The 2014 BBC Reith lecture with Dr Atul Gawande (previously) continue to amaze, delight and inform, and the third one, “The Problem of Hubris,” fundamentally changed how I think about (and what I fear about) death.
Gawande’s lecture concerns a fundamental shift in how health technology is deployed at the end of peoples’ lives. He advocated for an evidence-supported policy that trades duration of life for quality of life, at the end. Dying patients are coached to acknowledge that they are at the end of their lives, and to identify their priorities for their last days, weeks or months, and are sent home with a hospice nurse who helps them achieve those goals, giving them enough painkillers to get through the pain, and enough ritalin (or other uppers) to function on that dose of painkiller. The results are remarkable: dying people live longer, have fewer surgeries, don’t require the ICU, and end happy and fulfilled — leaving behind survivors who are substantially less traumatized.
It’s amazing because it’s human-centered, humane, and cheaper than the approaches currently used — and it does more to prolong life than those approaches.
Listening to Gawande describe the research and its outcomes, I found myself feeling more optimistic about end-of-life than I have in years, since I hit the demographic bulge wherein a substantial number of my cohort and elderly relatives started to die, often in lingering, terrible ways.
One missing element from Gawande’s lecture is treatment of people with dementia, which killed two of my grandparents so far, and is killing a third one right now. I don’t see how this can apply to their situation, which is sad, because of all the ways I’ve seen people go, dementia is by far the worst.
The Problem of Hubris [MP3]