Health & wellbeing

Being Mortal

Atul Gawande

Medicine and What Matters in the End

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  • 11 key ideas
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  • Published 2014

Introduction

Atul Gawande, a surgeon and writer, argues that modern medicine has learned to fight disease but not to help people through ageing, frailty and dying. Drawing on his patients, his own family and research on elder care, palliative care and hospice, he shows how hospitals and nursing homes put safety and survival ahead of what people care about, and how a few doctors, nurses and builders of new kinds of homes have tried to change that.

The book has an introduction, eight chapters and an epilogue. The first five chapters follow ageing: how families and societies changed, what happens to the body, and how nursing homes and the alternatives to them came about. The last three turn to serious illness and dying: why treatment so often goes on past the point of benefit, how to have hard conversations about what matters most, and the courage to act on the answers. In the last chapters, Gawande also tells the story of his father's illness and death. This summary follows the 2014 text.

Note: the book describes mainly the American health system, with its hospitals, nursing homes and hospice services, and the studies in it are reported here as Gawande presents them. It tells of the deaths of real people, including his father. This summary is not medical advice: if you or someone in your family faces such decisions, talk to your own doctors.

  1. 1Gawande argues that medicine has turned ageing and dying into medical matters it was never trained to handle, and that this experiment is failing
  2. 2Gawande says modern societies replaced respect for elders with respect for the independent self, which leaves no plan for when independence ends
  3. 3Gawande reports that ageing is a slow wearing-out of the body, and that geriatric care, which aims to keep people able rather than to cure them, works but is neglected
  4. 4Gawande argues that nursing homes were built to free hospital beds and keep people safe, not to help them live, which is why so many residents feel imprisoned
  5. 5Gawande shows that assisted living began as a home where frail people kept control, but drifted back toward safety rules because families choose for their parents
  6. 6Gawande cites Laura Carstensen's research that what people want depends on how much time they feel they have, so as horizons shrink, everyday pleasures and close people matter most
  7. 7Gawande argues that people need reasons to live, not only safety, and that homes built on this idea let even very frail people stay the authors of their lives
  8. 8Gawande argues that, facing incurable illness, patients, families and doctors default to one more treatment, because they plan for the long-shot hope instead of the likely outcome
  9. 9Gawande reports that hospice and honest conversations about goals often bring less suffering, and in some studies longer life
  10. 10Gawande says doctors should neither dictate nor just list options, but ask what matters most and match treatment to it, as he learned with his own father
  11. 11Gawande argues that courage means facing what is to be feared and hoped and acting on it, and that because a life is a story, its ending matters

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Being Mortal by Atul Gawande: summary | Daridanesh