Jacob Chose Hospice: A Critique of Invasive End-of-Life Care

Being Mortal: Medicine and What Matters in the End
by Atul Gawande
Metropolitan Books, 2014

What does the Torah have to say about end-of-life care? Its most striking story on this topic appears in the last four chapters of Genesis, which describe the hospice death of the Jewish patriarch Jacob. After Jacob became ill, he summoned his children and grandchildren, and requested burial in the Caves of Machpeleh, alongside his parents (Isaac and Rebecca) and his grandparents (Abraham and Sarah). He gave blessings to his sons, and “when Jacob finished instructing his sons, he drew his feet onto the bed; he expired and was gathered to his people” (Gen. 49:33). He suffered no invasive medical interventions, he was surrounded by his family and was able to bless them, and he died a peaceful death.

This model of a peaceful end-of-life process has been lost in the contemporary world of modern health care, as shown by Atul Gawande in his new book, Being Mortal: Medicine and What Matters in the End. Gawande was already well known for his writings on the deficiencies in our health care system, but Being Mortal stands out as his most profound and most personal account. He was deeply affected by the illness and death of his father, also a physician, and this led him to look at the end-of-life process with a humility that enhances his already astute and critical perspective.

“I learned about a lot of things in medical school, but mortality wasn’t one of them,” he writes. “The purpose of medical schooling was to teach us how to save lives, not how to tend to their demise.” Gawande’s insight is shared by many of us in health care who have long realized the incompetence and insensitivity of our profession’s approach to end-of-life care. Gawande’s book reinforces the recent report from the Institute of Medicine, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.” Jointly, these texts underscore the deficiencies caused by an already fragmented care delivery system and exacerbated by financial incentives that rely on the profits of acute care settings for treatment of terminal illness.

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