Life before Death - what really matters?

Book Review


Living life to the fullest is important to me.  I have just read "Being Mortal" by Atul Gawande.  It raises important issues about life before death.  If you are told you have a terminal illness, how would you cope?  How would your family manage? What actually matters in the end? What "trade offs" are you willing to make to prolong your life? How do you want to spend your last year, months or days?  These are important questions that few people discuss until they have no choice.


Atul Gawande is a surgeon based in the USA.   He talks about long term care for the elderly and aggressive treatment of diseases.  His main discussion is about what matters most to people who are terminally ill.  Atul reports on research that shows hospice care (received at home) can result in some patients living longer, in less pain and with more dignity than those who receive aggressive treatments.  Of course, this depends on each patient's circumstances.  He talks about the right questions to ask a patient when they face the news that they are going to die.  It's important to find out what that person understands about their illness.  What steps they want to take and the trade offs they are willing to make.

Chocolate and American Football

He gives an example of a patient that is terminally ill.  The patient must decide if he should have an operation. The operation could leave him paralysed below the neck if it is not successful.  If it is successful it could prolong his life for a few years.  The patient has already spoken to his daughter.  He says that as long as he can watch the American football on television and eat chocolate ice cream life is worth living.  The operation has complications and the doctors ask the daughter if they should carry on.  She asks if he can still watch the American football on television and eat chocolate ice cream if they carry on.  "Yes" they say.  So she tells them to proceed.  The patient survives for several years paralysed but still leading a life worth living for him.  What a simple way of making a big decision!  They spoke about what matters to the father so the daughter could assess the risks and make a decision for him.


Terminal illness

I draft Lasting Powers of Attorney for Health and Welfare for clients all the time.  I ask my clients if they have discussed decisions about end of life care with their Attorneys.  Attorneys are often spouses and children so they are close family members.  Isn't it natural to talk about these things with loved ones? I know that it isn't, but it should be.  I would like my family to know my wishes, wants and needs. They can then help me to live the life I want to lead for as long as possible.  I want them to know the trade offs I am willing to make (being able to eat chocolate is a definite for me!).  I want them to know that I would rather receive care at home than go to a residential care home.  These are just my wishes but when you start talking about them you can also start planning for them.


The book is easy to read, funny and important.  We need to be more open about these things.  This book is relevant to everyone because it talks about things that matter to everyone.  I recommend it to you.  I hope you find it will help you talk to your family about what matters most to you.


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