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loved ones thought provoking well written required reading atul gawande assisted living quality of life health care highly recommend everyone should read terminally ill nursing home palliative care life issues modern medicine terminal illness beautifully written great book read for anyone excellent book
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Serena
TOP 500 REVIEWERVINE VOICE
5.0 out of 5 stars The Old and Sick Are Not Children
Reviewed in the United States on May 26, 2016
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This is a timely book for me because my parents are very elderly (94 and 88) and determined to stay in their home until the last possible second. After reading this thought provoking book that teaches so much I am thinking that it may be possible for them to stay until the end which could be next week or a few years from now. It's going to take some organizing, but it looks like it is worth some research and time. It makes me sad to see how much of their independence they have lost, but they still enjoy their lives as limited as they are.

There is a tendency to treat old people like children which I realize now is usually very wrong. My dad is a diabetic and we (my siblings and I) have told him over and over that his diet of sugary cereal or cinnamon rolls and orange juice for breakfast and light store brand fruit yogurt with grapes and three cookies for lunch is not what he should be eating. He acts surprised every time we mention this, but doesn't change a thing because I now understand that he wants the independence of eating as he pleases. He has lost so much--can barely hear or see or walk, that he needs these very small pleasures to continue. I imagine he doesn't see the point in giving up anything else because he has so little left. My mother's memory is going and she has COPD, but somehow has lots of get up and go. She does a lot for my dad even though I suspect she is the sicker one. Being Mortal is making me think about the best way to help my parents which will probably start with asking them what they want.

One thing that surprised me completely was Dr. Gawande's statement that genetics is only a small part of reaching old age. Here I've been thinking that because my parents have lived so long that reaching old age is probably a no brainer for me. I have to think about that possiblity some more--a lot more.

This book has some touching stories about very sick people and how their lives ended. Unfortunately for many sick people the medical community is driven to act, but not necessarily to do what is best for the individual. It seems to me that they've forgotten "the do no harm" part of being a doctor. It seems to me it does harm people to ruin the time sick people have left.

A very through provoking book that will ultimately make me think about what I want when the end is near. I wish everyone would read it; especially medical people.
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amachinist
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5.0 out of 5 stars "There is a time for everything..." (Ecclesiastes 3:1)
Reviewed in the United States on February 20, 2018
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Dr. Gawande writes that modern medicine can extend the limit of our mortality, but there is a finite boundary to that limit. This book is emotionally difficult because the reader and Dr. Gawande confront painful topics that one is loath to consider: aging, frailty and death. Yet, these are essential stages of life and there are essential decisions that one must make at each stage.

One can see the signs of aging as they appear on the outside: gray hair, age spots, and wrinkles. Dr. Gawande, a surgeon, also shares what he sees when he peers inside the body of an older patient. Each day some parts of the body die and are remade while others wear and change with constant use. What happens when the limitations of one's aging body require a change in one's lifestyle? There are now many choices and Dr. Gwande rails against settling for just safety and longevity, institutionalization and restriction. He relates the history of nursing homes and visits first-hand the many options for living a life of privacy and community, of vibrancy and purpose. He applauds those in the field of gerentology who have thought "outside the box" for the development of active communities for those who are aged and frail.

