Care for the dying needs more imagination – and less hospitalisation

‘To die of age is a rare, singular and extra-ordinary death’, wrote Montaigne, ‘and so much less natural than others: it is the last and extremest form of dying.’ Not any more. Thanks to the marvels of modern medicine, we are limping and stumbling and mumbling and forgetting our way into the grave at greater ages than ever before. Since such longevity is still new, we’re not really prepared for it: we are dying beyond our means, outliving our usefulness, our pensions and even our individual body parts. Outliving, too, the patience of our families. In affluent countries like ours, the spectre of the care home holds more menace than death itself.

Atul Gawande is a surgeon, as well as a professor at Harvard Medical School. He writes on medicine and medical ethics for the New Yorker and has published several bestselling books about how to be a better doctor, all of them excellent and of great interest to the lay reader. He has no professional need to worry about old people, nor even to trouble himself unduly about the dying. So it is to his tremendous credit that Gawande has turned his attention to mortality. We need people of such outstanding intelligence and compassion to consider the ever-growing problems associated with our ageing population.

Throughout our lives we visit our doctors as consumers, with the expectation that they will be able to do something: give us pills and potions, zap anything nasty, mend broken bits, replace worn-out joints. This is all well and good until we get to the end. The sad fact is that more NHS money is spent on the last six months of people’s lives than any other stage, with unhappier results. As Gawande says:

The simple view is that medicine exists to fight death and disease and that is, of course, its most basic task.