Being Mortal Summary

Death is normal, but dying has become something to be feared and prolonged. How can we reclaim dignity and meaning in the process of dying?

1. Aging brings loss of independence, physical and mental challenges

As people age, their bodies gradually lose strength and functionality. Bones weaken, muscles deteriorate, and joints stiffen, leading to problems like high blood pressure and dangerous falls. These physical changes make it harder to perform simple, everyday tasks. Simultaneously, the brain also shows signs of aging, as shrinking and neural loss often lead to conditions like dementia.

This process of decline forces many older adults to give up their independent lifestyles. Tasks they once did with ease – such as grocery shopping or personal hygiene – become overwhelming. Eventually, many rely heavily on family or medical professionals for daily care. Maintaining autonomy becomes an increasing challenge as they enter care facilities or hospitals.

The inevitability of dependence doesn't make it easier for the elderly or their families to accept. Discussing these difficulties openly can help alleviate the fear of aging, allowing both individuals and society to better address the emotional and physical realities of growing older.

Examples

• Over 350,000 elderly people in the US break their hips annually due to weakened muscles.
• Dementia affects millions, robbing them of memory and decision-making capabilities.
• Tasks like using the toilet or cooking, once second nature, often require assistance later in life.

2. Hospitals and institutions dominate the end-of-life experience

Medical advances have extended human lifespans significantly. While this is a triumph of science, it has changed the way people age and die. Historically, families cared for aging loved ones at home, offering emotional connection and comfort. Dying at home was part of the family circle, though those without family faced grim conditions in poorhouses.

In modern times, many families live far from one another, making it difficult to provide in-home care for the elderly. As a result, hospitals and nursing homes have largely replaced personal care. Today, these institutions manage most end-of-life care, focusing on hygiene, safety, and medical needs.

However, while hospitals and nursing homes offer a clean and controlled environment, they often fail to address the emotional and psychological needs of dying patients. Dying in an institution can feel sterile and isolating compared to dying in the comfort of one’s home.

Examples

• The number of deaths at home in the US fell to 17% by the 1980s.
• Families are often spread across cities or states, making caregiving difficult.
• Poorhouses of the past were dirty and degrading, a stark contrast to today's hygienic yet impersonal facilities.

3. Autonomy matters, even in old age

Losing independence doesn't mean losing all control. Even when aging lowers physical or mental abilities, individuals still want to make choices about their lives. People of any age value autonomy; they want to feel their actions reflect their will and carry meaning.

Often, elderly individuals want to maintain as much normalcy in their lives as possible, whether that means continuing hobbies or preserving relationships with loved ones. For instance, an older person who enjoys cooking may prefer help shopping rather than abandoning the activity entirely. These small freedoms can bring great emotional satisfaction.

Studies show that as people get closer to death, they focus more on relationships and simple joys rather than grand adventures. Yet the structure of many care settings often restricts these personal preferences, amplifying fears of aging and dependency.

Examples

• A Stanford study revealed elderly people prioritized time with family over meeting new acquaintances.
• An older person might value something as simple as drinking their favorite tea on their schedule.
• Emotional bonds, like being surrounded by loved ones, become far more cherished with age.

4. Care facilities often strip people of dignity

While nursing homes and hospitals provide essential medical care, they often fail at respecting the emotional and psychological needs of the elderly. These institutions usually prioritize safety and medical protocols over personal freedoms. As a result, elderly patients are often subjected to rigid routines that resemble control more than care.

Staff members frequently make decisions for their patients instead of involving them in those choices. For instance, while patients could be supported in dressing themselves, caregivers might find it faster to dress them directly. Though efficient, such practices erode the individual’s confidence and self-worth.

What elderly people long for are spaces where they can feel valued and treated as individuals. Overworked and understaffed care facilities often struggle to meet these needs. A humanistic approach, however, can significantly enhance the well-being of senior residents.

Examples

• Scheduled meal times in homes leave little room for personal preference.
• Residents lose privacy in environments where staff must constantly observe them.
• Overstaffed care homes leave little time for meaningful human connection.

5. Prolonging life sometimes diminishes its quality

Medical advancements have made it possible to fight diseases longer, but this often leaves people enduring prolonged suffering. At times, the emphasis on extending life overrides considerations of how people live during those months or years.

