Atul Gawande: The angel of good death opens up his surgery

The American surgeon and bestselling author begins his Reith lectures this week on why doctors sometimes do harm. And the nation is dying to hear them

The Sunday Times: 23 November 2014

As a senior surgeon who has become a bestselling author by writing about his day job, Atul Gawande has unusual advice for the medical profession: he thinks practitioners should talk to their patients more about death. The 49-year-old son of Indian immigrants to America, who studied philosophy, politics and economics at Oxford and influenced President Barack Obama’s healthcare reforms, is about to be hailed with a very British honour: he will deliver the BBC’s 2014 Reith lectures, entitled The Future of Medicine and to be broadcast on the next four Tuesdays.

It is not just the wonders of modern medical science that have fascinated Gawande for most of his professional and literary life, but the blunders that occur, the amount of money wasted and the way more effort goes into extending life expectancy than into the quality of life towards the end.

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.

Gawande, a practicing surgeon, addresses his profession’s ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person’s last weeks or months may be rich and dignified.

Full of eye-opening research and riveting storytelling, his most recent book, Being Mortal asserts that medicine can comfort and enhance our experience even to the end, providing not only a good life but also a good end.

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