Live for today: Atul Gawande makes the case for hospice care

In what could turn out to be a seminal article that helps raise demand for hospice care and helps the terminally ill consider a more thoughtful approach to the art of dying, Brigham and Women's surgeon Atul Gawande describes the difference between standard medical care and hospice in terms we haven't necessarily read before in The New Yorker.

The difference according to Sarah Creed, a nurse with a hospice service that his hospital works with, lies in priorities. It is not the difference between treating and doing nothing.

In regular medicine, the goal is to extend life. Doctors sacrifice your quality of life in the short term--by performing surgery, providing chemotherapy, putting you in intensive care--in hopes of gaining more time later.

Yet the top priorities of patients with terminal illnesses include avoiding suffering, being with family, having the touch of others, being mentally aware, and not being a burden to others. "Our system of technological medical care has utterly failed to meet these needs," writes Gawande, who also serves as an associate professor of surgery at Harvard Medical School.

Hospice puts the emphasis on the here and now, rather than on raging against the dying light. It deploys nurses, doctors and social workers to help people with a fatal illnesses have the fullest possible lives in the present. As a result, the focus shifts from goals like a longer life to goals like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while.

"Spending one's final days in an ICU because of terminal illness is for most people a kind of failure," Gawande writes. "You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place."

To learn more:
- read Atul Gawande’s New Yorker article
- Art Buchwald’s Washington Post column
 
Related Stories:
Final days: Americans getting treated to death
What happened in September 1974 that makes me passionate about Planetree

Post a comment