The reader experiences the morphing of Dr. Gawande from a mere practitioner to the son of a dying parent. How does a doctor broach the difficult end-of-life options with terminally ill patients and loved ones? The menu of medical options for treatment can be insufficient and it is essential that the practitioner also ask the patient what she or he wants most in the finite time remaining. Is it a mistake to prolong suffering or is it better to provide value in a shortened life? The author suggests that courage is required for both aging and sickness: the courage to confront the reality of mortality and the courage to act on the truth of that reality. Have the courage and the wisdom, dear reader, to explore these difficult topics presented in the pages of this transformative book.
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Janie U
4.0 out of 5 stars Uncomfortable and challenging
Reviewed in the United Kingdom on September 10, 2018
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This book had been chosen as my latest book club choice because we all decided that it would challenge us. There is no doubt of that as we all contemplate the concept of mortality - of peers, parents and our own. All of the group have parents who are elderly, dying or already dead which present constant dilemmas for those left to care or take responsibility in any way.
The book is just over 280 pages, split into eight chapters by subject.
I was slightly scared to read this book as I expected it to force me to confront emotions that I usually bury. And it's true that there were some very familiar issues dealt with regarding the quality of life and the moralities of the healthcare system forcing people to live longer than they actually should be able to.
The narrative is very easy to read . It is direct, not avoiding difficult subjects and discussing decline/death in the way that you would hope of a physician.
It should be noted that this is a US author so the statistics and examples are all from the US. The easiest way to approach this from the UK is assume that everything is the same here but, of course, that isn't necessarily true.
Many problems are raised with the system but, unsurprisingly, not too many solutions are discussed. It is never going to solve problems but will provoke thought which I think is its main purpose. The ideas that are raised are very plausible though and worthy of trying out.
There are many points in the book where the author theorises and I thought that it was much more effective when he used real examples to illustrate what he is trying to say.
He tackles geriatric care very openly but when he moves on to the mortality of terminally ill younger people the book becomes more controversial - money is always a limiting factor and we are asked to think about whether extending a life temporarily (and miserably) is sensible - he actually refers to this option being the "default choice" of many people in the medical world.
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Chiara Santamaria
5.0 out of 5 stars The "D" word
Reviewed in the United Kingdom on June 27, 2016
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I first got interested in death and in the process of dying in year 2000, after my Mum's death. Her illness and death went - somehow - all wrong. In this book Atul Gawande explains what can go wrong, and why. My Mum got it all and more. We, the family, were neither prepared nor able to find for her (and for ourselves) a better way to get to the end. If you put in the picture that in Italy - maybe "the" Catholic Country of all - physical pain has always been regarded as the sacred way to get to heaven, (a mentality that is still lingering here and there) - then you can imagine what she went through. Since those days I have red endless books on death and dying: this is undoubtedly one of the best. What people do not understand is that books on these subject are deep, rich, intense and help you to live a better life. If we only could talk freely about death and dying, our life would be richer and happier.
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Miss S C Millar
5.0 out of 5 stars A truly great read. Crucial. A fascinating insight.
Reviewed in the United Kingdom on February 1, 2018
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I enjoyed this book more than any other I have read for a long, long time. It was recommended to me by my daughter's radiographer at Sick Kids Hospital in Edinburgh. I have no medical knowledge but the whole book is so brilliantly written for both medics and laymen. Funny, tragic, fascinating and wholly accurate. I cannot over-emphasise the importance of this book. It gave me so much food for thought. I laughed and cried and highlighted parts franctically throughout. I hope this book will start many new discussions within medical professionals and families alike. Each life 'story' in the book is crucial to the bigger picture. I will read this book again to ensure I didn't miss anything. Thank you for writing such a succinct, self-effacing, encouraging, depressing, and informative read. And thanks to your friends, family and patients for sharing their stories.
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Tristan Sherwin
5.0 out of 5 stars Poignant and Sobering - a must read!
Reviewed in the United Kingdom on February 3, 2016
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Despite its sombre black cover with Golden lettering -- which I personally find very beautiful -- this is not a morbid book about death, as such, but rather the latter moments/years of life and the quality of those years.

Being Mortal's main focus is on how medicine and medical care has maybe skewed our perception on what it means to live. Does the quality of the life we have at the end often get overshadowed by a focus of extending our life -- even if this extension comes at the cost of stripping our final days of everything that gives meaning to a definition of "Life".

The book begins by investigating the kind of care that is offered to our culture's elderly; a care that can, more often than not, remove as much of their autonomy and dignity as possible in favour of safety. The latter half of the book then moves into discussing the kind of medical direction that is adopted with/by those who are diagnosed as terminally ill.

In both cases, Dr Gawande, eruditely and with much sensitivity, proposes that a better kind of end-of-life-care would be given, and a better quality/freedom of life would be had, if we moved our focus away from trying to ward off the inevitable and placed it instead on assisting and cultivating what life there is remaining. Gawande's proposition is for a more considered medical approach towards those facing the final chapter of their story; one that would allow people to maintain as much control of their life as possible. In such cases the question is not a matter of "would we like to live or die", but what quality of life would we like to have available to us prior to the end, and what levels of quality are we prepared to "trade" in order to extend what little time we have left? The concern of medicine and care would therefore be more inclined in providing the patient with an attainable desired life and not putting them through unnecessary cycles of treatments which, inevitably, erode what quality of life could be had whilst giving so little time (if any) back in return. In such an application, the "well-being" (physically, mentally and emotionally) of the patient would be more important than treating the incurable.

