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Last Rights: Rescuing the End of Life from the Medical System 1st Edition
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*Starred Review* Anyone who has stood helplessly by as physicians insisted that a battery of tests and interventions could prolong the life of a loved one, only to see those expensive efforts fail, is certain to be moved by Kiernan's presentation. While his assertion that the American way of dying has changed only during the last 30 years may be debatable, there is no question that the process of dying has undergone a radical makeover. It has become, too often, a parade of last-ditch, state-of-the-art medical interventions, to the direct detriment of the dying person and his or her family and friends. Those who have a terminal illness, Kiernan says, deserve to die quietly, in their own homes, surrounded by loved ones and as pain-free as possible. He makes it sound simple enough, and a lot cheaper than the currently popular, if futile, pricey hospital heroics that prolong little more than misery. The problem is that American medical schools devote more time to teaching students about diseases not even found in the U.S. than to preparing them to work with terminal patients. Doctors, therefore, are ill equipped in every way to accompany a patient down the path to a serene death. A nice polemic, even without practical advice on assuring one's own peaceful demise. Donna Chavez
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"With an uncommon mix of stories and scholarship, Stephen Kiernan has described the challenges that remain at life's end, despite efforts to reform care over the past few decades. With candor, clarity, and an advocate's sense of urgency, he seeks to understand why our acute-care system has been so resistant to change and how we can infuse
greater humanity to life's final chapter."---Joseph J. Fins, M.D., F.A.C.P., Chief of the Division of Medical Ethics, Weill Medical College of Cornell University, and author of A Palliative Ethic of Care: Clinical Wisdom at Life's End
"Last Rites paints a frightening picture of the disorganized, deficient, and disastrous ways many people are cared for and die. Thankfully, Kiernan goes beyond exposé to uncover hopeful progress and practical ways to protect and nurture the people we love. Kiernan's Last Rites is to end-of-life care today what Nader's Unsafe at Any Speed was to car safety in the 1960s. This is one book that America must read!"---Ira Byock, M.D., Professor of Palliative Medicine, Dartmouth Medical School, and author of Dying Well and The Four Things That Matter Most
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I feel like this kind of sentimentalism often comes from a religious point of view that insists on seeing something that isn't there.
I don't disagree with the author that one needs to make the best of the last days of life and that staying out of the hospital and getting as much help as possible both with palliative care and with everyday affairs generally helps to that end, nor with some of the specific things he wants our institutions to do a better job helping with. That would be good. I certainly agree too that to make the most of hospice care, one should sign up for it early without the fear that this is a bad step to take, as in general the earlier one involves an excellent hospice, the better the time at end of life will be.
But, for me, his general point of view that the moments of connection and love during dying outweigh the rest of it, is unhelpful.
As well, the book is disorganized and a bit rambling. It doesn't have the practical advice some other books offer and I think those seeking help can do much better.
About 1200 people a day make it this way. The other 5300 who die on an average day die in a hospital, surrounded by machines and strangers, and often in pain because the doctors are afraid to give to many drugs to patients where the government might come down on them.
My own father reached a point where he was given six months to a year to live. Or he could have an operation. He had the operation. Only afterward were we told that now he had perhaps one to five years. He lived a year and a half, and was in pain every day. The medical profession did not do him a favor.
For me this book can be summed up by four sentences on the last page, they reflect my exact hopes for myself when the time comes:
'Dozens of people taught me that same lesson during my research. They did not fear death, but they feared dying badly. They did not want to live forever, but they wanted to live well for as long as possible. They did not want to die one moment too soon, but they did not want to suffer one moment too long.'
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Works with bereavement as well.