In 2010, just a few years before his book “Being Mortal: Medicine and What Matters in the End” was published and became a bestseller, Dr. Atul Gawande wrote in the New Yorker:
“In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality, and created a new difficulty for mankind: how to die.”
Modern medicine is great at staving off death. It is terrible, Gawande says, at fostering authentic conversations about what terminally ill patients actually want.
To spark those important conversations, on Tuesday at Wenatchee Valley College, Confluence Health is hosting a free screening of the PBS documentary based on Gawande’s “Being Mortal,” followed by a panel discussion about planning for end-of-life care.
In the documentary and the book, Gawande urges a dramatic shift in the way physicians and patients approach treating seriously ill patients, especially the elderly — away from a survival-at-all-costs attitude and aggressive in-hospital treatments until the very end.
Instead, when death is certain but the timing is not, patients and their health care team should acknowledge the limits of their capabilities and focus on how best to provide comfort and peace in the final days of life. Too often these conversations are pushed off until it’s too late, until the patient lands in the ICU, or in hospice.
The language we use around illness is combative — fight, battle, survive. There is always another treatment option to try. Another surgery. Another clinical trial. Be a fighter, we hear. Don’t let the disease win.
Most patients and their doctors resist hospice until all therapeutic options are exhausted. According to a recent report in the Harvard Business Review, more than one-quarter of all hospice patients get enrolled when they have less than three days left to live, many of them coming straight from the ICU. Nearly one in three Medicare patients undergo an operation in the year before they die, even though the evidence shows that many are more likely to be harmed than to benefit from it.
As Gawande writes in “Being Mortal”:
“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. They are spent in institutions — nursing homes and intensive care units — where regimented, anonymous routines cut us off from all the things that matter to us in life.”
But there’s a better way, Gawande argues. It starts by having open and frank conversations with your family and doctors about your condition, about your fears and hopes for the future, about what you are willing to sacrifice for more time on this planet, and what you are not. Decide whether you’d prefer to end up in your own home, or if you’d feel more comfortable receiving care in a hospital during your final days, and then make sure everyone knows exactly what you want.
Because, as Gawande reminds us, well-being is about more than just survival.
Talking with your loved ones openly, before a health crisis hits, can mean the difference between prolonging life at a terribly high cost, or a relatively peaceful end.
Kelli Scott’s email address is firstname.lastname@example.org.