How to Die

Atul Gawande argues that physicians should focus care on the good life—including its very end.

Sophia Rosenfeld in The Nation:

In the early 1990s, an upstate New York doctor became the medical director of a nursing home populated almost entirely by severely disabled elderly people. Unhappy about all the unhappiness he saw around him, the doctor launched an experiment. Shifting attention from “treatment” to “care,” he introduced plants in the living quarters, flowers and vegetables in the garden, and a veritable menagerie all around the property, including two dogs, four cats, and 100 parakeets. Eventually, he added an outdoor play area for the employees’ children. The results were surprising: greater contentedness in the home’s residents (measurable in part by a large decrease in the need for psychotropic drugs like Haldol), but also extended lives.

Atul Gawande believes in targeted fixes, especially small ones. His previous book, The Checklist Manifesto, detailed the outsize benefits of that favorite of highly organized people, the checklist. In Being Mortal, the writer-physician turns his attention to what happens when the elderly or infirm are granted a plant to look after, a chance to break an in-house rule, or even a sustained conversation about their future. His contention is that such little adjustments not only produce big payoffs for well-being, but also represent significant breakthroughs in terms of our thinking about questions of such daunting ethical and emotional magnitude that we generally avoid contemplating them at all. Questions like: What can we do to improve the existence of people in the final phase of life? How do we prepare others—and eventually ourselves—for the end?

More here.