Introduction
In 2014, a surgeon and public healthcare researcher published the book “Being Mortal”. His name is Atul Gawande. He published as well some other important books in Health Care. But “Being Mortal” is the one where this review is going about.
This review should be published in the Dutch magazine “Medisch Contact”. Therefore, this magazine will reach the people working and studying in healthcare and health-ethics. In particular, people who are working directly in healthcare, such as doctors and nurses. The book contains examples from the United States and is written by an American. However, that is not a reason, a review could not published in a Dutch magazine. Medisch Contact provides a stage on which physicians and other health-care employees could exchange their minds and discuss about healthcare topics (Medisch Contact, 2016). This book is going about being mortal in medicine. Therefore, it is a good subject to publish and discuss about, as well for changing minds in Dutch healthcare. Several topics will be used in this review. Firstly, the central claim will be explained together with the core concepts and the audience of the book. Secondly, the argument of the book in relation to potential competitors and alternatives will be discussed. Thirdly, there will be a discussion about the scientific and/or societal relevance. Finally, I added the lessons that I have learned by reading this book.
Core concepts and Audience
Gawande describes that being mortal is the struggle to cope with the constraints of our biology, with the limits set by genes, cells, flesh and bones. Medical science will give a remarkable power to push against these limits. At the moment, doctors are most of the time focusing on making people better and solve medical problems (with treatments). However, medicine can also provide a good life, a better process of dying. Medicine can comfort and enhance our experience, even to the end of our life. Treatments could make people also sicker and make their last quality of life till the death much worse. Nonetheless, doctors never think about death or will talk about it with their patients. As a consequence, patients wouldn’t think about dying, as well the best choices they must make at the end of their life. These people are not, as Gawande claimed, “Being Mortal”.
Therefore, Gawande used some core concepts to make this view more clear. I think, he used these concepts to look at the topic of mortality from different sides. The role of doctors is one of these concepts. He emphasizes the questions that a doctor should ask the patient. In particular to find out which factors are important in their last phase of their life, but even to make sure that the patient is really convinced about the choice he will make. In his book, Gawande has a good note about this: “We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being”. Another concept Gawande used in his book is “Being Mortal”, such as the title. He emphasizes in his whole book that every person is going to die. He shows us that not everyone is strong enough to accept that. “How we seek to spend our time may depend on how much time we perceive ourselves to have.” At the same time, he emphasizes how the process of dying is a difficult stage for patients. Gawande used an example of an old person in palliative care who said the following: “It is not death that the very old tell me they fear. It is what happens short of death—losing their hearing, their memory, their best friends, their way of life”. One of the other concepts in this book is the use of medicines. Gawande emphasizes that medicine is not always the right choice. Especially, if the chances of improvement and recovery are bad. Nevertheless, the last concept, the role of the patient, is even important in this stage. Gawande described that sometimes the doctor is telling the patient that there is an little change to survive after a treatment. However, every person has some kind of hope and a lot of patients are choosing a treatment against the advice of the doctor. In this situation, Gawande describes several examples in which he let you see that a good conversation between doctor and patient could improve to a better quality and end of a person’s life.
The audience which Gawande would like to reach is very broad. I think that the public could be the whole society, not only in the United States but in the whole world. His book will let you think about the choices you have. In particular, when you have a disease or you are very ill. Do you always need to choose a treatment (that not always make your life better)? Or is better to choose a good process of dying with a longer high quality of life? I think Gawande wants that everyone should think about this ethical decision.
Furthermore, the medical world could also be the audience of this book. Especially, doctors and nurses who are working directly with patients. They run daily against this ethical problem. Their mind setting could be changed by this book. Therefore, they could have more empathy in situations about dead and the end of a patient’s life. The book let these audience thinking about how to work with terminal patients, and about witch topics to talk about with them. I think, when they have read this book, the people working in healthcare will think more about the quality of life of patients
Potential Competitors and alternatives
There are more authors that have written about death and the end of life, related to what patients and doctors will needed to do. In 1959, a Dutch psychiatrist wrote an article: The doctor and the problem of death (Rümke, 1959). He found that for no one the death is easy as for a doctor. It was a paradoxical statement because also doctors do not like to think and talk about death, even if they are working more with people that are going to die (Krabben, 2002). In that time, it was a real progressive thought. However, Gawande’s book shows that the death, even when they talk about it, is a real problem for doctors.
