Tuesday, April 25, 2017

Modern Death: Book Review

Published February 7, 2017.
Modern medicine has increased the average life expectancy of people living in industrialized nations.

However, modern medicine has also decreased the health span.

In other words, people are living longer, but many are living in a state where their quality of life is very low while managing numerous chronic diseases and sometimes--for years--a terminal disease.

Particularly salient are Warraich's questions about how to balance extending life with quality of life during end-of-life care.

Haider Warraich, a fellow in cardiology at Duke University, provides a thoughtful exploration of issues surrounding end-of-life care in his book Modern Death: How Medicine Changed the End of Life

His book is one of more erudite on the topic. The academic register is a bit high.  And one of the earlier chapters discusses death at a cellular level, which I found very challenging. 

Nevertheless, Warraich includes a number of case studies to balance out the history, philosophy, statistics, and evidence-based research.  These stories help illustrate the complex and difficult situations that patience and their support team of family members and health care professionals face. 

For example, he cites statistics that only about 3% of people who receive CPR recover enough to go home and lead a normal life by six months time. But he doesn't just tell the readers this, he relays stories of people receiving CPR.  But his conclusions are not black-and-white. For example, he describes the gratitude a family felt for seeing the medical team perform CPR, even though it can be an aggressive and startling act.  Their family member did die, but they felt that the doctors had done all they could--even if the doctors might have felt that the outcome was inevitable without attempting CPR. 

Even though I have read quite a bit about end-of-life care, Warraich introduced very specific concepts about brain death, organ donation, physician-assisted suicide, euthanasia and how each of these elements can influence the administration and withdrawal of medical care.  

End-of-life care is not just the concern of medicine. The fields of law, ethics, and theology also influence end-of-life care, so Warraich discusses life-and-death issues through these lenses as well. 

Another helpful element was the role of the health care proxy--sometimes a spouse, an adult daughter, or a sibling.  Even if the patient has an advanced directive in place, these documents are often too broad or too narrow, requiring a family member to make judgment calls about when it might be prudent to move from curative care to comfort care.

Even though people in the modern world avoid discussing death and dying, we are all affected by the deaths of our loved ones--and ultimately by our own death. It's imperative to read about this time of life before it become personal. If you can mange the high academic register, this book is a good overview of the issues. 



  1. Great post - this is a huge fear of mine both for my mom and myself. I've read before that the way doctors choose to die is very different from the care they provide their end of life patients. It's important to understand the side effects from any effort to prolong life - they may be worse than dying in some cases.

    1. Yes, most doctors switch to comfort care a bit earlier than patients. The study said patients who are religious with little education and Hispanic or black minorities tend to choose curative care for prolonged deaths over other demographic categories.

  2. This information is so important! I'm a cancer survivor (twice), so I don't mean to be flippant, but it's important to ask hard questions. I was dumbfounded to learn that with difficult cancers, chemo might only extend life by a month or two. I was surprised to read about CPR survival stats in this post. Who knew? Facing death isn't easy, but it is important that we attempt to learn as much as possible so we can make better decisions in the future. Thank you!

    1. Pam: Sorry for the delay in commenting. I've been traveling and away from computers. Thank you for sharing your personal experience. Your comment will help others be more attentive to life-and-death health issues.

  3. Very important topic. The death care is different - on the one hand, it is not easy to provide it. On the other hand, it is not easy to survive. