It’s easy to see why Being Mortal: Medicine and What Matters in the End by Atul Gawande is a favorite for so many readers. It is one of those rare books that blends the precision of a surgeon’s mind with the compassion of someone willing to confront the truths most of us would rather avoid. At its heart, the book wrestles with a universal reality: how we age, how we die, and how medicine — for all its brilliance — often stumbles when confronted with the inevitability of mortality.

Gawande begins with a personal revelation from his own career. Like most doctors, he trained to diagnose, treat, and cure. Success was measured in lives saved and diseases beaten back. But over time, he found that many of the people he cared for were facing problems that weren’t fixable in the traditional sense — frailty, chronic illness, terminal diagnoses. The central question they brought him, “Should we do something?” often didn’t have a simple or satisfying answer.

This dilemma is rooted in a profound shift in human life over the last century. Thanks to public health improvements and medical advances, average life expectancy in developed countries jumped from around 47 years in the early 1900s to nearly 80 by the year 2000. Much of that gain in recent decades has come in late life. The result? We now live, on average, two decades beyond age 65. But with these added years came a change in where and how we die: in 1950, most people died at home; by 1990, over 80% died in institutions — hospitals or nursing homes — places designed around safety and medical intervention, not necessarily around living well.

Medicine’s bias is toward doing something — there’s almost always a procedure, treatment, or intervention available. Yet in many cases, especially near the end of life, these measures prolong suffering without offering real benefit. We’ve run a decades-long experiment in medicalizing mortality, and the results have been mixed at best: higher costs, more pain, and surprisingly little improvement in the experience of dying.

What’s missing, Gawande argues, is a deeper understanding of what matters most to people when time is short. Research by Stanford psychologist Laura Carstensen offers a clue. For over 20 years, she tracked people’s emotional priorities and found that as people age — or when they face serious illness — their focus shifts. The younger “signature” is about expanding horizons, building networks, and chasing achievement. The older “signature” is about narrowing in on the relationships and activities that bring meaning, cultivating intimacy, and valuing the present moment. Paradoxically, even as health declines, emotional well-being often improves: less anxiety, more calm, and even the capacity for poignancy — feeling joy and sadness at once.

This isn’t just about chronological age. People with terminal illness, even when young, often shift to the older signature. The same thing happened to the general population after 9/11 — for a brief time, people prioritized connection and community over acquisition and ambition. When life feels fragile, our priorities change.

The challenge is that our healthcare system and cultural ideals don’t reflect this shift. We still equate the “good life” with independence, health, and productivity. That definition doesn’t fit the reality that many of us will spend years living with frailty, illness, or limitations — and that those years can still be deeply meaningful if our priorities are honored.

Unfortunately, our institutions often work against that possibility. Nursing homes, Gawande found, frequently resemble hospitals: built around nursing stations, focused on minimizing risk. Residents are “kept safe” but stripped of autonomy, sometimes in absurd ways — Alzheimer’s patients hoarding cookies because they’ve been restricted to puréed diets, or rules forbidding a glass of wine. As one administrator put it, “Safety is what you want for those you love. Autonomy is what we want for ourselves.”

Gawande’s prescription is deceptively simple: recognize that people have goals beyond just living longer. They have loyalties, values, and purposes they’d sacrifice for. Yet in medicine, we rarely ask about them. Less than a third of seriously ill patients are asked about their goals and priorities if their health worsens. When they are, outcomes improve dramatically: less suffering, fewer hospitalizations, more time at home — and in some cases, even longer life.

The questions that guide this approach aren’t complicated:

What’s your understanding of your health and your condition right now? What are your goals and priorities if time becomes short? What are your fears and worries for the future? What are you willing to sacrifice, and what are you not willing to sacrifice?

Asking — and truly listening — can transform care. It shifts the focus from “How do we fix this?” to “How do we help you live the way you want to live, even if your health can’t be restored?”

This is not just a medical challenge; it’s cultural. It demands that we redefine success in aging and illness, create systems that honor autonomy and meaning, and accept that well-being is more than survival. It’s not enough to merely exist — we must be able to live, on our own terms, until the very end.

Being Mortal is a book about medicine, but it is also about humanity. It insists that dying is not a medical failure — it is the condition of life itself. Our task, both in healthcare and in society, is to make every stage of that life worth living.

Credit: Based on the work and talks of Atul Gawande, author of “Being Mortal.”