In short, could our current medical practice (along with our own expectations of what medicine is for/about) be failing those who are facing death by preventing them from experiencing as much life as is possible in their final moments?

Such an approach does require us courageously accepting our own mortality; which is a modern challenge in the technological age we live in, and something our ancestors never really struggled with. But this acceptance would lead us towards embracing a life we can have now instead of forfeiting this for something that, sadly, lies beyond our reach.

At this point, some may be thinking that Being Mortal is about Euthanasia. Although this highly complex ethical issue is briefly discussed within the book's eighth chapter (entitled Courage), the context of the book is not arguing for prematurely bringing someone's life to close ("assisted dying"), but improving the quality of life for those who are terminal, and helping them to best prepare, both emotionally and physically, for this end. In other words, this book is arguing for "assisted living". That said, I'm certain that both sides of the Euthanasia debate would find much food for thought within Dr Gawande's writing, along with examples that could be taken to both strengthen and challenge their held positions. Personally, I'm not sure whether the topic under discussion within this book would fall under the header of Euthanasia; it could be argued that prolonging treatment to fight a terminal illness that has already won, could lead into an earlier death.

I found this book extremely fascinating, poignant and sobering. I'll admit, at the age of thirty-five, the quality of life I would desire at my own end isn't something I've given much thought to. I have now. Reading this book will certainly have that affect on you. But the book has also made me think a lot about others, especially the elderly I know and love.

Death, and preparing for it, is such a difficult topic to discuss. So I admire Dr Gawande's courage and compassion as he navigates this issue; and he navigates it very well. To help him in this task, many personal stories from those who have faced this natural crisis have been used; even Atul's own moving description of his father's last years. At first, I found some of the core issues raised by these stories repetitive; wondering whether they could have been condensed together. However, with the hindsight that birthed when I was about three quarters of the way through this book, I became very grateful for every syllable. These personal words help to enlarge our perception of what it means to live; they enable us to grasp how universal our hopes and fears are when it comes to preparing for the end of our own tale.

It is -- though it may seem a very awkward thing to read in public -- an excellent book. One that maybe we all should read.

-- Tristan Sherwin, author of *Love: Expressed*
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Lady Vibart
5.0 out of 5 stars A sensitive discussion on age related illness and our attitude to the elderly and to dying.
Reviewed in the United Kingdom on February 13, 2019
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A friend recommended this book as, like me, she had elderly parents and was doing her best to look after them. The book looks at how western society has fragmented in that it no longer feels responsable for the older generation nor is it prepared to give elderly parents and relatives a home or much time either. Obviously there are people who love and respect their parents and do take them in and care for them if they can’t cope alone. But generally, with husband and wife both working and taxi-ing the children from sleep overs to rugby or whatever, there is little time or energy left for the older generation. So there often exists a lack of communication and respect, of understanding and empathy between grand parents and grand children as a result. He then travels back to his native Pakistan and is horrified to see similar or even worse abandonment of the elderly. It is something so integral, he believed, to the caring nature of his own culture, of the importance of family, that he struggles to accept the huge change he sees where the elderly relatives are left to the care of philanthropists and lying on sacks in an unused warehouse. He is understandably shocked and distressed.
He continues his research into the treatment of the older generation in the medical arena. Why he wonders, do so many octogenarians have to suffer painful operations which not only don’t improve their life quality but often downgrade it by causing daily ongoing pain. He looks at the percentage of elderly who die in hospital surrounded by tubes and medics but not by their loved ones and looks at where most of us would prefer our last breath to be drawn- at home with our family in a peaceful and familiar environment or attached to myriad tubes and bed pans with bleeping machines and uniformed medics checking us every hour.
He examines our modern quest for immortality and extending life well beyond our ‘pleasurable’ life span, and again asks how and if this really benefits us? Living for many extra years but immobile, semi parálised and on a Cornacopia of drugs is not really something most thinking adults would wish for themselves or their loved ones. But as he points out, humans have to learn and accept our own mortality, accept being mortal and, eventually dying.
This is a very moving and sensitively written book on a subject that many of us avoid discussing until it’s too late. It puts a very different perspective on the need for Hospices where infirm elderly people can be cared for with compassion and dignity rather than being regimented in a medicalised hospital environment however caring the staff. It ask many deep and searching questions and really challenges the modern perceived view of mortality .
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