Re­flec­tions on the ideal exit strat­egy

The Weekend Australian - Review - - Books - Paul Monk

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

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