Introduction
Every year, billions are spent researching new treatments to save lives from various diseases. Despite significant advances in medicine, death is an inevitable part of life that needs a medical approach and evaluation. The film, Being Mortal, based on Dr. Gawande’s book, reflects on whether modern medicine can make the last days of life and death more refined and happier. Dr. Gawande confronts the viewer with the ethical and medical dilemma of defining the doctor’s mission: saving the patient’s life at all costs or the patient’s well-being.
Dialogue About Death with a Patient
Medical schools annually produce excellent doctors who know how to treat. These same doctors are far from being so good when faced with incurable problems – old age and death. According to a recent study, the United States, which leads the world in healthcare spending, ranks 43rd for end-of-life care among 81 countries (Sepulveda et al., 2022). The authors note that all past research on palliative care has almost completely ignored the preferences of patients and caregivers (Sepulveda et al., 2022). In this environment, Being Mortal has become an essential phenomenon in the medical community, which claims that there are better ways to help patients survive the end of life.
In the documentary, Gawande leads viewers behind closed doors to show intimate and heartbreaking conversations about impending death between doctors, patients, and their families. A 34-year-old woman diagnosed with stage 4 lung cancer, eight months pregnant, suffered a lung collapse during childbirth and is so weakened by chemotherapy that she cannot hold her newborn. The viewer sees a 46-year-old man with an aggressive malignant brain tumor. Gawande’s father, a surgeon, had shoulder pain, which the MRI showed was a huge mass in the spinal cord (Gawande & Jennings, 2015).
Everyone faces a grim prospect, but even then, there is a choice. Gawande demonstrates that the patient and his family must know the realistic prognosis to make an informed choice. Such a dialogue is a difficult task for the doctor, too. He must give the patient the initiative to continue active treatment, which in the later stages may be useless and likely to impair quality of life or allow for palliative care.
Priorities in End-of-Life Care
Patients who seek to be cured and who know they are dying have different medical priorities. For the first group, the effectiveness of treatment and the consequences of medicine are essential. Terminally ill patients focus on other priorities, such as the absence of pain, the opportunity to be with loved ones, and maintaining autonomy in decision-making. Thus, patient awareness of their condition is a critical aspect of treatment.
Until recently, there has not been enough research into what patients want. The last study found that most terminally ill patients worldwide die of pain under conditions of psychological stress and not in the place of their choice. Dying patients also often regret their treatment, costly and urgent services that are of little benefit at that stage of their illness (Sepulveda et al., 2022). The families of these patients are also often left with medical debt that can lead to bankruptcy.
According to Sepulveda et al. (2022), the existence of hospices and palliative care does not entirely solve the problem of end-of-life care, but it is an important aspect. For instance, death in a chosen location or access to friends and family has been shown to matter more than a modest increase in life expectancy or even a reduction in pain. Thus, priorities for palliative care for patients should be based on an individual approach.
The Role of the Family in End-of-Life Care
Being Mortal concentrates heavily on the role of the patient’s family and close relatives. In the film, they act not as minor characters but as full-fledged participants in dramatic events. This fact is fully justified for health care. Equally important are confidential and honest conversations between the doctor, the patient, and the patient’s relatives. After all, they are the ones who make many medical decisions that affect the quality of end-of-life care. Therefore, the patient needs to discuss how and where they want to die.
Conclusion
Being Mortal explores the role of healthcare providers in caring for patients in the terminal through the stories of the patients themselves, their families, and the experience of doctors who are not palliative care specialists. The most important aspect of this relationship is openness and awareness, which allows patients to make informed decisions about end-of-life care practices. Terminally ill patients change priorities when they learn that the disease cannot be defeated.
Most times, the choice of a place to die, the opportunity to be close to friends and family, and the absence of pain are more important than the ability to prolong life or receive quality medical and resuscitation care. Thus, to improve the quality of end-of-life care, it is crucial to focus on the wishes of the patient and their individual experience. At some point, the doctor must choose between saving a life at all costs and the patient’s desire.
References
Gawande, A. (Co-writer), & Jennings, T. (Director, & co-writer). (2015). Being Mortal (Season 2015, episode 6) [TV documentary episode]. In T. Jennings (Executive Producers), Frontline. WGBH-TV.
Sepulveda, J. M. G., Baid, D., Johnson, F. R., & Finkelstein, E. A. (2022). What is a good death? A choice experiment on care indicators for patients at end of life. Journal of Pain and Symptom Management, 63(4), 457-467. Web.