Published February 7, 2017.
Modern medicine has increased the average life expectancy of people living in industrialized nations.However, modern medicine has also decreased the health span.
In other words, people are living longer, but many are living in a state where their quality of life is very low while managing numerous chronic diseases and sometimes--for years--a terminal disease.
Questions about how to balance extending life with quality of life are particularly salient during during end-of-life care.
Haider Warraich, a fellow in cardiology at Duke University, provides a thoughtful exploration of issues surrounding end-of-life care in his book Modern Death: How Medicine Changed the End of Life.
His book is one of more erudite on the topic. The academic register is a bit high. And one of the earlier chapters discusses death at a cellular level, which I found very challenging.
Nevertheless, Warraich includes a number of case studies to balance out the history, philosophy, statistics, and evidence-based research. These stories help illustrate the complex and difficult situations that patience and their support team of family members and health care professionals face.
For example, he cites statistics that only about 3% of people who receive CPR recover enough to go home and lead a normal life by six months time. But he doesn't just tell the readers this, he relays stories of people receiving CPR. But his conclusions are not black-and-white. For example, he describes the gratitude a family felt for seeing the medical team perform CPR, even though it can be an aggressive and startling act. Their family member did die, but they felt that the doctors had done all they could--even if the doctors might have felt that the outcome was inevitable without attempting CPR. Even though I have read quite a bit about end-of-life care, Warraich introduced very specific concepts about brain death, organ donation, physician-assisted suicide, euthanasia and how each of these elements can influence the administration and withdrawal of medical care.
End-of-life care is not just the concern of medicine. The fields of law, ethics, and theology also influence end-of-life care, so Warraich discusses life-and-death issues through these lenses as well.
Another helpful element was the role of the health care proxy--sometimes a spouse, an adult daughter, or a sibling. Even if the patient has an advanced directive in place, these documents are often too broad or too narrow, requiring a family member to make judgment calls about when it might be prudent to move from curative care to comfort care.
Even though people in the modern world avoid discussing death and dying, we are all affected by the deaths of our loved ones--and ultimately by our own death. It's imperative to read about this time of life before it become personal. If you can mange the high academic register, this book is a good overview of the issues.
Related Books on the Dying Process
