Being Mortal, Atul Gawande

This book was a mega-hit some 10 years ago, and I’m glad, because it really is a profound meditation on aging and how we make decisions about elderly and end of life care. The main thrust of the book is, first, that we should focus on quality of life rather than on extending it as long as possible, and second, that we should really think carefully about what quality of life means for each individual.

This might not seem so revelatory, but it becomes more so in the context of concrete considerations about, say, retirement home policies. Very understandably, most institutions are laser-focused on safety. But in fact, for quite a lot of people (I certainly include myself in this), their safety — or rather, avoiding risk — is not a top priority. They will gladly trade some risk for the sake of pleasure, or even just for a sense of agency or freedom. But it’s so much harder to make that trade-off when you’re making a decision on someone else’s behalf. You see this in parenting, too — the benefits of risk seem far less appealing when you’re imagining your vulnerable loved one out in the world. And so, we may not consider what that other person actually wants — what makes their life feel meaningful and worthwhile.

Gawande goes through plenty of specific cases of various people, so you really get to see how these dilemmas play out in practice. And although I think it’s clear what his opinions are, the book doesn’t seem polemical — he’s insisting that you consider the problem, but not telling you that there’s only one answer. Or maybe it only seemed that way to me because I agree with him.

In any case, I really think it’s a book that everyone should read, but I recommend it extra warmly for people who are beginning to face these questions with elderly family members — a part of being middle aged that nobody warns you about (somehow I am consistently caught totally off guard by all of these fairly universal experiences).