After some resistance, cardiologists now accept: A. E. Epstein et al., “ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities,” Circulation 117 (2008): e350–e408. See also R. A. Zellner, M. P. Aulisio, and W. R. Lewis, “Should Implantable Cardioverter-Defibrillators and Permanent Pacemakers in Patients with Terminal Illness Be Deactivated? Patient Autonomy Is Paramount,” Circulation: Arrhythmia and Electrophysiology 2 (2009): 340–44.
only a minority of people saved from suicide make a repeated attempt: S. Gibb et al. “Mortality and Further Suicidal Behaviour After an Index Suicide Attempt: A 10-Year Study,” Australia and New Zealand Journal of Psychiatry 39 (2005): 95–100.
In places that allow physicians to write lethal prescriptions: E.g., the state of Washington’s Death with Dignity Act, http://apps.leg.wa.gov/rcw/default.aspx?cite=70.245.
one in thirty-five Dutch people: Netherlands Government, “Euthanasia Carried Out in Nearly 3 Percent of Cases,” Statistics Netherlands, July 21, 2012, http://www.cbs.nl/en-GB/menu/themas/gezondheid-welzijn/publicaties/artikelen/archief/2012/2012-3648-wm.htm.
The Dutch have been slower: British Medical Association, Euthanasia: Report of the Working Party to Review the British Medical Association’s Guidance on Euthanasia, May 5, 1988, p. 49, n. 195. See also A.-M. The, Verlossers Naast God: Dokters en Euthanasie in Nederland (Thoeris, 2009).
About half don’t even use their prescription: E.g., data from Oregon Health Authority, Oregon’s Death with Dignity Act, 2013 Report, http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year16.pdf.
Technological society has forgotten: L. Emanuel and K. G. Scandrett, “Decisions at the End of Life: Have We Come of Age?,” BMC Medicine 8 (2010): 57.
Acknowledgments
I have a lot of people to thank for this book. First and foremost are my mother, Sushila Gawande, and my sister, Meeta. In choosing to include the story of my father’s decline and death, I know I dredged up moments they’d rather not relive or necessarily have told the way I did. Nonetheless, they helped me at every turn, answering my difficult questions, probing their memories, and tracking down everything from memorabilia to medical records.
Other relatives here and abroad provided essential assistance as well. In India, my uncle Yadaorao Raut in particular sent me old letters and photographs, gathered memories about my father and grandfather from family members, and helped me check numerous details. Nan, Jim, Chuck, and Ann Hobson were equally generous with their memories and records of Alice Hobson’s life.
I am also indebted to the many people I got to know and interview about their experiences with aging or serious illness, or dealing with a family member’s. More than two hundred people gave me their time, told me their stories, and let me see into their lives. Only a fraction of them are explicitly mentioned in these pages. But they are all here just the same.
There were also scores of frontline staff in homes for the aged, palliative care experts, hospice workers, nursing home reformers, pioneers, and contrarians who showed me places and ideas I’d never have encountered. I especially want to thank two people: Robert Jenkens opened doors and guided me through the large community of people who are reinventing support for the aged, and Susan Block of the Dana Farber Cancer Institute not only did the same for the world of palliative and hospice care but also let me become her partner in research into how we might make the insights described here part of the fabric of care where we work and beyond it.
The Brigham and Women’s Hospital and the Harvard School of Public Health have given me an incredible home for my work for more than a decade and a half. And my team at Ariadne Labs, the joint innovation center that I lead, has made mixing surgery, health systems research, and writing not only feasible but also a joy. This book would not have been possible without the particular efforts of Khaleel Seecharan, Katie Hurley, Kristina Vitek, Tanya Palit, Jennifer Nadelson, Bill Berry, Arnie Epstein, Chip Moore, and Michael Zinner. Dalia Littman helped with fact-checking. And, most indispensably, the brilliant and unfazable Ami Karlage spent the last three years working on this book with me as research assistant, storyboard artist, manuscript organizer, sounding board, and supplier, when necessary, of Bourbon Brambles.
The New Yorker magazine has been my other creative home. I count myself as unfairly lucky not only to have gotten to write for that amazing publication (thank you, David Remnick) but also to have had as my editor and friend the great Henry Finder. He saw me through writing the two essays for the magazine that became the foundation of this book and guided me to many pivotal additional ideas. (He was, for instance, the one who told me to read Josiah Royce.)