Priorities

One of the oft repeating points that is made in “Being Mortal” is the quality of life at its end. Dr. Gawande frequently made the important point that “quality of life” has different definitions depending on one's perspective. A dynamic triumvirate often develops in the hospital room of a very sick or dying patient. The three sides that have different opinions of what quality care is are the doctor, the patient's family and the patient.

Physicians are trained to cure people. But that's impossible with a dying patient. Most physicians are not trained in geriatrics and are often reluctant to provide the family and patient with the real hard facts, the prognosis, the length of time the person has left. The family is sure the patient will recover with the right treatment. And the patient who is in pain mainly wants relief. When a physician does provide some...