Premise: How can medicine not only improve life, but also the process of its ending?
Dr. Gawande understands that medicine has triumphed in modern times, but on the condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit.
He believes physicians committed to extending life; continue to carry out devastating procedures that in the end just extend suffering. Often Doctors are uncomfortable discussing patient’s anxieties about death and fall back on false hopes and treatments that actually shorten lives instead of improving them.
He reminds us that death often comes after a long period of decline and the average American spends a year or more disabled and living in a nursing home no matter how careful he or she is or how healthful their habits. When that happens, the medical system and nursing homes will often be of little help at the end.
Dr. Gawande believes nursing homes rarely have anything to do with providing an environment that speaks to the dignity of the individual. He offers personal stories, and examples of typical nursing home experiences contrasted with stories of assisted living facilities that are structured to keep the individual’s last weeks or months as rich, dignified and independent as possible for as long as possible.
He strongly believes we must question what makes life worth living when people get old, frail, ill and have to depend on another person for their daily care. He also stresses the need to have that discussion with family members before they reach that stage in life.
Dr. Gawande feels what is needed in our declining years is a life with meaning, a life as rich and full as possible under the circumstances. This cannot be fixed by modern medicine, so we need to find a better way.
Dr. Gawande gives us a clear look at aging and death in our society and at the harms we do in turning it into a medical problem rather than a human one. Narrowing the lives of the aged down to mere existence in institutions and submitting the dying to the full procedures that modern medicine has to offer cause enormous unnecessary suffering. He reminds us there is no way to make old age and all its infirmities disappear. That is what life deals us. But he shows us we could handle it a lot better. The ultimate goal is a good life lived all the way to the end.