Sunday, March 15, 2015

End of Life Thoughts

Our modern healthcare system fails people two ways:
  • Senior residences and nursing homes focus on physical welfare, rather than striving for optimum quality of life. 
  • As patients near end of life, physicians subject them to extreme but futile medical treatments.  
These ideas come together in Gawande's latest book Being Mortal. He lambastes nursing homes' focus on measuring the purely medical needs of their patients, like getting medications on schedule, but failing to care for their quality of life. Many activities that would provide stimulation for people's lives, could add risk to their health. Many residents in these homes would prefer to take these risks in return for a better life (by their own definition), but they are not given the choice.

Gawande also takes on the medical profession's obsession with intervention in late stages of life, interventions that can make the end of life agonizing for the patient. Yet studies have shown that, on average, these brutal measures don't extend life expectancy beyond that for people who choose palliative care.

Gawande advocates rethinking our entire system's approach to late-life end-of-life care, including a fleeting reference to assisted suicide.

This book brings together so many things I've been thinking about recently. Some time ago I wrote a review of How to Die in Oregon, a documentary about assisted suicide, one of the best documentaries I've seen at Hot Docs. It reinforced my support for assisted suicide options. And Canada's Supreme Court recently ruled that adult Canadians in grievous, unending pain have a right to end their own life with a doctor's help(details here). I've also written a glowing review of The Checklist Manifesto and of Atul Gawande's TED talk, which first made me a Gawande fan.

He's hit the ball out of the park again with this book. A must-read.
Links to past book reviews, with some of my favourites at the top:
Non Fiction:
The Innovator's Dilemma
The Wave: In Search of the Rogues, Freaks and Giants of the Ocean (my most viewed book review)
Curiosity (my second most viewed book review)
The Immortal Life of Henrietta Lacks 
The Checklist Manifesto
The Lean Start-up
The Upside of Irrationality
Thinking, Fast and Slow
Steve Jobs
Global Warring

Life After Life
A Possible Life (I love anything by Sebastien Faulks)
Mr. Penumbra's 24 Hour Bookstore
Major Pettigrew's Last Stand
Rules of Civility
The Taliban Cricket Club
The Vault
Before I Go To Sleep
A Son of the Circus
Still Alice
Faithful Place
Defending Jacob
The Strangler
The Help
The Housekeeper and the Professor

Some series I've liked:
Donna Leon's series about the Venetian detective Guido Brunelli: A Question of Belief
Canadian Peter Robinson's series about British detective Alan Banks: Before the PoisonBad Boy
James Church books about a North Korean detective: A Corpse in the KoryoHidden MoonBamboo and BloodThe Man with the Baltic Stare
Gianrico Carofiglio's series about an Italian policeman: Involuntary Witness
Jo Nesbo's series about Norwegian detective Harry Hole: The RedeemerThe RedbreastNemesis
Alexander McCall Smith's series about the No. 1 Ladies' Detective Agency
Andrea Cammillieri's books about Sicilian Inspector Montalbano: The Shape of Water
Martin Walker's series about French local policeman Bruno, Chief of Police
Louise Penny's detective series set in the Eastern Townships of Quebec: Still Life
Jussi Adler-Olsen's series about Danish detective Carl Morck: The Keeper of Lost Causes
Ruth Rendell's books about Chief Inspector Reg Wexford
Arnald Indridsadon's books about Finnish detective Erlendur: Arctic ChillHypothermia and Outrage

Other books I've also liked:
The Spoiler
The Secret Race
The Blondes
San Miguel
The Better Angels of our Nature
The Believing Brain
Hellstrom's Hive
22 Britannia Road
The Imposter Bride
Murder as a Fine Art
The Invisible Bridge
This Body of Death
Sustainable Energy - Without the Hot Air
Berlin Crossing
The Marriage Plot
The Paris Wife
The Forgotten Affairs of Youth
Turn of Mind
The Secret Speech
The Thousand Autumns of Jacob de Zoet
The Makioka Sisters
Suite Francaise
The Man from Beijing
At Bertram's Hotel
Red April
You Are Not a Gadget
Five Smooth Stones
River of Gods
Nasty, Brutish and Short: The Quirks and Quarks guide to Animal Sex and Other Weird Behaviour
The Ghost
The Council of Dads
The Elements
The Elephant, The Tiger and the Cellphone
The Janissary Tree

Some books I didn't like very much:
A Perfect Heaven
Potsdam Station
The End of the Wasp Season
The Dark Room
Dead or Alive
A Vintage Affair
The Finkler Question
When the Devil Holds the Candle

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