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. 


This valuable book is a pleasure to read. The style is smooth and varied, ranging from moving stories about patients and families as well as about Warraich’s own family and feelings as he has attended dying patients. The author analyzes technical, historical, and ethical issues, presents his own direct criticisms of modern medicine, and makes suggestions for improvement. Warraich attacks forms of taboo that inhibit frank discussion of dying, and urges changes in our habits and ill-considered assumptions. He feels that doctors’ education does not impart realistic understandings of death, and doctors (and families) often assume “doing everything” is good; as a result, doctors often feel guilt when patients die. He argues that surrogate roles for decisions at the end of a life often do not represent what the patient actually wanted.

Another memorable sentence:  “On many nights, I have been asked, and have complied, with requests to double up on the morphine drip until the line on the heart monitor ran flat, flat, flat….” (p.254, his ellipses).

Many brief insights are helpful.
People need confidants, and “Loneliness is dangerous” (p. 218).
“Startling data shows that paraplegics aren’t much sadder and lottery winners aren’t much happier than anyone else” (p. 199).
Because “doctors favor quality of life for more than length of life,” they “rarely want CPR performed on them” (p. 278).              

Of  Pakistani origin, Warraich sees great differences in Western, high-tech medicine and very limited services in his native land. Deaths there are routinely at home, not in a hospital.


Carefully researched, the book has 33 pages of footnotes and a 11-page index. 


St. Martin's Press

Place Published

New York



Page Count