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Dave and Anke
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Wednesday, April 14, 2021

OVERVIEW: Being Mortal by Atul Gawande


Words to live by.
Words to die by.

Really, what's the difference?

Being Mortal by Atul Gawande

See also this review by Maria Popova

All boldface below are quotes from Dr. Gawande's book.

In Being Mortal, Dr. Gawande writes:

This is a book about the modern experience of mortality -- about what it’s like to be creatures who age and die, how medicine has changed the experience and how it hasn’t, where our ideas about how to deal with our finitude have got the reality wrong.

Our main take-aways from the book:

Quality of life is preferable to mere quantity for the vast majority of us.

Care should be determined - in discussion with one’s family, doctors and care-givers - by asking...

  • What is our understanding of the situation?

  • What do we fear?

  • What do we hope for?

  • What are the trade-offs we are willing to make?

  • What are the trade-offs we are not willing to make?

  • What is the best course of action which serves this understanding?

Consider, answer and communicate, if possible, before the onset of care…

  • Do you want to be resuscitated if your heart stops?

  • Do you want aggressive treatments such as intubation and mechanical ventilation?

  • Do you want antibiotics?

  • Do you want tube or intravenous feeding if you can’t eat on your own?

Hospice approaches and attitudes appear to serve the terminal patient much better than standard medical interventions.

In the Epilogue, Dr. Gawande writes:

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. And well-being is about the reasons one wishes to be alive. 

Those reasons matter

not just at the end of life,

or when debility comes,

but all along the way.


  1. Good to see you're back "on the air". Your post is really relevant to us, as we just finished home hospice for a neighbor and friend who passed a few days ago.

    "Consider, answer and communicate, if possible, before the onset of care…" is sage advice and so often ignored until it's too late.

    It's especially relevant for us boomers as we face end-of-life care for our parents and increasingly for ourselves. Hospice can be comforting at that time, but also worth thinking about is whether we want to take matters into our own hands.

    That's what our neighbor originally wanted to do before several strokes gradually ended her ability to implement a quick end. She finally decided to quit eating, but even with hospice meds, it was not a quick or easy exit for her. Nonetheless, having thought about it in advance, she was at least prepared to end it in weeks rather than lingering on for months or longer.

    1. Hi David and Pearl,

      So sorry to hear of the loss of your friend and that her passing was not as easy for her as she wished.

      I agree that an 'exit strategy' is so important. That bias against deciding for one's self when it's time to let go is alive and well. I believe it works against our essential human right and takes a whole range of autonomously humane options off the table.

      A phrase I think of often (in this among so many other contexts) is 'early, decisive, correct action'.

      Yes. It can get complicated. But isn't everything?

      Dave Z

  2. Posted on behalf of JOHN:

    Hello Dave and Anke,

    You've offered profound, if disquieting, thoughts regarding dying. Former radio talk show host Diane Rehm has written a book and produced a video about the idea of people choosing how and when to die. From the book:

    "In When My Times Comes, Diane Rehm—renowned radio host and one of the most trusted voices in the nation—candidly and compassionately addresses the hotly contested right-to-die movement, of which she is one of our most inspiring champions.

    "Through interviews with terminally ill patients and their relatives, as well as physicians, ethicists, religious leaders, and representatives of both those who support and vigorously oppose this urgent movement, Rehm gives voice to a broad range of people personally linked to the realities of medical aid in dying. With characteristic evenhandedness, she provides the full context for this highly divisive issue and presents the fervent arguments—both for and against—that are propelling the current debate: Should we adopt laws allowing those who are dying to put an end to their suffering?

    "Featuring a deeply personal foreword by John Grisham, When My Time Comes is a response to many misconceptions and misrepresentations of end-of-life care. It is a call to action—and to conscience—and it is an attempt to heal and soothe, reminding us that death, too, is an integral part of life."
    When My Time Comes: Conversations About Whether Those Who Are Dying Should Have the Right to Determine When Life Should End

    When My Time Comes (Video)
    Expires: 05/05/21

    For those who don't know Diane Rehm, she has a speech impediment called spasmodic dysphonia, which is a neurological voice disorder that causes strained, difficult speech. Don't be put off by the sound of her voice. She is has a very sharp mind. In spite of her dysphonia, she hosted a very popular radio talk show for a number of decades.

    Best Regards,

    1. Hi John,

      Thanks for the recommendation. We'll check her out as soon as we're able.

      I admit to being flummoxed that there is a debate over the right to die. It seems as elemental to me as the right to live. In both cases, the decision rests squarely (I believe) in one's own hands.

      Dave Z