Wisdom and insights around end of life planning

Being Mortal, by Atul Gawande, MD

Reviewed by David Strother, CFP, AIF, AIFA

One powerful message at the heart of this thoughtful book is simple, and seemingly obvious: each of us is mortal, and no matter how heroically our doctors work to prolong our lives, those efforts will eventually fail. If we live long enough and don’t die from some sudden cause, we may very well become dependent on others — and powerless to make our own decisions.

Fortunately, this book offers an alternative approach to end of life planning that urges us to envision a “final act” in our life that is exactly what we want — as opposed to simply what our doctors or family members think is best for us.

One of the reasons I found this book so interesting is that it parallels the work I do as a financial advisor. At my firm, we’re similarly focused on helping clients script their lives — but while we strive to help them make sure they have the financial resources in place to fulfill their wishes, this book focuses on the equally important issue of end of life planning. For me, it’s humbling but important to be reminded that the financial aspect of one’s life is only part of the picture.

My own introduction to this book occurred several years ago, when my brother recommended it to me. We were trying to help our elderly aunt, who had remained independent and alert into her 90s. We had noticed she was starting to slip, and convinced her to move to a facility where she could have 24-hour medical support. Within a short while, however, we realized we’d made a big mistake. She hated the facility — and especially the fact that she was surrounded by all these “old people”! — and so we arranged for her to move back to the farmhouse where she’d lived for many years.

After my brother and I had both read Being Mortal, we had a new perspective. We visited our aunt at her home to talk about her wishes, and sitting with her at the kitchen table, asked her how she would like to script her last day, if she could. She said immediately, “Sitting here at this table where I’ve sat for decades, and watching the sunset.” That wish was so important to her, we knew it was settled. End of story? She lived to 102, saw her last sunset from her kitchen table, went to bed and then did not wake up.

Our changing expectations about life and death

Dr. Gawande is a physician, surgeon and professor at Harvard Medical School, and one of his central observations is how profoundly the traditions and possibilities around aging and dying have changed, especially in our country. For example, people are living longer. In the 1700s, only 2 percent of the population made it past 65; now it is many times that. Another change is that today just a small percentage of people die in their own homes, surrounded by loving family members; 75 years ago, the vast majority did. What’s more, today’s families are significantly different than they were just a few generations ago: they have fewer children overall, and the children tend to live farther away.

Dr. Gawande urges the reader to focus on the fact that, even though medicine today can do miracles (especially compared to what was once possible), there still comes a point where it’s no longer possible to fix or cure the patient. He also observes that for many of us, our own visions for our end-of-life are quite different from what our younger loved ones might assume. We want to be conscious during our last days, with our pain managed, and ideally to be around those we care most about.

The problem is, if we have not made clear in advance our wishes about our end-of-life care, and then we become dependent, we may not get our wish. Our younger or healthier loved ones may feel they have no choice but to direct our medical providers to try to prolong our life, at any cost. Often, what we end up with is simply a lingering and lonely death in a sterile hospital environment.

One of the core messages of this book is that trying to cure the incurable and fix the unfixable generally leads to great harm relative to the objective of ending life with dignity. Just prolonging a life is not necessarily doing anybody any favors.

A better alternative

The very first step toward a better end of life, Gawande says, is recognizing that mortality is a 100% certainty for all of us. As a result, choosing the type of care you receive at the end of your life may be one of the most important decisions you can make in terms of controlling your life.

We should think through our end-of-life script, Gawande urges, in order to make sure that our “final scene” gets the equivalent of a standing ovation. Then we need to make sure our spouse (if we have one) and children understand our wishes and how they can help make them happen — either through having conversations, a living will, or both. Such conversations can be awkward, emotional, and hard. But they can also bring a huge sense of relief. The more clarity you can achieve — whether it’s understanding your parent’s wishes, or conveying your own wishes to your adult children — the better for everyone.

Conclusion

Accepting that we are indeed mortal, and that life will at some point end, gives us the opportunity to make choices about our care at the end of our lives, so that the end will be more like the way we would want to script it. To make sure that happens, we need to do two types of planning in parallel: planning around the end-of-life issues raised in Being Mortal, and the financial planning necessary to ensure that our own needs and those of our families are taken care of.

For anyone who is starting to wrestle with mortality or end of life planning — whether their own or that of a loved one — I cannot recommend more highly Dr. Gawande’s Being Mortal.

The views and opinions expressed in this article are those of the financial professional and do not represent the views and opinions of Avantax Wealth ManagementSM or its subsidiaries.

 

David Strother, a financial advisor at Darnall Sikes Wealth Partners, reviews Being Mortal, by Atul Gawande, MD. The book explores the inconvenient certainty of our own mortality, and how we can make decisions in advance to improve the likelihood that the end of our life happens according to our wishes.

 

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