At Peace: Choosing a Good Death After a Long Life

by Samuel Harrington MD

Overview

The authoritative, informative, and reassuring guide on end-of-life care for our aging population.

Most people say they would like to die quietly at home. But overly aggressive medical advice, coupled with an unrealistic sense of invincibility or overconfidence in our health-care system, results in the majority of elderly patients misguidedly dying in institutions. Many undergo painful procedures instead of having the better and more peaceful death they deserve.

At Peace outlines specific active and passive steps that older patients and their health-care proxies can take to ensure loved ones live their last days comfortably at home and/or in hospice when further aggressive care is inappropriate.

Through Dr. Samuel Harrington's own experience with the aging and deaths of his parents and of working with patients, he describes the terminal patterns of the six most common chronic diseases; how to recognize a terminal diagnosis even when the doctor is not clear about it; how to have the hard conversation about end-of-life wishes; how to minimize painful treatments; when to seek hospice care; and how to deal with dementia and other special issues.

Informed by more than thirty years of clinical practice, Dr. Harrington came to understand that the American health-care system wasn't designed to treat the aging population with care and compassion. His work as a hospice trustee and later as a hospital trustee drove his passion for helping patients make appropriate end-of-life decisions.

Product Details

ISBN-13:	9781478917410
Publisher:	Grand Central Publishing
Publication date:	02/06/2018
Pages:	304
Sales rank:	540,310
Product dimensions:	5.50(w) x 8.40(h) x 1.10(d)

About the Author

Samuel Harrington, MD, an honors graduate of Harvard College and the University of Wisconsin Medical School, concentrated his clinical practice at Sibley Memorial Hospital in Washington, DC. There he served as a medical staff leader, a trustee, and as Sibley's representative to the Johns Hopkins Quality and Safety Board Committee. This work and his service on the board of trustees of a nonprofit hospice brought Dr. Harrington into the discussion of end-of-life medical care.

Table of Contents

Introduction xi

Part 1 Limits and Failures of American Medicine

Chapter 1 Good Death, Bad Death, Better Death? 3

Chapter 2 American Health Care: Failing the Elderly 12

Chapter 3 The Denial of Old Age: Immortal in America? 28

Chapter 4 The Median Is the Message 49

Part 2 Understanding Disease

Chapter 5 How Different Diseases Lead to Common Causes of Death 63

Chapter 6 Deathbed Scenarios: How Does the End Finally Arrive? 92

Chapter 7 Dad's Final Weeks 110

Chapter 8 How to Recognize a Terminal Diagnosis 119

Part 3 Practical Aspects of Planning for Death

Chapter 9 The Value of Your Prognosis 143

Chapter 10 The Hard Conversation 157

Chapter 11 Hospice Care 177

Chapter 12 Voluntary Refusal of Fluid and Food 196

Epilogue: Reflections and a Road Map 211

Abridged Chronology: Mom and Dad's Decline 224

Appendixes

Appendix I Advance Directives 229

Appendix II Dementia 245

Acknowledgments 255

Notes 257

Resource List 271

Index 275

About the Author 283

Editorial Reviews

Dr. Sam Harrington has provided an invaluable road map for all of us facing the challenge of critical end-of-life decisions for friends, family, and ultimately, ourselves. He demystifies medical terminology with an experienced, transparent, and literate guide for boomers like myself, and for our aging parents. How to have the conversation? When to decide that a caring choice is the decision to avoid repeated hospitalizations and over-testing? Here is a medical expert who puts patients and their welfare first. This is an invaluable addition to the literature.—Andrea Mitchell, anchor and correspondent for NBC News


Well researched, clear-eyed, and brilliantly practical. This is a guide and conversation starter for older Americans seeking control and comfort at the end of life. An antidote to modern overmedicalization that's both simple and sage.—Lucy Kalanithi, MD, clinical assistant professor of medicine, Stanford University School of Medicine, and author of the epilogue of When Breath Becomes Air, the book by her late husband, Paul Kalanithi


There is no easy way to approach the literally life-and-death questions that are the focus of Samuel Harrington's book. But his spare and graceful clinical tone conveys a deeply humane perspective on choices we all will face. This is a book of wisdom and value for people at any stage of life.—James Fallows, The Atlantic

From the Publisher

11/15/2017
Death comes to all people, whether they are happy or not, kind or mean, and whether they practice yoga or watch TV all day. So why does one pick up a book about how to die? The answers come from those who have participated in the deaths of others, by listening, affirming, and then helping those who remain.In At Peace, physician Harrington, who serves on the board of a nonprofit hospice in Washington, DC, describes the terminal patterns of the six most common diseases, then guides readers in end-of-life conversations and instructs them in how to minimize painful treatments. He speaks with experience and compassion as he discusses the biological and emotional factors of aging and outlines the practical aspects of planning for death. Chapters on dementia and advance directives conclude his work.In With the End in Mind, physician Mannix, through her expertise in palliative care and cognitive behavior therapy, shares stories from a lifetime of caring for the dying. Using case histories, Mannix provides poignant insight into the way people live when they know they are dying, and what those around them may be thinking and wishing to say. The book ends with a template for writing a last letter to loved ones. VERDICT Where At Peace provides a framework for dying, With the End in Mind puts meat on the bones, with some overlapping of personal accounts and medical processes in each. Both are highly recommended.

Library Journal

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