Reflections on the ideal exit strategy
Being Mortal: Illness, Medicine and What Matters in the End By Atul Gawande Profile Books, 282pp, $27.99
One Foot in the Grave discriminating and ancillary way than it is now.
Gawande writes chiefly of the situation in the US, but with an eye on global trends. He argues that the key to our humanity is that each of us lives our lives as a story, and those who are dying need, to the greatest extent possible, to be supported in remaining the authors of their own stories to the end, not the mere objects of invasive and debilitating medical interventions. His catchcry, early in the book, is that: The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit … Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by the imperatives of medicine, technology and strangers.
The first half of Being Mortal is devoted to examining the impact on the aged of this lack of coherence and reliance on impersonal technology. The second half is looks at the impact on the terminally ill.
Gawande is nothing if not a realist as regards the intractable problems confronting us. We are all complicit, he says, in the logic of the situ- The swirling figures in the surge Of surf are lifted by each wave, and fall, Dive, tumble and emerge Through that foam-shattered sprawl, To form an intricate design In which they’re too involved to be aware, Motifs that shift and shine Like water. From the air — The copter on the shark alert — Those folding liquid three dimensions flatten, Which distance would convert Into a stable pattern. And from this earthbound distance too, The nursing home that overlooks the sea, A not much different view Extends, apparently. I see it. But my mother, no. She faces but does not take in the shore. Whatever is on show Is not exterior. Perhaps the scenes that she surveys Through inner distance, everything that filled What used to be her days, Are also flattened, stilled, A tableau too remote to reach. Or is she still among the swimmers there, Buffeted at the beach, Swirling and unaware? ation, because we tend to avert our eyes from the implications of illness or ageing until it is too late to do much but react according to the existing confused imperatives.
But it is possible to do better and he insists that ‘‘we have the opportunity to refashion our institutions, our culture and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives’’.
He does not avoid the subject of euthanasia, though he leaves it until almost the end and touches on it warily. He holds the Hippocratic line that ‘‘our ultimate goal, after all, is not a good death, but a good life to the very end’’. He believes the fact one in 35 Dutch people seeks assisted suicide at their death (based on 2012 figures) ‘‘is not a measure of success. It is a measure of failure.’’
So, however, are what he frankly describes as the ‘‘deep gouges’’ inflicted by an oblivious institutionalised medicine at the end of people’s lives. This, he believes, is where we need to concentrate our reforming efforts. And his stories show where such reform might concentrate its energies to greatest effect.
Mortal toil: Richard Wilson as Victor Meldrew in the TV series