Running Head: HEALTH POLICY ANALYSIS ON BEING MORTAL: MEDICINE AND

WHAT MATTERS IN THE END

Health Policy Analysis on Being Mortal: Medicine and what matters in the end

Xochithl Aguilar

Sam Houston State University

HEALTH POLICY ANALYSIS ON BEING MORTAL: MEDICINE AND WHAT MATTERS 1
IN THE END
Health Policy Analysis on Being Mortal: Medicine and what matters in the end

Atul Gawande’s book Being Mortal: Medicine and what matters in the end, centers

around the harsh reality of human mortality while emphasizing on old age and end of life health

care as well as the institutions and medical practices that are meant to provide or manage

specialized care during the period of old age and death. A typical example of an institution

bound to provide end of life care is one such as a nursing home. Gawande notes the difference in

the purpose of a nursing home form then to now. In the beginning nursing homes served as a

means to free beds in hospitals and provide individuals rehabilitation services. Today, nursing

homes view their residents as patients and in the majority of cases care turns into treatment, the

individual treatment is viewed as a medical necessity by the staff who often forget to ensure

humanity and dignity for the person in their care. Gawande provides exemplary details for us

regarding what has happened throughout time with institutions such as nursing homes and the

people reaching old age. How nursing homes came to be and the health policy changes that came

along.

Ways or systems for quality measurement were not around before the model for quality

assessment S-P-O, came to be. The poorhouses mentioned by Gawande, are the institutions that

many of the elderly turned to for lack of a better place and for lack of money. These places

lacked a structure, a process, and outcome. Poorhouse inhabitants were not solely elderly, there

were younger alcoholics, poor immigrants, and mentally ill individuals. There were no licensing

or accreditation within these facilities, the inhabitants paid for their stay with labor. A process

did not exist, there were no treatment protocols, many elderly people received improper

nutrition, health care, and died untended. There was no dignity as the institutions were overrun

with rats and mice, no respect, or compassion as the elderly still had to work, and husband and
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wife were separated. There was no such thing as recovery or improvement. The outcome for

people in poorhouses, was simply poor as people contracted tuberculosis from uncontrolled

contagion.

Today, the world health organization (WHO) has identified three crucial approaches for

the success of long term care institutions. The first approach is to establish the foundations

necessary for long term care, then create a sustainable workforce within in the industry, and

finally ensuring quality of care within. After industrialization, nursing homes provided

professional health services as well as rehabilitation services and followed a more structuralized

form of S-P-O. Nursing homes can now be measured in safety and medical outcomes as well as

be held accountable for the two. However, Gawande mentions how we can hope for something

better, more than a nursing home.

An alternative for nursing homes that is mentioned is assisted living facilities, initially

called a “living center with assistance” in the book. The institution address SEPTEE in every

aspect. The living center provided residents with a button that alerted the staff when urgent

assistance was needed, providing safety and timely services to the residents. The entire

institution was patient-centered, “the residents had control over the schedule, the ground rules,

the risks they did and didn’t want to tale” (Gawande 90). The institution was efficient, the elders

with advancing disabilities were provided with the care they needed including, personal care and

medications. The state monitored the experiment closely, and if there had been an issue with

equitability it would have been known. The outcome of the living center with assistance was

astounding as the resident’s physical and cognitive functioning had actually improved. Also, the

cost for the residents under government support was lower than those in nursing homes. This

alternative for nursing homes definitely transformed the health care for many elderly people.
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In the reading we learn about Sara Monopoli, a patient of Gawande himself, who was

diagnosed with lung cancer that was inoperable. We have also learned about The Paradigm Shift

which was first to suggest and provide data that proves that more care is not necessarily better

and that patient outcomes may be better with less treatment or more conservative treatment. For

Sara, the cancer that invaded her left lung had no cure. However, the possibility to prolong her

life was a better way of coping with the disease and thus she suggested that they aggressively

managed the diagnosis. Sara was put on many different medications, one after another and all

failed to slow down the metastasizing cancer. At this point, Gawande gives many examples of

end of life situations for different patients who were very near dying and yet continued to receive

medical intervention that would not better their situation in any way. In cases like this, costs very

often outweigh the benefits. Which brings the attention to hospice services, whose mission “is to

provide quality, compassionate care to those with terminal illness and to support families through

caregiving and bereavement” (Taylor & Francis). Gawande further explains that patients who

accepted hospice services had to sign a form in which they accepted that they understood their

illness was terminal and thus they were giving up medical services that were aimed to stop it.

There are differences from treating patients in ordinary medicine and hospice. You change

surgeries and intensive care units in ordinary medicine to hospice care with more conservative

treatment such as managing pain, and helping patients maintain mental awareness for as long as

possible. Gawande reflects intensely on the inevitable mortality of humans and the difficulties of

recognizing that death is imminent when hospice care is advices or considered.

Being Mortal: Medicine and what matters in the end, a book that makes the reader aware

of the reality that awaits many people, portrays many different health care policy changes and

medical practices. The book navigates from the beginning of the nursing homes to the
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improvements that have taken place within management to alternatives for such, to medical

practices and end of life care. Gawande emphasizes on the faulty aspects of medical processes

and medical institutions, who need to center not only on medical treatment but furthermore on

human dignity, respect, and compassion for the patients. It teaches and informs the reader by

providing real life situations and examples. Gawande seeks to show the reader that the person

being cared for is not simply and ill individual whose death is imminent, rather another human

being who desires to be treated with dignity and respect.

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References:

Gawande, Atul. Being mortal: medicine and what matters in the end. New York: Metropolitan,
2014. Print.

Taylor & Francis Group, LLC. Journal of Social Work in End-of-life & Palliative Care, 11:224-
243, (2015) Retrieved from
http://eds.b.ebscohost.com.ezproxy.shsu.edu/ehost/pdfviewer/pdfviewer?vid=2&sid=d607533e-
eee2-41e3-b7d4-2b41d536e193%40sessionmgr102&hid=111

World Health Organization: Long-term-care systems. Retrieved from

http://www.who.int/ageing/long-term-care/en/