The author takes a hard look at aging and what used to happen and what now happens in America in the post modern, indrustrialized society. Our attitudes and focus have definitely taken a shift over the century from all viewpoints: the medical field, the aged themselves and those coming up behind who are to care for their loved ones. The author presents the idea that what medicine created in allowing longer lives has not kept up on the end of serving it's end of life citizens well, whether they are end of life through aging or or through illness.
"Medicine has been slow to confront the very changes it has been responsible for - or to apply the knowledge we have about how to make old age better"
As medicine has allowed for longer lives, for the aged and the infirm, there has become more aged and less doctors who want to care for the aged. The author points out the fact that there is no money to be made working with the aged, no challenge but to hear their regular complaints of bodies no longer working the way they used to. Most medical students are opting for specializations that are exciting, more glamourous and making them money for their efforts. This is not found in the caring for the aged. As he goes through various cases he has dealt with, including his own father who faced a rare and debilitating cancer, he started to ask "What makes life worth living when old and frail or unable to care for ourselves". He explores how medicine in it's concerns with extending life have run opposite to what might make living worthwhile for each individual. Doctors approaches have become an "information dump" onto patients so that they can know their choices not ever pausing to ask what are the patients desires and goals for outcomes. What do they individually want and not want, what is the goal for them. It is as individual as each person. And it is this that is missing in our care of them. The author argues that quality of life for each individual should be the desired goal and doctor/patient decisions should be made upon those expressed ideals.
"When to shift from pushing against limits to making the best of them is not often readily apparent. But it is clear that there are times when the cost of pushing exceeds it's value"
This was an eye opening book as the author made his arguments through real life stories and his experiences as a surgeon. His explored the various approaches that different medical disciplines take and how doctors need to take more time to really get to know their patient and what it is they really want. His arguments for "finding the quality of life" and living the best possible day today are laid out in an easy to read language and he encourages us to ask the hard questions of our loved ones before they are not able to communicate what is quality of life to them. What do they want to sacrifice now for time later and what do they not? What do they want out of their last days? What are their fears? We should not assume we know and we will probably be surprised by their answers. He argues that when we ask these hard questions it helps both the individual and those who care for them (professionals and family) to be able to make the confusing, hard decisions when we are faced with them. He advocates for quality hospice care so that a person's last weeks or months may be rich and dignified according to their own goals of end of life.
"...the role of caring professions and institutions...ought to be aiding people in their struggle with those limits. Whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person's life."
"We've been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well being".
"Our ultimate goal, after all, is not a good death, but a good life to the very end"
(?? I forgot to take note of what page these quotes were on)
I gave it a 9.5/10 Well worth the read!