A better life, even if it's a shorter life

Australia's aged care policies are being overhauled, with a crucial aspect, the Commonwealth Home Support Program, beginning on 1 July. This program will hopefully encourage older Australians to remain independent in their own homes for longer.

Let's hope so.

What better time then to consider how other jurisdictions are wrestling with an ageing demographic?

Enter Atul Gawande.

This gentleman practices general and endocrine surgery at Boston's Brigham and Women's Hospital and is professor in both the Department of Health Policy and Management at the Harvard School of Public Health, as well as the Department of Surgery at Harvard Medical School.

At least that's what his website states.

But you wouldn't know it from peeking at the cover of his latest tome: Being Mortal, in the event that you're lucky enough to pick up a copy at your local bookstore.

The book's cover is devoid of post-nominal letters and as it carries just one simple endorsement, you could be forgiven for thinking the book was penned by someone far less clinically qualified and not quite a Rhodes Scholar.

Gawande's thesis is stark. It is as simple for the ill to understand as it is disconcerting to many physicians: eventually people die and regardless how healthy and fit they are, en route to the grave most will suffer indignities, endure pain and possibly lose their minds. And much, much of this can be avoided.

For too long Western societies held (and continue to hold) that both old age and death are medical problems in search of medical solutions. But the fact is while many consider these as "problems", they are certainly not medical "problems". In fact, they are not problems at all. They are experiences.

Gawande shares excerpts from several patients' lives, that start with a person's pre-illness vitality and independence and - regardless of the length of the medical intervention or technologies used to prolong life - terminates with a person's death. A death where dependence on strangers or drugs or both has elbowed out hitherto known independence. Gawande holds up his own father's long battle with a slow growing spinal cord lesion as one example.

He also takes aim at the West's biggest single biggest source of unnecessary yet orchestrated, impersonal and structured diminution of patients' quality of life: the innovation of elder care accommodation whose residents, while often disabled or drugged to their corneas are nearly always subjected to the "Three Plagues" – boredom, helplessness and loneliness.