Does it surprise you that Gawande reports how other countries are changing to exhibit more "Americanized" views on death and dying as modern medicine becomes more accessible to underserved populations? Why or why not?

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It should not be particularly surprising that any aspect of American culture was widely adopted in other countries at the beginning of the twenty-first century. Entire industries, such as film, music, and computer games, as well as vast corporations in many other sectors, have been spending billions of dollars for decades on exporting the culture of the United States around the world. Among these are pharmaceutical companies and, just as it profits McDonalds and Coca-Cola when the world eats and drinks like Americans, it profits the drug companies when everyone adopts the American model of death that Atul Gawande refers to as "medicalized mortality."

Gawande is critical of the American model, in which death is regarded as the ultimate evil and everything is done to postpone it for as long as possible, even if the cost of a little more, low-quality time is very high. However, many communities around the world have historically had to accept frequent early deaths as an essential part of life. Now that the wealthier people in these communities have access to American-style healthcare, it is not surprising that, with the encouragement of the media and changing cultural attitudes, they also adopt American ideas about life expectancy.

As Gawande points out, part of the reason for the widespread adoption of medicalized mortality lies not with the patients but with the doctors. American doctors rarely ask patients about their values and priorities, simply assuming that every patient wants to live as long as possible at all costs. This ethos is clearly present in American medical schools and is becoming ever more prevalent worldwide through American influence.

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