The American way of dying: how our refusal to face up to the realities of aging and mortality causes needless suffering.

• Author: Longman, Phillip
• Position: On political books - Being Mortal: Medicine and What Matters in the End - Book review

Being Mortal: Medicine and What Matters in the End

by Atul Gawande

Metropolitan Books, 275 pp.

For most of us, death will not come suddenly. Instead, the modern way of dying often extends over weeks, months, and increasingly years, with its exact starting point and multiple causes often hard to identify even after the fact, and with many rallies and relapses along the way to journey's end.

Two years before their death, fully 28 percent of Americans are already suffering from one or more serious disabilities that typically require long-term nursing home care or extensive caregiving by family members. By age eighty-five, 40 percent of us are afflicted with textbook dementia. Within one month before the end, well more than half of us will have become too feeble to perform normal activities of daily living, such as dressing or using the toilet without assistance.

By that point, many of us will have suffered through a cascading series of setbacks--falls compounded by strokes, compounded by metastasizing tumors, compounded by failing body organs--that will cause us to be shunted in and out of intensive care units. There, respirators, catheters, defibrillators, dialysis machines, artificial feeding tubes, and other high-tech paraphernalia marginally prolong still further the process, and often the agony, of dying. No one wants to pass this way, and there is no good reason why so many of us have to, yet forces beyond our control often conspire against our wishes.

The message of Atul Gawande's masterful new book, Being Mortal: Medicine and What Matters in the End, is that we need to get over our denial and confront the needless, massive harm we do to each other, including our future selves, by not facing up to the realities of modern mortality. "Our reluctance to honestly examine the experience of aging and dying has increased the harm and suffering we inflict on people," writes Gawande, "and denied them the basic comforts they most need."

A more qualified messenger on this subject would be hard to find. Gawande's credentials include not only being a practicing surgeon at Brigham and Women's Hospital in Boston, which has given him vast experience with end-of-life issues from a doctor's point of view. He is also one of the most talented, accomplished, nonfiction writers of his generation, with credits that include having written groundbreaking articles as a staff writer for the New Yorker, plus three best-selling books, exposing and explaining in chilling detail the breakdown of America's health care delivery system.

Gawande's effectiveness...