The medicine of just a few decades prior would be considered impotent in 2019. Diseases of the heart and lungs were particularly deadly in the early 1960’s and 1970’s. Treatments of the time were less effective in mitigating resultant traumas of heart disease, stroke, and emphysema. Today, medicine has reached a point where these once-devastating diseases are neither — necessarily — deadly nor crippling.
These advances have done wonders for life expectancy. Many of us reading this have likely encountered someone well into their 80’s or 90’s; I’ve personally met several people over the age of 100. But for us to live longer than humans have ever lived before means we must take care of elderly people longer than we have ever had to before. With this new-age longevity in mind, Gawande raises several questions.
With people living longer than ever before, how can we allow the aged to age and die gracefully? And how should we balance longevity with comfort?
Should we place more gravity in keeping the dying comfortable or alive as long as possible?
Despite the medical success story of new-age longevity, these questions cannot be overshadowed. Ever-evolving technology and medicine are letting us live longer, though our approaches to long-term treatment and care for those who become dependent (which, eventually, is everyone) have developed at a much slower rate.
Through interviews and anecdotes in nursing homes and hospices, Atul Gawande posits that a high stressor for the elderly is a fear of “being a burden” on their loved ones. This is fueled further by a desire for individuals to remain as independent and autonomous as possible, in spite of the physiological detriments associated with aging.
To be frank, Gawande explains, our society isn’t set up all that well to care for the aging and dying for long periods of time. Keeping people alive is a magnificent step in medicine and for humanity, though taking care of dependent elderly for an extended time remains a challenge.
Traditionally, before the development of nursing homes and advanced medical practices, aging was a community affair. Parents would take care of their children and the favor was returned as the children became adults taking care of their aging parents. Life expectancy was shorter and medicine was worse at postponing the physiological declines of aging. Aging (and dying) was a familial responsibility and care-taking was the only option, given that life-extending medicine hadn’t arisen yet.
Then, with the societal and medical developments of the 20th century, hospitals and nursing homes sprouted across the Western world and aging became less of a community affair and more “outsourced.” People live longer, certainly, though care-taking has taken a backseat to medical treatment.
Taking care of the aging and dying, Gawande argues, should take salience over keeping someone alive via medical intervention. Comfort and enjoyment are an oft-overlooked part of medical treatments, though they should take center-stage. Sacrificing happy aspects of life to stay alive is not an easy undertaking, and people have varying degrees of willingness to sacrifice.
As Gawande put it,
“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.”