This
intelligent and compelling book invites us to evaluate the losses pertaining to
“modern death” and to consider better ways—whether from the past or in the
future—to care for the dying, their families, and all care-givers.
Some
chapters, such as “How Life (and Death) Were Prolonged,” are historical,
describing changes in inoculations, living conditions, and medical care that
extended the human life span but also changes in dying, now often prolonged by
technology. Another chapter, “How We Learned Not to Resuscitate,” relates how
CPR, initially lauded and popularized, is now widely understood as futile care,
especially in older people. Warraich discusses various attempts to define death
(brain-based, heart-based, American Bar Association, Harvard Criteria, Uniform
Determination of Death Act, even NASA) and some of the issues that still
remain.
Other
chapters are more physiological: “How
Cells Die” explains natural processes of cell death (necrosis, autophagy, and
apoptosis). Most non-medical readers haven’t heard of these and perhaps some
medical personnel as well. Unaware of them as regular and usual processes, we resolutely
expect people to live some four-score and ten, perhaps even more. The
next-to-last chapter, “When the Plug is Pulled” discusses “terminal sedation”
(a legal dosage that eases pain but is not strictly speaking euthanasia or
murder) and statutes that allow for assisted death and removal of life-sustaining
machines. The Nancy Cruzan case and others illustrate many difficulties. (Cruzan was in a persistent vegetative state and supported by a feeding tube. A 1990 U.S. Supreme Court 5-4 decision allowed the removal of the tube.) Warraich
argues further for “patients’ right to demand and acquire the means to end their
suffering with the aid of a physician” (p. 263).
Lack of
resolution of these difficulties leads to problems for families of the dying
and all medical personnel attending them, especially in ICU situations. Living
wills are often of no help and “the end of life has become a battleground” (p.
211). He argues that surrogate roles for decisions at the end of a life often do not represent what the patient actually wanted because the surrogate's values may be different from the patient's and family members may not reach agreement on decisions. He concludes, “All in all, overinvolved family and underinvolved doctors unsurprisingly make for a particularly caustic combo” (p.214).
In “When
Death Transcends” we read that spiritual and religious matters are often
ignored in medical settings. Such resources, however, “may be the only means
that patients have of finding comfort” (p. 148). Warraich surveys various
religions, including his own, Islam. This is one of the longest chapters in the
book and carefully considers the wide range of faiths people have and the
regrettable lack of training for doctors in this area.
Warraich
concludes, “Death needs to be closer to home, preceded by lesser disability and
less isolation” (p. 278). For deaths to
be “truly modern,” we need to push past taboos and misunderstandings about death.
