As a newly-minted college student, aging is not something I ponder very often. Youth is exuberant in its approach to life, whether that be academically, physically, or emotionally. It is experienced fully and openly, and a lot of times it is taken for granted. A couple of months ago though, I picked up Being Mortal by Atul Gawande and found myself coming back to its ideas constantly. Being Mortal delves into the societal decision regarding advancements in medicine as a cure for death. Due to cutting-edge life-saving medical technologies, people now survive previously fatal medical conditions, and with these advancements have come to the mindset that any disease can be cured. Because so much is treatable, the eventual decline of patients with age or terminal illness is seen as a failure in medicine rather than a medical inevitability. 

However, Gawande reminds readers that, even with modern-day medicine, death is certain no matter how delayed. With his claims, Gawande discusses how once a patient has passed a certain threshold, the focus of medical care must shift – from prolonging their life to celebrating their last days. Though a treatment might increase the patient’s lifespan, in many cases the treatment comes at the expense of certain physical or mental capabilities. Gawande argues that this should not always be the condition that patients are met with and expected to accept. There is a tradeoff, and patients should be able to decide, reflect on, and consider whether it is an accommodation they’re willing to make. He emphasizes the importance of conversations between patients, their families, and their providers to evaluate where the line between prolonging life and prolonging quality of life. Patients and their families should focus on the bottom line: which activities and interests are foundational to the patient’s life? In other words, which functions must a patient retain in order to find the rest of their life fulfilling? This might range from simply being able to enjoy ice cream to being able to play tennis three times a week. Though these bottom lines may seem contrived or “too much” to ask for, especially when they are in competition with a longer life, it makes a huge difference in patient morale.  In many cases, when patients remain satisfied, comfortable, and fulfilled towards the end of their life, they end up living for longer as well. 

Although it is a hard topic to discuss, these conversations are some of the most worthwhile and valuable exchanges to have in the medical field. Through them, not only are the limitations of medical advancements confronted but the end goal of treatment can be reflected. Above all, medicine is a project in bettering the human condition. While it includes helping people live longer, healthier lives, it also includes being realistic about the capabilities and limitations of technologies that enforce that. There is a point where adding another round of chemotherapy or taking another novel drug will do more harm than good, and that line must be recognized, respected, and indeed central to the values of physicians and healthcare institutions. As advancements in medicine continue to accelerate, it will become increasingly important to keep patients’ bottom lines in mind in order to preserve their quality of life.


Source: Being Mortal by Atul Gawande