Atul Gawande’s Being Mortal
Atul Gawande’s Being Mortal (2014) is a thought-provoking book tackling the process of ageing and dying in our modern world. It demands our attention by asking an uneasy, yet crucial, question: How do we want to navigate our final days?
Having said that, this isn’t a narrative steeped in sadness. Instead, Gawande offers us an open door, an invitation to engage with ageing, dying, and mortality—unavoidable chapters of our life story. With Being Mortal, Gawande prompts us to pause, reflect, and truly face these realities.
We’re living longer, sure. But is our quality of life tagging along for the ride? In Being Mortal, Gawande reaches an intriguing realisation: We aren’t handling frailty all that well, and that problem is only getting bigger. The reason can be found in today’s families.
The Inescapable Realities of Ageing and Death
Unlike older times, the modern family is mostly a nuclear one, which means fewer folks are sticking around to take care of Grandma and Grandpa. It’s a tough pill to swallow, but Gawande doesn’t shy away from it. He stares it down, and he asks us to do the same. Because, at the end of the day, it’s not just about how long we live—it’s about how well we live.
In Being Mortal, Gawande challenges us to consider a shifting societal perspective: why don’t we honour the elderly as we once did? The answer, he suggests, may lie in our technological advances. As lifespans stretch out thanks to modern medicine, living to a ripe old age isn’t the achievement it once was.
Take India, for instance. Hitting the century mark—or even a little less—is a rare feat. And in Japan, a country where the average life expectancy hovers around 85, ageing isn’t just a personal concern. It’s a national issue, with a significant chunk of the population in their twilight years. Through these global examples, Gawande underscores a pressing question: As longevity increases, are we losing our reverence for those who have weathered the test of time?
Gawande’s Being Mortal candidly addresses the shifts in intergenerational dynamics. These days, the financial ties between younger and older generations aren’t as strong. Children are not bound to take over the family business, and that changes things. In countries like Germany., social security provides a safety net for the elderly—a concept that we in India are still grappling with. This could explain why we see more homes housing multiple generations under one roof here.
Accepting Mortality
Still, living longer doesn’t mean we’ve mastered the art of halting the ageing process. Our bodies age. Organs don’t perform as efficiently, metabolism slows down, aches and pains become a part of daily life, teeth wear down, and skin loses its firmness. Here’s the hard truth: We’re so accustomed to quick relief from ailments like fever by taking a painkiller, that it’s difficult to accept it when modern medicine doesn’t offer immediate solutions to these age-related changes. It’s a bitter pill (no pun intended), but Gawande urges us to swallow it nonetheless.
In Being Mortal, Gawande makes a compelling argument: we need to shift our perspective on ageing. It’s not a disease to be cured, but a natural stage of life that we must acknowledge and offer support for. He posits that we need to brace ourselves for our body’s inevitable decline and rally behind the elderly in their journey. But here’s a personal observation: in India, more often than not, it’s non-specialists who take up the mantle of caring for the elderly.
These non-specialists may struggle to address the distinct needs and challenges that come with old age. Gawande prompts us to realise that the metrics of a good life go beyond medical standards. Sometimes, it’s the simple ability to shower independently or to share a meal with loved ones that bolsters a person’s well-being. In his view, we need to embrace this broader, more holistic approach to ageing.
Role of Geriatricians
In Being Mortal, Gawande shines a spotlight on the importance of geriatricians—specialists in elderly care who understand the unique needs of this demographic. However, their expertise is often out of reach in many countries. Despite some strides made by 2023, the demand for geriatricians far outstrips the supply. But this isn’t the only issue at hand. Gawande also critiques a key aspect of modern healthcare, particularly in the U.S.—the heavy reliance on nursing homes.
While these institutions provide care, they often fall short in meeting the elderly’s need for autonomy. In Gawande’s view, these systems need to evolve to offer our elders not just care but a sense of independence and dignity. Gawande isn’t just critical of the current systems—he offers alternatives, too. He points to assisted living as a better model for elderly care. With the freedom to make daily choices—what to eat, when to sleep—residents often experience less depression compared to those in nursing homes. This freedom, Gawande suggests, is not just about maintaining a sense of normalcy. It’s about preserving dignity, promoting autonomy, and ensuring that the later stages of life are not just about surviving, but thriving.
Gawande’s Being Mortal also tackles another delicate issue: our society’s growing discomfort with death. We’ve become so focused on extending life that we often forget to prepare for our inevitable end. In earlier times, death was a more common occurrence. Seeing it around us prepared us to face our own mortality. But today, with the advent of life-support machines capable of keeping us alive even when our organs fail and mobility ceases, death has become something we’re less willing to accept. Gawande prompts us to question this reluctance and to consider the importance of preparing for our own mortality.
How, one may ask.
Gawande suggests shifting our focus to present-oriented priorities. Rather than solely extending life, doctors should prioritise understanding and meeting patients’ current needs. Elderly individuals often prioritise maintaining existing relationships over forming new ones. They desire closeness with long-time friends and loved ones. Gawande emphasises the importance of honouring these preferences. By considering present-oriented priorities, we can enhance our approach to end-of-life care, fostering a compassionate and fulfilling experience for those in their later stages of life.
Having the Hard Discussions
One critical aspect that Gawande highlights in Being Mortal is the pressing need for open discussions about ageing and dying. Unfortunately, dominant cultures tend to shy away from these conversations. Often, doctors either view these discussions as mere treatment planning or leave them solely in the hands of the patient’s family. Gawande proposes a different approach—a more interpretive one. He encourages patients to openly express their fears and hopes, enabling them to determine what they truly desire from end-of-life care. Whether it’s being able to savour specific foods or attend a meaningful family gathering, doctors can assist in fulfilling these wishes.
Most importantly, clarity regarding hopes and fears allows individuals to make informed decisions about what truly matters when their time inevitably dwindles. Another vital aspect is granting autonomy to the elderly. Providing them with positive autonomy is crucial as they navigate the realities of approaching death. This means allowing them to shape their lives according to their values and desires. Gawande emphasises the significance of caretakers who can help the elderly engage in activities that bring purpose and meaning to their lives. Ultimately, our role is to support old people in leading the life they truly want to lead, fostering a sense of agency and fulfilment during their final chapters.
Focusing on What Matters Most
Gawande also stresses the importance of being careful in end-of-life care decisions, that is, being clear about what you want and not trying to address every single medical issue that arises. He believes that as people approach the end of their lives, they should have the opportunity to wrap up their affairs, leave behind legacies, and have heartfelt conversations with their loved ones. Gawande also highlights hospice care as a wise approach that focuses on meeting the urgent needs of those who are dying. By taking a thoughtful approach to end-of-life care, we can ensure that individuals receive the necessary support and resources during this critical time.
Ultimately, in Being Mortal, challenges us to confront our own mortality and contemplate the choices we would make regarding our final days. As we navigate the complexities of ageing and dying in the modern world, Gawande urges us to reflect on where we truly want to spend our last moments. Do we desire aggressive treatments that may extend life but potentially diminish its quality? Or do we prefer a path that focuses on preserving dignity, autonomy, and cherished connections?
With its poignant insights and profound questions, Being Mortal serves as a necessary reminder to engage in these important conversations and make informed decisions about the kind of end-of-life care we desire. It prompts us to contemplate the choices we would make and encourages us to live our lives with intention and purpose, knowing that how we spend our last days ultimately shapes the legacy we leave behind.