“We as a society have medicalized mortality.”
That is the key insight from our Book Club’s August selection, “Being Mortal” by Atul Gawande.
On August 25, Policy Advisor Dr. Julius Chen held an online discussion with 21 members of the Free the Facts community about Gawande’s book, which challenges readers to accept a hard truth: No amount of health care can keep us alive forever, and at some point, the costs of prolonging our lives can arguably outweigh the benefits.
As our participants discussed, talking about our own mortality with loved ones can be deeply uncomfortable, but that doesn’t make it any less necessary.
One participant recalled a time when their parents tried to discuss their future retirement:
“I tried to stop the conversation and change the subject,” they admitted, “but after reading this book, I went to my parents and we did have the discussion.”
The conversation doesn’t get any easier at a national level. In Being Mortal, Gawande shares the stories of multiple patients who received medical care that extended their lives, but with a significant decrease in quality. Their stories raise obvious questions over what services and treatments private insurance and Medicare should cover.
Dr. Chen pointed out that in the U.S., we use quantitative metrics to determine whether medical treatment is successful. We measure, for instance, the total number of hospital visits or the number of years a cancer survivor lives after being treated.
By contrast, the U.K. uses a metric called quality-adjusted life years, or QALYs. Instead of looking at just how many years a treatment will add to a patient’s life, health care providers also look at the expected quality of life during those years. They ask themselves, for instance, “Is a treatment ‘worth it’ if you get 5 more years to live, but are bedridden during them?”
You can imagine why this method is controversial, and some participants voiced their reservations. But this very debate raises an important question: In our single-minded attempt to keep the elderly alive, are we really doing what’s right for them? As many Book Club participants pointed out, in discussions about end-of-life care, elderly people often feel as if they’ve lost their autonomy and that their loved ones are making all the decisions for them.
But even though mortality can be scary to think about, all our participants agreed it is much better to talk about it with loved ones early on in our lives. “Being Mortal” raises hard but important questions, all of which we need to ask ourselves to make sure our loved ones live with dignity.
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