrained in beds, share rooms, and eat inflexible diets. The business of the nursing home is often to take care of the patients but not as individuals with different needs. This leads to a conflict where patient needs are followed throughout their healthy life, but as the body begins its decline, the needs of the patient are not regarded anymore. In the book, the author presents research to show that most elderly patients would rather remain at home with their families rather than trade this freedom for their health. Rather than social activity, the solution should involve more established relationships and everyday pleasures with the family that enable the patient to deal with the stress and anxiety of their inevitable death. The author suggests models of assisted living, home living, and hospice.
Dr. Gawande consults a palliative care specialist that enables him to identify best practices for dealing with patients at the end of their lives. A large part of the end of life discussion involves enabling the family to negotiate the uncertainties and anxieties of losing their loved ones, suffering, and their finances. Patients have to reach the point where they accept their own mortality and understand the limits of medicine rather than engaging in expensive medical procedures that do not improve their health and wellbeing.
Having an end of life discussions with patients is a difficult process for any individual, even a medic. The grieving process is a major factor that nurses have to consider as they guide patients and their families at the end of life. While proper communication is important for caregivers at this point (Hebert 326), it is essential that the medics have a guideline to use as they negotiate the end of life care. This involves sitting down with the patient and their family and assuring them that you wish things were better for them. Questions that follow this include asking the patient what is important to them in case time becomes short, how they understand their prognosis, and the concerns about what lies ahead. It is also important that the patient discusses trade-offs they are willing to make, how they wish to use their time if their condition worsens and how to make a decision when the patient is not in a position to make such decisions.
Hospice care is promoted by the author as a suitable model through which the end of life experiences of patients can be improved. Palliative and hospice care in this aspect lead to improved control of a patient’s symptoms as well as better satisfaction with the care provided. This care also addresses the spiritual, psychological, and physical needs of patients leading to a better quality of life. Hospice care in the last six months of a patient’s life is delivered without curative treatments to enhance the quality of living at this stage. Misconceptions about this kind of care have led to low adoption rates in society (Shalev 432). However, the author argues that providing palliative care can enhance the quality of life for patients and bring their families satisfaction.
In conclusion, Dr. Gawande encourages caregivers to develop an interpretive relationship with their patients, which encourages shared decision-making. Patients and physicians can agree on the best type of care that respects the needs of the patient, providing a more humanistic approach to mortality. This ensures that medical professionals enable the wellbeing of the patients even at the end of life.
Works Cited
Gawande, Atul. On Being Mortal, Medicine and What Matters in the End. New York: Metropolitan Books. 2014
Hebert, K., Moore, H., & Rooney, J. “The Nurse Advocate in End-of-Life Care.” The Ochsner journal vol. 11,4 (2011): 325-9.
Shalev, A. Phongtankuel, V., Kozlov, E., Shen, J., Adelman, D., & Reid, C. “Awareness and Misperceptions of Hospice and Palliative Care: A Population-Based Survey Study.” The American journal of hospice & palliative care vol. 35,3. 2018 pg. 431-439. doi:10.1177/1049909117715215
Sutton, Sue. “Book Review: Being Mortal: Illness, Medicine and What Matters in the End,” Patient Experience Journal: Vol. 2: Iss. 1, Article 22. 2015. Available at: https://pxjournal.org/journal/vol2/iss1/22