As a surgeon at a leading American hospital and professor of surgery at Harvard, Atul Gawande enjoys a high-status, well-paid and privileged position in society. And yet, for his fourth book, he has chosen one of the lowest-status and most neglected subjects: dying. Thank goodness that he has.

Gawande is not, by a long chalk, the first person to tackle how we as a society deal with the issue of ageing and dying. Poets, philosophers and priests have tried to make sense of the process of dying since humans could first talk; social reformers, health activists and politicians have been championing the idea of a ‘good death’ for generations. But Gawande is one of the first surgeons to have thought deeply on this topic and to propose some challenging and intelligent ways forward – and this in itself is significant. 

Gawande’s basic premise is that medicine has let us down. We are all living longer, healthier lives, thanks to improvements in social conditions and – to a lesser extent – medicine. Yet as our bodies ultimately fail we find ourselves incarcerated in institutions that prioritise safety and survival above basic