Terminal patients and their families frequently make decisions rooted in hope rather than reality. Many opt for aggressive treatments that offer only marginal survival benefits while causing severe side effects such as fatigue, nausea, and pain. Physicians, out of reluctance to devastate patients' hope, may encourage these treatments rather than emphasizing quality of life.

Studies reveal that those who discontinue intensive treatment enjoy better final days, surrounded by loved ones and feeling less anxiety. Ultimately, health care should focus on helping the terminally ill live with dignity and comfort rather than extending life at any cost.

Examples

• 25% of US healthcare spending goes toward treating people in their final year of life.
• Patients in hospice care often report higher satisfaction than those in aggressive treatment.
• Oncologists frequently recommend treatments they know are unlikely to work.

6. Creative solutions can bring meaning to care settings

Modern care settings often fail to create environments that encourage joy and purpose. Yet, examples of innovation prove that even modest changes can dramatically improve the lives of the elderly. Facilities that allow residents to interact with children, animals, or plants can rejuvenate their spirits and help create a sense of purpose.

For instance, some centers have brought gardens or animals into their spaces. These simple additions provide patients with daily responsibilities and interactions, reminding them that their contributions still matter. Similarly, intergenerational programs where children visit nursing homes create shared moments of happiness.

Creating meaning in care isn’t just about reducing loneliness. It’s about sparking joy and giving people a reason to live another day.

Examples

• A nursing home with a garden saw a reduction in medication use by 50%.
• Visits by pets have been shown to reduce stress and depression among older adults.
• Regular interactions with children gave residents a 15% lower annual mortality rate.

7. Doctors must learn to have compassionate conversations

Doctors often avoid addressing the severity of a terminal diagnosis due to fear of upsetting their patients. Yet avoiding these conversations prevents individuals from making informed and meaningful end-of-life decisions. Physicians need to find the balance between providing clear information and offering emotional support.

Rather than simply presenting options, doctors should work collaboratively with patients to identify what matters most to them. For instance, if staying mobile or being with family is a priority, treatments that preserve those abilities should take precedence over experimental but debilitating therapies.

Doctors also need to be open to discussing difficult topics like pain management and even assisted dying. Open dialogue helps patients feel respected and supported, even when facing the toughest outcomes.

Examples

• Studies show a lack of honest communication often leads patients to regret their treatment choices.
• Doctors who ask patients about their priorities achieve better outcomes.
• Assisted dying remains controversial but encourages honest discussions about suffering.

8. Families must have early and honest discussions about mortality

Many families only discuss end-of-life wishes when faced with immediate health crises, which often forces rushed and unclear decisions. By proactively discussing aging, illness, and death, families can better align care with the wishes and values of their loved ones.

Conversations could explore questions like what makes life meaningful or what trade-offs are acceptable in pursuing treatments. These discussions foster mutual understanding and prevent future conflicts over medical decisions.

Acknowledging mortality can also inspire individuals to live more purposefully, figuring out what legacy they want to leave or what relationships they want to nurture.

Examples

• Families with clear advance directives experience less stress during medical crises.
• A piano teacher used her final days to give farewell lessons to her students.
• Preparing for the end of life enables people to pass on memories or lessons in meaningful ways.

9. Aging and dying can still hold meaning

Mortality shouldn’t just be endured; it can also be faced with dignity and purpose. By focusing on what truly matters, whether it’s relationships or simple joys, people can create meaningful memories even during their last days on earth.

Society must shift its approach to aging and dying, embracing models that prioritize personal and emotional fulfillment. From better designed care settings to expanded hospice services, there are ways to put the human experience at the center of care for the dying.

When approached thoughtfully, the end of life can reflect the values and contributions of a lifetime.

Examples

• Hospice care prioritizes the patient’s comfort and emotional needs.
• Residents in meaningful care homes form connections with animals or children.
• Patients who reflect on their legacies often pass surrounded by gratitude and love.

Takeaways

1. Start conversations about end-of-life wishes with loved ones now to avoid rushed decisions later.
2. Advocate for meaningful changes in care settings, such as incorporating gardens or animal visits, to improve quality of life for the elderly.
3. Discuss personal goals with doctors when confronted with terminal illness to ensure treatments align with your priorities.