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

He contrasts this with the management of the old and the sick in undeveloped economies such as India, where families and not nameless, faceless and cold institutions are responsible for looking after the old and the infirm in a shared, multigenerational manner. Not only is the Third World's way of doing things cheaper, many old folk also live longer and live better than in the First World.

Most Americans - and plausibly, Australians - imagine that they will live in good health until someday down the track they would suddenly out of the blue, drop dead.

But in truth, regardless of how we expire, be it following a fatal disease or a chronic disease or as a result the expected breaking down of our bodies over time (commonly called "old age"), very, very rarely do we die quickly.

While surveying elder accommodation, Gawande notes that while superficially they vary widely in how they look and what they offer, they are one in their overwhelming objective: to appeal to the residents' children, not the residents themselves, by repeatedly emphasising their commitment to "safety", often at the expense of allowing the residents to live lives they want. It's as though the nursing homes understand that children put a priority on how far away Mum 'n Dad's funerals will be held rather than asking "what quality of life do Mum 'n Dad want to be able to enjoy at Shady Pines"?

Gawande's stories including those of his mid 70s father, an Athens, Ohio urologist Atmaram Gawadne, as well as that of a 34 year old Sara Monopoli, demonstrate that modern death is often excruciating and lengthy, irrespective of a person's age. In both of these cases, death followed a painful struggle against cancers, Gawadne's being spinal and Monopoli's being lung.

In all such cases, most of the old and infirm as well as their families deceive themselves into thinking that the timing of their exit from this life is under their control, and while they have to a greater or lesser extent managed to live a dignified life, they will somehow be allowed to pass away in a dignified manner.

Gregory House, M.D.,the misanthropic fictional diagnostician from the highly acclaimed TV series House M.D., touched on the same widely held hallucinations of an easy death.

Onerous treatments continue even when objectively they are pointless and only generate more suffering. Why? Three reasons: patients are hard wired not to give up hope; patients' families are idealistic about their medical goals and the real kicker is that often, doctors themselves fear to be perceived by patients as giving up too soon.

Gawande is an exceptional communicator.

His goals of bringing end of life matters to the attention of the public are noble, worthy and timely. But he's up against formidable enemies: dying patients (and their families) that regardless of the facts will not accept defeat; physicians' (at times irrational) loyalty to their patients and Big Med, whose focus remains to grow its customer base (i.e. occupied nursing home beds) at all costs, even if the cost is the constant pain their customers have to "live" with.

After all, from Big Med's standpoint, dead patients don't need accommodation or medical consultations.

And of course, the dead don't get prescriptions filled, do they?