Dr. Atul Gawande believes that caring for the dying shouldn’t be primarily about keeping people alive longer but about ensuring quality of life.
“The goal is not a good death. The goal is a good life all the way ’til the very end,” Gawande told “CBS This Morning” on Wednesday. His book, “Being Mortal: Medicine and What Matters in the End,” helped transform the conversation about aging and end-of-life care.
“This is about what are you fighting for. People turn out to have priorities in their life besides just living longer. We need to ask people what their priorities are – especially when they have a serious illness or frailty. If we don’t ask, our care and what we do to people isn’t aligned with what matters most to them and then you get suffering,” said Gawande, a surgeon and Harvard Medical School professor.
His book, now available in paperback, spent 85 weeks on the New York Times best- sellers list.
Gawande says it’s important to ask questions like, “What are you willing to go through and what are you not willing to not go through for the sake of more time?” and “What’s the minimum quality of life you’d find acceptable?”
He shared an anecdote about the medical director of a nursing home who fought against staff and regulators to allow residents to have pets in the home, despite claims that it posed a safety issue.
“Life is bigger than safety and survival. Do I have love in my life? Which the pets brought. Do I have responsibility, do I have something to care for?” Gawande said.
After that nursing home added cats, birds and plants to their facility, it saw a 62 percent decrease in drug costs and residents lived longer.
“What definitely starts the conversation sometimes on a public stage is, we spend a quarter of all Medicare dollars on the last year of life – most of it in the last couple of months – and the evidence is it’s often increasing suffering rather than improving life,” Gawande said.
After his own father found out he had a brain tumor, Gawande asked him “What are you really fighting for?” For him, it was to be able to be at the dinner table with family and friend at least some of the time. Gawande said they used that as a guide to inform his father’s treatment decisions.
“The real moral question is getting to that focus on how do you want to live — what really matters to you,” Gawande said.
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