Description of aging in a village in Mumbai:
"he was surrounded and supported by family at all times, and he was revered - not in spite of his age but because of it. " p.14
"how he wanted to live was his choice, and the family's role was to make it possible." p.16
"he was surrounded and supported by family at all times, and he was revered - not in spite of his age but because of it. " p.14
"how he wanted to live was his choice, and the family's role was to make it possible." p.16
How is this description different than what happens today?
Where do you hope to spend your final days?
"Home is the one place where your own priorities hold sway. At home, you decide hw you spend your time, how you share your space, and how you manage your possessions. Away from home, you don't." p.89
How did you feel about the various options described for living out your later years? Which aspects did you find compelling and which were appalling?
SAFETY VERSUS AUTONOMY
“We want autonomy for ourselves and safety for those we love.”
Gawande discusses the tension between increased longevity in the U.S. and the decline of the family as primary caregivers of elderly persons. Multiple factors contribute to this disconnect and “our elderly are left with a controlled and supervised superficial existence, a medically designed answer to unfixable problems, a life designed to be safe but empty of anything they care about” (p. 109).
That remains the main problem and paradox for the frail. “Many of the things that we want for those we care about are things that we would adamantly oppose for ourselves because they would infringe upon our sense of self.”
How do we determine the tradeoffs between safety versus autonomy?
What are you willing to give up to be safe? What are you unwilling to give up?
our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.
TENSION OF STANDARD MEDICAL PRACTICE VERSUS HOSPICE
Atul Gawande says mortality has become a clinical experience that robs patients of quality of life. He argues doctors and healthcare facilities need to shift their approach to aging and dying away from a regimented safety focus to one that fully engages the human spirit.
What does that mean to each of us and our loved ones?
What does that mean to each of us and our loved ones?
Standard medical care – may sacrifice quality of life for a chance of gaining time later •
Hospice care – quality life now for as long as you live, which is often longer because of the quality of care and life.
Hospice care – quality life now for as long as you live, which is often longer because of the quality of care and life.
Under what circumstances would you opt for hospice for yourself or a loved one?
Who in your life knows what makes life worth living for (and fighting for) you?
Thinking about yourself right now, could you imagine answering: “What are the tradeoffs you are willing to make and not willing to make?”
Thinking about yourself right now, could you imagine answering: “What are the tradeoffs you are willing to make and not willing to make?”
DIFFICULT CONVERSATIONS
Who is the most challenging person in your life to talk about death and dying with? Why?
As we age, we are bound to develop some type of frailty and eventually we die.
(1) What are your fears in this regard?
(2) What would you consider a good death vs. a bad death: any experiences to share?
(1) What are your fears in this regard?
(2) What would you consider a good death vs. a bad death: any experiences to share?
Gawande references Plato’s dialogue on courage, observing it takes two kinds of courage to face illness and sickness: “the courage to confront the reality of mortality...” and “the courage to act on the truth we find.” (p. 232)
What part of the aging & dying process feels like it will take the most courage for you?
a hypothesis: how we seek to spend our time may depend on how much time we perceive ourselves to have. When you are young and healthy, you believe you will live forever. You do not worry about losing any of your capabilities. People tell you “the world is your oyster,” “the sky is the limit,” and so on. And you are willing to delay gratification—to invest years, for example, in gaining skills and resources for a brighter future. You seek to plug into bigger streams of knowledge and information. You widen your networks of friends and connections, instead of hanging out with your mother. When horizons are measured in decades, which might as well be infinity to human beings, you most desire all that stuff at the top of Maslow’s pyramid—achievement, creativity, and other attributes of “self-actualization.” But as your horizons contract—when you see the future ahead of you as finite and uncertain—your focus shifts to the here and now, to everyday pleasures and the people closest to you.
What do you value more now or in what ways have you shifted your focus because you are later in life than when you were younger?
[excerpts from Jean Abbott, M.D., Larry Dansky, M.D., Kathryn Dansky, Ph.D. www.TheConversationProjectInBoulder.org]