My rating: 5 of 5 stars
I thought that I had thought all the necessary questions about end-of-life decisions, and I had thought many. But Gawande opens up new questions for evaluating those issues.
Gawande also opens up new ways to think about dealing with debilitating changes forced by disease or age. He offers a critique of traditional nursing homes, of what “assisted living” has become, and of medical practice based more on procedures than persons. His illustrations with case studies–some showing failure, others showing success–take the book beyond theory to readable.
Gawande challenges the narrow focus on safety and extending life and replaces it with concern for quality of life. He notes that people making quality-of-life decisions for patients often think in terms of what they, themselves, want, not what the patient would want. He questions the Maslow hierarchy’s application to all ages and stages. “Freedom to be the author of our lives” within whatever circumstances we are dealt becomes primary. He offers discussion questions for medical personnel and family to use to understand what the patient sees as desirable quality of life, then urges discussion of ways to accomplish it.