Two books have made thought-provoking reads recently. When you see their subject matter, you may well just switch off; please don't. Each is written in a thoughtful, yet matter-of-fact manner about subjects that will affect each and every one of us.
The first - Atul Gawande's "On Being Mortal" - is about the very important subject of living a good end of life. With the massive progress made in medical science, most of us will now reach old age and so face negative changes to our physical and/or mental capabilities. Families are spread far and wide and most families have both adult parents working at least part-time in order to afford the ever-increasing costs of living. Far too many are facing the double challenge of bringing up children and having to care for ageing parents.
There can be a tendency to idealise how duty requires that family care for the elderly in places such as India. Gawande describes how this is a positive experience for his own grandfather, whilst acknowledging that his father's siblings and their families are left with the difficult duty of caring for someone who lives to 110. The grandfather rules the roost, but the families are left with no autonomy of their own. It is a far from ideal situation for them.
Then Gawande's father is diagnosed with a terminal illness and this story runs alongside his examination of what facilities are available for those who are no longer able to live alone in their own homes. It is clear that society has largely handled this badly. Gawande's admission that giving this task to the medical profession has resulted in the focus being more about safety than respect for the individual is an important one. The lack of specialist knowledge within the medical profession of geriatrics is pretty shameful, but I don't suppose most older readers needed to be told that. Many of us will have first or second hand knowledge of an elderly relative's negative experience of health care.
What I did learn from this unflinching examination is that a "good" end of life is an entirely personal thing. If we start with the assumption of the rights to autonomy of all involved, thereafter communication is key. We must not avoid the difficult subjects - in some cases that is death itself but, as important, is the loss of independent living. If it is important to be rigorous in seeking the best option, it is crucial to prioritise the individual's desires - as far as is possible - and not to impose our own need to wrap them up in cotton wool and keep them safe. They are still living and have a right to choose how to live. Their age and medical conditions will already have applied limitations to that ability, they do not need additional restrictions if they can be avoided.
It is critical that we are fully aware of their wishes, their specific wishes, in order for us to be trusted with their final decisions. I am not talking about assisted suicide, simply about what level of medical intervention each individual considers acceptable, whether there's a wish to be at home or in hospital, what level of medication is desired, what trade-offs are to be made in order to achieve what small amount of control an individual has over their final time - be that hours, days, weeks, months or years.
My parents are elderly, I am facing this very situation. Gawande's book enable me to have a better conversation than I'd have been able to do previously. For that alone, it was worth it. I cannot recommend reading this more highly. It is a well-written, honest, pragmatic and tender study of a subject we'd all rather avoid, but probably cannot.
The second book is about how our society handles death and how those practices have changed over time. Caitlin Doughty's "Smoke Gets in Your Eyes: And Other Lessons from the Crematory" is an interesting and somewhat graphic read. Caitlin describes her experience of working in a crematorium and of training for the funeral industry. These experiences contrast markedly with her own study of the history of death and its processes. The comparison she draws between our modern day practices and those historical methods are what gives this book its value.
Will many - or indeed any - of us change our wishes after reading this? It's possible. The idea of a green or natural burial has certainly increased in appeal to me.
Do you have any reads on difficult but important subjects that you recommend?
The Old Shelter
Iain Kelly Writing
Bit 2 Read
A Back of the Envelope Calculation
No Love for Fatties
What are They
Petrichor and Clouds