Mortality and the Limits of Medicine – Comment Magazine


Mortality and the Limits of Medicine – Comment Magazine

What does it mean to live as mortal creatures? It is a timeless question, but the answers will vary greatly depending upon the era and place in which you live. Atul Gawande gives an extremely illuminating account of the contemporary opportunities and challenges for living as mortal creatures in his book, Being Mortal. I wrote an engagement with the book in Comment Magazine — you can read from it below, or click here for the full article:


Why is the experiment of turning dying into a medical experience failing? When medicine becomes the heroic master over human life rather than its servant, it crowds out the space otherwise filled by family and faith communities. Gawande contrasts our current practice of dying in institutions with the practices in India as his grandfather faced death. His grandfather displayed the characteristic Indian pattern of dying: he lived with his extended family as an elder—seen as a source of wisdom to the young—and as he gradually lost his bodily functions, the family stepped in and helped. Dying was a process observed by the whole family, who answered the call to be caretakers. In contrast, in the modern West today, usually “death comes only after long medical struggle with an ultimately unstoppable condition—advanced cancer, dementia,” and so on. Rather than dying with the living in the home and sharing last words of wisdom and confession, most today die in a sterile hospital with highly trained strangers, “fighting” to delay the inevitable. With terminal illnesses today, “death is certain, but the timing isn’t. So everyone struggles with this uncertainty— with how, and when, to accept that the battle is lost. As for last words, they hardly seem to exist anymore. Technology can sustain our organs until we are well past the point of awareness and coherence.”

Gawande notes that this way of dying contrasts not only with his grandfather’s context in India but with historic rituals that thrived in the West as well. “Dying used to be accompanied by a prescribed set of customs. Guides to ars moriendi, the art of dying, were extraordinarily popular.” These guides “provided families with prayers and questions for the dying in order to put them in the right frame of mind during their final hours. Last words came to hold a particular place of relevance.”

Make no mistake: the cultural liturgy has changed. As our master, medicine feeds our attempt to cling to life as if limits to our life are artificial or unreal. We’ve replaced final words with family members agonizing over when to shut off the ventilator. We’ve replaced the known pastor with the unknown ICU doctor. Rather than admitting that before God our life is “like a breath” and our “days are like a fleeting shadow” (Ps. 144:4) and thus putting our final hope in joining Christ in resurrection, we keep hoping for a quick medical “fix” around the corner. Many patients and some doctors act as if even preparing for death is an unforgiveable surrender, an unpardonable heresy.