Being Mortal: Medicine and What Matters in the End by Atul Gawande Metropolitan, 282 pp., $26.00

In his newest and best book, the surgeon Atul Gawande lets us have it right between the eyes: no matter how careful we are or healthful our habits, like everyone else, we will die, and probably after a long period of decline and debility. The average American, he tells us, spends a year or more disabled and living in a nursing home. Furthermore, the medical system will be of very little help at the end. In Gawande’s words:

The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. They are spent in institutions—nursing homes and intensive care units—where regimented, anonymous routines cut us off from all the things that matter to us in life. Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need.

Gawande wants us to know that the tragedy of old age and death cannot be fixed by modern medicine, so we better find some other way to deal with it. He divides his book into eight beautifully written chapters that follow the trajectory from independence to death. Being Mortal, the most personal book he has written, ends with the long dying of his own father.

In the first chapter, Gawande introduces us to his wife’s grandmother, Alice Hobson, age seventy-seven when he first met her in 1985. At that time, she was completely independent—living alone, healthy, and active. Gawande’s parents were immigrants from India, and he contrasts Hobson’s kind of independence with his own grandparents’ lives in India, where

it was understood that parents would just keep living in their home, assisted by one or more of the children they’d raised. In contemporary societies, by contrast, old age and infirmity have gone from being a shared, multigenerational responsibility to a more or less private state—something experienced largely alone or with the aid of doctors and institutions.

This change from the traditional way of dealing with old age has its reasons: there are now more old people and fewer young ones; families require incomes from both the husband and wife, so there are few leftover daughters and daughters-in-law to care for parents and grandparents at home; and family members might not live even in the same state, much less the same town. Still, as Gawande points out, if you are healthy and can afford it, “there is arguably no better time in history to be old.”

He is right about that, I think. In fact, as shown in the Harvard Grant Study,1 old people who are healthy and have the means are generally more content than they were when young. They have either achieved their ambitions…