![]() ![]() That slow, long fade means we get to live longer, but often at the cost of our autonomy, and, in the view of some, at the cost of our most essential self. "The curve of life becomes a long, slow fade," Gawande writes. But these improvements have also changed, and extended, how we die. I was born in 1985 and, thanks to advances in technology and sanitation, my life expectancy is 82. A woman born in the United States in 1885 had an average life expectancy of just over 44 years. Modern medicine has done incredible things. Whatever the event, death happened quickly. Maybe it was a disease, maybe it was a car accident (or, even earlier, a horse and buggy accident). There is this first graph, which shows what life used to be like a century ago: moving along, steadily, until some horrific event happened. Two graphs near the beginning of Gawande's book help make clear how recently this tension developed. When death came quick and fast, there was no fight to remain autonomous. It is about what makes life worth living, and if, in keeping people alive for so long, we are consigning them to a fate worse than death. This conversation is really about autonomy. "Death" is the word that confuses the conversation, that makes people too afraid, and too angry, and too frantic to keep talking. This conversation isn't about death at all. "And we in the medical world have proved alarmingly unprepared for it."Īfter months of watching this debate unfold, I've realized something that feels, to me at least, like a revelation. "Scientific advances have turned the processes of aging and dying into medical experiences," he writes. He argues that his profession has done wonders for the living, but is failing the dying. The following month, Atul Gawande, a surgeon, published his new book, Being Mortal: Medicine and What Matters In the End. I will accept only palliative - not curative - treatments if I am suffering pain or other disability." And that good reason is not 'It will prolong your life.' I will stop getting any regular preventive tests, screenings, or interventions. "I will need a good reason to even visit the doctor and take any medical test or treatment, no matter how routine and painless. At 75, Emanuel says, he will become a conscientious objector to the health-care system's life-extending work. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived," he wrote. In September, Ezekiel Emanuel - an oncologist, bioethicist, and health-policy expert - wrote a powerful essay for The Atlantic about why he will no longer seek medical treatment after he's 75. The science of human decay: inside the world's largest body farmīut recently, the most interesting stories in health care have been about death: the situations where all the hospitals, doctors, and drugs in the world cannot halt the inevitable. Usually I don't have to think much about dying: my job as a health-care reporter means writing about the massive part of our country devoted to saving lives - how the hospitals, doctors, and drugs that consume 18 percent of our economy all work together, every day, to patch up millions of bodies.ĩ lessons Atul Gawande taught me about dying I joke about death because I am as terrified of having serious end-of-life conversations as the next person. In this joke, my parents' death is a simple, quiet, and uncomplicated death at home. But it's also, in its own, ghoulish way, a bit of a fantasy - an affront to the way that Americans tend to die in the 21st century, with ticking machines and tubes and round-the-clock care. Yes, this is a bizarre thing to crack jokes about. Specifically, my brother and I will come home for Thanksgiving one year and find them decomposing on the couch. But, every now and then, we joke about it.įor some reason, there is a running joke among my immediate family about how my parents will die. In my family, we don't really talk about death. ![]()
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