Do you enjoy contemplating the demise of your loved ones or your own inevitable journey towards the grave? Well, nobody does really, but the book Being Mortal by Atul Gwande does an excellent job of asking thought-provoking questions about how we deal with the end of life. When people are very sick or very old, does the instinct simply to keep them alive result in outcomes that we want as a society? Would you rather die in a hospital in the ICU or at home in your bed surrounded by your family as you let out your last sigh?
The crux of the book is the tension between being the author of your life and recognizing that nature is all-powerful in the end. We can manage this tension by attempting to make decisions that align with our priorities as the options available to us continue to narrow. This responsibility to understand priorities extends to those who often are forced to make tough decisions on behalf of a sick family member. If you know these priorities, medicine can be better used as a tool to enhance life rather than to simply keep it going.
The following quote sums up the main points of the book.
No one ever really has control. Physics and biology and accident ultimately have their way in our lives. But the point is that we are not helpless either. Courage is the strength to recognize both realities. We have room to act, to shape our stories, though as time goes on it is within narrower and narrower confines. A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.
The key here is priorities. Understanding an individual’s priorities is how to make the best possibile decisions with the options available. So whether you’re dealing with this process yourself or helping others, follow Gwande’s advice and have those difficult conversations about what matters most.