Embracing Our Mortality: Hard Choices in an Age of Medical Miracles

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Overview

While surveys show that most of us would prefer to die at home, 80% of us will die in a health care facility, many hooked up to machines and faced with tough decisions. When you, a family member, or a friend are in this situation, what should you do next? In Embracing Our Mortality, Dr. Lawrence J. Schneiderman, a physician who is our leading expert on medical ethics at the end of life, urges all of us, including health care professionals caring for people at the end of life, to face these decisions with sensitivity and realism informed by both the latest medical evidence as well as the oldest humanistic visions. Dr. Schneiderman vividly demonstrates the wisdom of this approach by interweaving true stories of his patients, current empirical research in care at the end of life, displays of the power of empathy and imagination as embodied in the work of writers like Tolstoy and Chekov, and examples of how the distortion of medical research by media, and its misunderstanding even by health care professionals, cloud the ability to think, feel, and decide clearly about mortal concerns. He ends by addressing the question implicit in all of this which is how to achieve a just and universal health care.

Dr. Schneiderman proves a refreshingly honest, astringent, and life-affirming guide to thinking about the choices that we or people we love will face when we dienot if, as the technological imperatives of modern medicine can suggestand to making decisions at the end of life that respect all that has preceded it.

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Editorial Reviews

Doody's Review Service
Reviewer: Sarah E. Hetue Hill, MA (Saint Louis University)
Description: Dr. Lawrence Schneiderman, respected physician and well known expert on ethics at the end of life, presents this book as a guide for wading through the chaos that occurs when having to make difficult decisions at the end of life.
Purpose: The book provides readers with the tools necessary to navigate treatment decisions that will occur during our own serious illnesses and those of our loved ones. As suggested in the preface, although most of us would prefer to die at home, a large majority of us will die in a healthcare facility hooked up to a myriad of machines and devices. This book is a timely and needed response to society's current immersion in the milieu of the technological imperative.
Audience: This is appropriate for a broad audience and is written in a manner that will be accessible to many, including those unfamiliar with medical terminology or ethics. The book also provides enough relevant information on the topics of empathy and empirical research to be useful to healthcare professionals whose patients are facing these intricate decisions.
Features: Throughout the book, the author recounts cases from his own practice as well as famous cases to illuminate his points. He provides a useful chapter on completing advance directives and another on how to accurately assess facts and statistics on treatment outcomes. He also incorporates literary references from Shakespeare, Chekhov, and Tolstoy into the text, and provides an appendix with poems by William Carlos Williams and Anne Sexton. The author concludes with a chapter addressing additional recent concerns in healthcare, including the need to provide universal healthcare and the inexorableness of rationing healthcare.
Assessment: This book is engaging, due in large part to the case studies and literary references. The concise arrangement of short chapters with numerous references makes the book manageable, but substantial enough to be valuable. The honest and realistic information is a welcome alternative to the inaccurate depictions of the end of life provided by the media.
From the Publisher
"Deciding how we ought to die is a subject that frightens most of us and leaves not a few unable to even enter into a discussion about it much less plan for our own mortality. If you fit this description, then you need to keep a copy of Embracing Our Mortality close at hand. Lawrence Schneiderman has the experience and the wisdom tomake you think and, more importantly, make you act."—Arthur Caplan, PhD, Emanual & Robert Hart Professor of Bioethics Chair, Department of Medical Ethics, and Director, Center for Bioethics, University of Pennsylvania

"Medicine has never had greater powers to cure disease, yet the same treatments that promote life in one case only prolong dying in another. This conundrum leads Dr. Lawrence Schneiderman to pose one of the essential ethical questions of contemporary medicine, What should we do now? Using case studies from his practice and cases of public notoriety (such as the Schiavo case), he provides the reader not only a wealth of facts, but also social, psychological, and spiritual insight into how some run from while others embrace mortality."—Robert L. Fine, MD, Director of Clinical Ethics, Baylor Health Care System, Houston

"A physician who is a playwright envisions his patients in the nuanced script of their lives. Dr. Schneiderman, who is indeed both, places the medical facts of drugs, operations, and statistics into human dramas of hope, anger, despair, and empathy pervading every encounter with a patient who is a person."—Albert R. Jonsen, PhD, Professor Emeritus of Ethics in Medicine, University of Washington; Senior Ethics Scholar, California Pacific Medical Center, San Francisco