Another book that has a lot of comparisons with the book of Gawande, is Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine (Jonson et al., 2015). This book is about the ethical issues that clinicians encounter as they care for patients. In order to practice excellent clinical care in modern medicine, clinicians must understand ethical issues such as informed consent, decisional capacity, surrogate decision making, truth telling, confidentiality, privacy, the distinction between research and clinical care, and end-of-life care. (Jonson et al., 2015). However, the book of Gawande contains less theoretical aspects. Gawande is using more stories to make this ethical aspects clear. Nevertheless, this is also a recently published book and could be a competitor or better said, an added value, of Gawande’s “Being Mortal”.
Matters of Life and Death: Making Moral Theory Work in Medical Ethics and the Law by David Orentlicher is a more philosophical book about life and death in medical ethics.
It contains debates over the fundamental principles that should guide life-and-death medical decisions and real-world choices made in hospital rooms, courthouses, and legislatures (Orentlicher, 2001). Gawande is also debating about life-and-death, but not directly from fundamental principles of medical ethics and law. Gawande is analysing situations and making conclusions out of them. Nonetheless, also this book could be a competitor or an added value of Gawande’s book.
Societal Relevance
On the one hand, 75% of all the Dutch thinking that home is the best place to die. In reality, only 25% die at home. On the other hand, the hospital is by 2% considers as the best place to die. However, 35% dies actually in a hospital. Therefore, there is a big gap between wishes of the patients and the reality. (KNMG, 2012). People do not like talking about their own death However, it is very important that a patient despite of his grief, fear and worries is considering and talking to relatives, friends and the doctor. Therefore, they know each other’s vision about the last phase of the patient’s life. At the same time, many doctors tend to continue the treatment at this stage. Patients often agree with that and are concluding that there is still hope. Doctors often think that their possibilities stopping as death comes in sight (KNMG, 2012).
Patients, doctors as well the whole society could get another opinions and views about death by reading this book. I think Gawande will let them think more about the end of their life. This book may cause that other changes were made, such as the place where people will die. Hopefully, patients will be at the place where they want to die. However, by reading this book, people could think more about what they consider as important in their live. Furthermore, they could get a different view on their life.
On the other hand, this book has also a little economic relevance. Most of the time, doctor will choose for treatments. If a lot of treatments are not any longer necessary because patients make other decisions about the end of their live, a lot of money of treatments is saved. Also when doctors are not always make the decision of a treatment anymore With this money the society could invest in care that is necessary for people in the end of their life. For example, in hospices. Gawande is writing about care at the end of life in hospices. In particular, people who are terminal ill could live here and be cared until the end of their life. They are cared in the best way and conditions, that improves their quality of life. This can only happen if the mind setting of whole society could change in accepting that people will die. Gawande’s book could help by changing this mind setting.
Being Mortal : The lessons I have learned
Before I started with reading, I thought this book was only going about dying, mortality and the process to the end of our life. I have learned, while reading this book, that you have to accept that at a moment you are going to die. When you are ill, talk and think about how your last time of your life will and should be. It’s a worldview what it is normal that people born, live and at the end going to die. Nevertheless, you can fill in this life such as the way you want. You could have a good and nice end of your life, it is located on the choices that were made. Gawande inspired me by describing that in different situations, the process of dying could be the most suitable. Therefore, he describes that it is important to find out what the exact preferences of the patient are. With the different stories, he showed that it is not always an easy way to confront patients with this, but this could be the best way of getting a good way to the end of their lives. Gawande changed my way of thinking about utility of medicine. It could be different, medicine is not always a solution to a better life. Working and talking about treatments and their consequences, about death and quality of life, is even or maybe more important than the treatment itself. I think, if you are working in healthcare and will take over the point of view in this book, you’re way of working would be really changed. You will think in another way, you will work in another way. With this book’s view on illness, medicine, the end of live and the death, healthcare could be changed and “Being Mortal”.
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