Atul Gawande’s book Being Mortal is the most important and exciting book that I have read in a number of years. The author, an American doctor, examines how society – and in particular the medical establishment – view ageing and mortality. While initially it makes for sobering reading, what stands out most is the review of what makes life worth living and how these elements can be incorporated into end of life care. Concrete examples of nursing homes/retirement societies in the US that have moved beyond the traditional, orthodox view of what care needs to be given are cited. Progressive homes are opening up which to maximise residents’ autonomy and integrity while offering a level of security that may no be available to someone living alone. Fewer anti-depressants are required by the residents in these homes and a very poignant example is given of a depressed, widowed man who after re-discovering meaning in his daily life (through connection with animals brought in to the home to be tended by the residents), regains enough of his health and spirit to be able to return to his own home.
In Ireland, so much of the media reports about nursing and residential homes make for grim reading: physical and emotional abuse and neglect are commonplace and HIQA recently reported that the majority of the residential homes it inspects are in breach of the standards set for them. And these are minimum standards, not gold ones.
If one of the founders of the progressive, life-affirming residential homes in the US came to Ireland, would they be able to set up a different style of nursing home? Would they be faced with huge bureaucracy? Would health and safety regulations prevent the introduction of animals which are shown to improve people’s mood and wellbeing? Those are my fears but I will hopefully be proved wrong. Being Mortal should be prescribed reading for all of us because, as Mark Twain said, “In this world nothing can be said to be uncertain, except death and taxes”.