Atul Gawande (2014) Being Mortal: Medicine and
What Matters in the End, Metropolitan Books
Atul Gawande is a medical researcher, surgeon and writer. Like
most of the popular writers of science, he is an evocative story teller. He
begins all his reflections from the practice of medicine, his vast clinical
experience, inevitable questions of his patients and ruthless self examination
of what it means to be a sensitive doctor in modern times. His narrative
expands with his ambitious canvas, from the microscopic particularities of case
studies, to the bigger questions that connect medicine with modern life. As the
author of four bestselling books- Complications, Better, The Checklist
Manifesto and Being Mortal- the core idea that he has dealt with in all his
works, is how revisiting the role of expert can help in serving modern life
better. He probes the limitations of his profession, the built-in ambiguities
of practicing medicine and the problematic situations that require fine
judgment from the practitioner. He is disturbed by the ‘tragic mistakes’ or the
experts’ inability to effectively use the knowledge she has, to make better
decision outcomes.
The fragility of caring
In Being Mortal,
Gawande examines how modern medicine has dealt with old age with evasive
unease. Medicine and public healthcare has ‘medicalised’ our existence so much that
we treat death as a clinical procedure to be overcome. Serious illness, frailty
and approaching death are sequence of a process none of us are immune to. It is
at once, about the individual at the heart of the problem as well as about his
loved ones waiting in the fringes. It is about dignity and control, choice and
decision making when faced with the fear of loss and uncertainty. The autonomy
and dignity that an individual has, makes the last days of his life, a kinder
and warmer experience for him and his loved ones.
The book has two parts. In the first part, the author examines
each available option of assisted living for the elderly and evaluates them. In
the second part, he discusses the option of euthanasia and what assisted death
has done to the idea of assisted living and palliative care. In his
characteristic narrative, the author weaves his arguments with powerful
stories, clinical case studies from different countries, personal encounters
with patients, friends and family. Our singular concern with health, longevity
and safety, he says, devalues the subjective values of what makes life
worthwhile in significant ways. Instead of fighting for a prolonged life,
Gawande argues for a life imbued with meaning to the individual concerned.
Changing perspective of
healthcare
The book calls for a change in our philosophy of heath care and
argues that our preoccupation with health should turn to well being. This is
especially relevant as traditional societies like India are rapidly moving from
joint-family to smaller family units. Care giving as we have known in these
societies as a family-centric event is rapidly changing. This shifting perspective
also alters the roles and responsibilities of the doctor, from being a mere source
of information, to being a partner in shared decision making. The importance of
palliative care and involvement of families become part of the solution.
The hard questions that the book raises are important; but there
are no easy answers. One problem with Gawande’s style of argumentation is that
qualitative case studies bring out the rich detail of individual cases but have
to be backed by data to understand larger trends. Secondly, the autonomy of an individual
with terminal illness becomes problematic when it is a case of dementia or
Alzheimer’s. This aspect is not explored fully in the book. Even then, Gawande
succeeds in raising the right questions for us to debate. As he remarks, ‘Arriving at an acceptance of one’s mortality
and a clear understanding of the limits and the possibilities of medicine is a
process, not an epiphany.’ This is indeed an important book for our times.
