All of us need to talk honestly about matters that concern us. Talking honestly about end-of-life choices is essential, and Atul Gawande (a surgeon in Boston) makes that clear in his book Being Mortal. Are the desperate surgical procedures and expensive treatments, which usually reduce the quality of life of a terminally ill patient, worth it? If discussed openly and honestly early in the process, would the patient choose to die in a hospital or at home with his family under the care of hospice?
Once one becomes seriously ill, even at an early age, perceptions change. What becomes important are the people in your life. The same is true as you approach death as an older person, and those last few months or years can be highlights of dignity, or they can turn into medical nightmares. “It’s perception, not age, that matters most.”
Dr. Gawande gives examples including the death of his own father, to illustrate different scenarios and notes that, “25% of all Medicare spending is for the 5% of patients who are in their final year of life, and most of that money goes for care in their last couple of months and is of little apparent benefit.” He readily admits doctors don’t ask the hard questions and he is changing his ways as a surgeon, but he wants the patient and family to get there first. This book is worth reading in order to understand, to contemplate, and to help make wise decisions about end-of-life issues.
For a more in-depth analysis, go to NPR Frontline.