“Damn, I wish I'd had this book before my own father died. Part a guide to thinking through the policy questions surrounding the end of life, and part an informal handbook for helping with the deaths of your own loved ones, it also offers a final and supreme gift: the chance to begin thinking about what your own life means in the context of its inevitable end.” Bill McKibben author of The End of Nature
“With an uncommon mix of stories and scholarship, Stephen Kiernan has described the challenges that remain at life's end, despite efforts to reform care over the past few decades. With candor, clarity, and an advocate's sense of urgency, he seeks to understand why our acute-care system has been so resistant to change and how we can infuse greater humanity to life's final chapter.” Joseph J. Fins, M.D., F.A.C.P., Chief of the Division of Medical Ethics, Weill Medical College of Cornell University, and author of A Palliative Ethic of Care: Clinical Wisdom at Life's End
“Last Rites paints a frightening picture of the disorganized, deficient, and disastrous ways many people are cared for and die. Thankfully, Kiernan goes beyond exposé to uncover hopeful progress and practical ways to protect and nurture the people we love. Kiernan's Last Rites is to end-of-life care today what Nader's Unsafe at Any Speed was to car safety in the 1960s. This is one book that America must read!” Ira Byock, M.D., Professor of Palliative Medicine, Dartmouth Medical School, and author of Dying Well and The Four Things That Matter Most
Most people find it difficult to face their own mortality and that of their loved ones. This book compassionately and skillfully addresses this difficult, emotional issue. Kiernan, a journalist with the Burlington Free Press (VT), discusses the disconnect between how people want to spend their last days and how they actually end up doing so. While most desire to feel no pain, functioning mentally and physically and surrounded by family, the reality is that the majority of us will actually die in hospitals, where extreme medical interventions are undertaken at immense costs and with little regard to pain, human comfort, or the stated wishes of the dying and their families. Kiernan argues that most physicians and other healthcare professionals do not know how to deal with death because textbooks and medical schools fail to address the issue adequately. His final chapters present a broad agenda to improve end-of-life care at both the societal and the individual levels. This well-written and thoughtful book, filled with surveys, interviews, and personal portraits, is highly recommended for all public libraries and consumer health collections.-Ross Mullner, Sch. of Public Health, Univ. of Illinois, Chicago Copyright 2006 Reed Business Information.
An impassioned appeal for a kinder, gentler death. George Polk Award-winner Kiernan, a reporter for the Burlington Free Press (Vermont), argues that last-ditch efforts to prolong life are leading causes of bankruptcy that also deprive the dying and their families of their dignity and peace of mind. He cautions that medical directives, which many assume will protect them from unwanted interventions, are routinely ignored by hospitals. Further, those who seek refuge in a hospice may be left out in the cold: A physician must attest that a candidate has six months to live, yet doctors are notoriously bad at estimating endpoints. Fewer Americans die of sudden illnesses or accidents, Kiernan notes. The majority linger with chronic illnesses like Alzheimer's or cancer, yet our medical system isn't equipped to handle those whose prognosis falls somewhere between "really sick" and "almost gone," nor to deal with their families, whose primary need may be respite care. The author sees some progress as hospitals begin to offer palliative measures designed to make final days more comfortable. He considers the benefits of a gradual death, which include greater intimacy with family members and time to plan for a conscious ending or to sum up a life. Kiernan tells how he and his siblings dealt with their mother's inoperable cancer, then turns the lessons they learned into a well-considered prescription for the entire population. He urges patients to fight for their right to die naturally; medical schools to devote more attention in their curriculum to the dying process; and policymakers to start making it easier for dying patients to receive adequate pain control. Gripping first-person stories andinterviews with exceptional caregivers make the human case for national reform. A superb resource for boomers dealing with their parents' final days and anxious to exert more control over their own rites of passage, as well as for health-care professionals who need to hear this story from the other side.