“Being Mortal,” by Atul Gawande: Discussion Questions

“We have come to medicalize aging, frailty, and death, treating them as if they were just one more clinical problem to overcome. However, it is not only medicine that is needed in one’s declining years but life – a life with meaning, a life as rich and full as possible under the circumstances. Being Mortal is not only wise and deeply moving, it is an essential and insightful book for our times, as one would expect from Atul Gawande, one of our finest physician writers.” – Oliver Sacks

“American medicine, Being Mortal reminds us, has prepared itself for life but not for death. This is Atul Gawande’s most powerful – and moving – book.” – Malcolm Gladwell

Discussion Questions

We are mortal: we’re born and, ultimately, we die. We resist the notion, we defy it, and eventually we succumb. What happens in the penultimate period, whether it’s weeks or months, is the topic of Atul Gawande’s very timely and useful new book “Being Mortal.”  Some questions:

1).  What would people think about someone giving this book to a person who may be terminally ill?

2.)  Dr. Atul Gawande says mortality has become a clinical experience that robs patients of quality of life. Gawande states that the medical care system is poorly equipped to care for even the physical aspects of aging let alone the social and psychological aspects.He argues doctors and healthcare facilities need to shift their approach to aging and dying away from a regimented safety focus to one that fully engages the human spirit. What does that mean to each of us and our loved ones? What do you think the role of the medical profession is at the end of life, to ensure health and survival or “to enable well being”?

3.)  Has reading this book changed your thinking about how you will approach the final months or weeks of your own life?

4.)  In the book there is a discussion of the meaning of courage. Dr. Gawande references Plato’s dialogue on courage, observing it takes two kinds of courage to face illness and sickness: “the courage to confront the reality of mortality…” and “the courage to act on the truth we find.” How would you describe courage in the face of a terminal illness?  How does the concept of courage apply to those who love the terminally ill patient?

5.)   Dr. Gawande writes: “Certainly, suffering at the end of life is sometimes unavoidable and unbearable, and helping people end their misery may be necessary. Given the opportunity, I would support laws to provide these kinds of prescriptions to people.”  Yet Dr. Gawande seems to be wary of such a policy at well.  Has reading this book changed your views on assisted suicide?

6.)  Dr. Gawande identifies five questions that we need to know in order to assist the terminally ill:

1. What is your understanding of where you are and of your illness?
2. Your fears or worries for the future
3. Your goals and priorities
4. What outcomes are unacceptable to you? What are you willing to sacrifice and not?
And later,
5. What would a good day look like?

Do you agree these are the fundamental questions that need to be answered?  Would you add any others to the list?

7.)  Letting go requires changing one’s perspective (stories of Jewel Douglass, Atul’s dad),what Gawande refers to as “stepping through the looking glass” with a serious illness diagnosis (p. 194). This brings into question procedures that prolong life, such as nutrition/tube-feeding, ventilators, and CPR (cardio-pulmonary resuscitation).  Have you had the conversation with your spouse/parent/children? What problems do you anticipate or did you experience?

8.)  Dr. Gawande discusses the tension between increased longevity in the U.S. and the decline of the family as primary caregivers of elderly persons. Multiple factors contribute to this disconnect and “our elderly are left with a controlled and supervised superficial existence, a medically designed answer to unfixable problems, a life designed to be safe
but empty of anything they care about” (p. 109).  Thinking about yourself right now, could you imagine answering: “What are the tradeoffs you are willing to make and not willing to make?”