Atul Gawande discusses end-of-life care on the Daily Show
The ever-prolific Atul Gawande chatted it up last night with Jon Stewart on the Daily Show, promoting his latest book, “Being Mortal.” The two discussed end-of-life care – and how patients and physicians should temper their pursuit of “doing whatever they can” in favor of living out life in a more meaningful way. For instance, Gawande noted that at the end of the 1990s, 17 percent of Americans died at home. The rest were in institutions.
“That’s not the way most people want to go,” Gawande said.
Instead, doctors should ask patients what the priorities are in a patient’s life besides living longer, he said. What are the tradeoffs they’re willing to make? Their fears? Goals? Gawande, a Harvard cancer surgeon, said that he really questioned the value of medical treatment versus a patient’s quality of life when his own father was diagnosed with a spinal cord tumor. The elder Gawande, also a surgeon, would say that if he could still do the things that were important to him – interact with people, do charity work – then treatment was worth it.
We did surgery because it would let him do those things more,” Gawande said. “But when the chemo took that away, that’s when we stopped it.”
The two discussed the power of palliative care and hospice – and how sometimes they can be far superior to aggressive therapy. However, Stewart aptly noted that this whole big pharma industrial complex pushes toward pursuing the bigger, more elaborate medical treatments.
“Every push in our system is towards do something more,” Gawande said. “I get paid more to do the operation by far than I’ll ever get paid to not do the operation.”
He cited a Mass General study that demonstrated the value of palliative care. Two groups of stage 4 lung cancer patients were given the standard oncology treatment, but one had a series of conversations with a palliative care specialist. The latter group chose fewer days in hospital, stopped chemotherapy sooner, went in hospice earlier and suffered less. They also lived 25 percent longer.
Gawande had a solid point of view, but the complexities associated with caring for people with cancer are a bit different than what many other people are coping with. Alzheimer’s disease and people with advanced dementia may have very different ideas of what would make them happy than the realistic options Gawande and his father grappled with.
The work involved with caring for someone in the last stages of their lives at home is too arduous for most people, and assisted living facilities are often pretty pricy. It’d be interesting to hear what Gawande has to say about this patient population on the subject of palliative care. But it would be great to make what for many is a taboo and fearful conversation a source of comfort and relief.
Not that any of this matters, of course.
“I think the good news, for some of this – because of Ebola, we’re all going to die soon anyway,” Stewart cracked. “While this is an incredibly heartfelt and well-reasoned book, two weeks from now…”
To watch a video clip of Dr. Gawanda’s interview with Jon Stewart from the October 6, 2014 Daily Show, click HERE