"A passionate, story-rich reaffirmation that the practice of medicine is about caring for human persons whose natural history includes getting sick, getting well, flourishing, failing, and ultimately dying."—Lance K. Stell, PhD, FACFE, Charles A. Dana Professor of Philosophy, and Director, Medical Humanities Program, Davidson College; Vice-Chair, Ethics Committee and Director, Ethics Consult Service, Carolinas Medical Center

"This book is engaging...The honest and realistic information is a welcome alternative to the inaccurate depictions of the end of life provided by the media."—Doody's, a 5 star review

"Embracing Our Mortality is an eclectic collection of essays, some previously published, focusing broadly on end of life issues, advance directives and futility, then concluding with Schneiderman's take on the problems of our current healthcare system...While one may disagree with him on specifics, he has picked out some of the better current ideas for reparairing the system....These are complex issues, and he might actually supply better long-term answers than many of our politicians..."—Ethics and Medicine

Library Journal

As medical advances and lifestyle changes carry more and more Americans beyond the age of 80, decisions about quality of life and manner of death grow increasingly unavoidable. Schneiderman (Univ. of California at San Diego Medical Sch.) and geriatrician McCullough (The Little Black Book of Geriatrics ) remind us that the issues surrounding decline and death are not isolated, spectacular events happening to others, as in the Terri Schiavo case, but a part of all our lives. Here, they each discuss the need for advanced planning and thoughtful communication and care.

Schneiderman emphasizes the need for clear and current advance directives to balance the tendency of modern medicine, abetted by hopeful loved ones, to continue treatments to the detriment of the patient's comfort. Using many literary references (this M.D. is also a novelist, a short story writer, and a playwright) and calling on philosophy as well as science, Schneiderman argues that physicians need to work from an "ethic of care" that gives equal status to the relief of suffering and the restoration of health.

McCullough's concept of "slow medicine" is an example of that ethic of care in action. Having worked through these issues himself with his own mother's death, he here guides families as they move with an aging relative along what he calls the "eight stations of late life" preceding death. McCullough believes communication at this time is essential, and he emphasizes gentle, low-impact, and thoughtful care from the first signs of the body or mind's decline. Often, he points out, elderly patients can benefit more from attentive listening, conversation, touch, and a reduction in medications than fromacute interventions. Good additions to such works as Ira Byock's Dying Well , both these books are recommended for public libraries.-Dick Maxwell, Porter Adventist Hosp. Lib., Denver

Copyright 2006 Reed Business Information.
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Product Details

  • ISBN-13: 9780195339451
  • Publisher: Oxford University Press, USA
  • Publication date: 3/3/2008
  • Edition description: New Edition
  • Pages: 232
  • Product dimensions: 7.10 (w) x 5.30 (h) x 1.00 (d)

Meet the Author

Lawrence J. Schneiderman, M.D, is Professor Emeritus at UCSD Medical School and Visiting Scholar in the Program in Medicine and Human Values at the California Pacific Medical Center in San Francisco. He has been a visiting scholar and visiting professor at institutions in the United States and abroad and has written more than 170 medical and scientific publications, as well as a novel and award-winning plays and short stories.

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Table of Contents

Introduction: Facts, Statistics, Empathy, and Imagination
1. Putting in Writing What You Want (and Don't Want)
2. What May Happen If You Don't Make it "Clear and Convincing," and Lawyers and Judges (and Politicians!) Get Involved
3. Facts and Statistics
4. Empathy and the Imagination
5. Ancient Myth and Modern Medicine: What Can We Learn From the Past?
6. Hoping for a Miracle
7. What Could Be Wrong with Hope?
8. Medical Futility
9. Beyond Futility to an Ethic of Care
10. Future Decisions We Probably Will All Have to Make
Appendix
"Unknown Girl in the Maternity Ward"—Ann Sexton
"Spring and All"—William Carlos Williams
UCSD Medical Center Policy & Procedures
Limitation of Life Sustaining Treatment

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