Thursday, March 30, 2017

Modern Death?

I picked up a copy of Haider Warraich’s book Modern Death as soon as I saw it advertised.  This is a topic that I find fascinating and Mr. Warraich’s book was billed as the “follow-up” to Atul Gawande’s Being Mortal, so I didn’t think twice about the impulse purchase.  While reading the first few chapters, I was a little disappointed.  Mr. Warraich wasn’t presenting anything that I hadn’t already read or taught about as a professor of health law and ethics.  I didn’t make my first earmark until page 91, but shortly after had to be careful not to earmark every other page.   I quickly decided that Mr. Warraich had written a text that should be read by everyone – not just people fascinated with the legal and ethical issues surrounding end of life.

Modern Death begins with an overview of issues surrounding death, including the legal definition of “death” and methods of sustaining life.  Landmark cases are explained and a detailed history of the development of CPR is included.  After building a firm foundation, Mr. Warraich delves into the issues he sees most often as a physician.  That first earmark on page 91?  It was for this quote: “The reason people increasingly don’t want CPR is not that they are afraid it will fail but that they are afraid it will only partially work.  Patients are afraid that if CPR makes their heart start beating again their brain will have to pay a huge cost.”  In a society that values independence and self-reliance, this is so very true.  Most people would rather not continuing living if they have to live in a vegetative or severally impaired condition.  What is life in today’s world if you cannot continue to do the daily activities that you love?

After an excellent ethical analysis of death and resuscitation efforts, Mr. Warraich considers deeply the role of religion in the dying process.  He states: “Physicians very frequently find themselves in difficult situations with patients who have a strong faith, but rarely do they talk about religion and spirituality.”  One study estimates that only 10% of physicians broach this difficult but important subject.  This number is extremely low considering a study of cancer patients showing that patients provided with “spiritual care had a better quality of life prior to their deaths, were more likely to pass in hospice, and were less likely to receive aggressive and unnecessary care close to death” when compared to patients not provided spiritual intervention.

Modern Death also examines the role of physicians assisting care-givers and surrogate decision makers.   He proffers that physicians are usually at the center of the decision-making process and they are often required to buffer the various opinions of family members and caregivers.  In addition, he states that the burden placed on surrogate decision makers (aka health care proxies) is seriously overlooked.

The topics of euthanasia and physician assisted suicide are also touched on in Modern Death.  Mr. Warraich offers his own personal perspective and thoughts regarding this controversial topic.  He provides a unique perspective regarding the shift in opinion over centuries, not just decades.

I have added this book to my list of texts that every healthcare professional should consider reading.  Additionally, I will be giving it to my parents.  Per Mr. Warraich’s suggestion, I will instigate the talk that everyone avoids, but everyone should have before it is too late and we simply have to guess.
Submitted by Valerie J Connor, MA CCC-SLP; MS CHES

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