Talking about death: end-of-life care

Bestselling author Dr. Atul Gawande’s new book focuses on medical care for the dying. In an interview, he speaks with SPIEGEL about end-of-life priorities, when treatment is a mistake and how rules in care homes are made to be broken.

SPIEGEL: Doctor Gawande, are you beginning to feel your age?

Gawande: Without question. I had to switch bifocals this year. I was always near-sighted and now I’m also far-sighted.

My 19-year old daughter has started beating me at word games because I just don’t process like I used to. While playing tennis, I never had to stretch nor worry about injuries. That’s over as well. Overall, it’s the kind of little aches and pains that make you think: Yes, I’m getting older.

SPIEGEL: In your book “Being Mortal,” you describe vividly what happens when we age: Our heart muscle’s performance begins to deteriorate at 30, before the age of 40 our brain power starts to decline. At the age of 60, on average, we’ll have lost one third of our teeth. Does your own decline scare you?

Gawande: It’s an experience that definitely bothers me. The mental image I have of myself is still the person who was 30 years of age rather than the person turning 50 this year.

SPIEGEL: Four years ago, your father passed away at the age of 76. Did the experience of his death magnify your concerns?

Gawande: Surprisingly, no. It actually helped me. Up until the end, my father had things he loved and cared for. We should consider ourselves lucky to become older than the generation before us.

Many of us will become dependent, that’s inevitable, but that doesn’t mean one can’t have a good life. For my book, I talked with a 94-year-old man. Every joint he had was aching. He had to support himself with one of those walkers that had tennis balls on each of the legs. Sometimes, he seemed confused. Yet, he had things he loved about life and that was true of my father as well. Continue reading

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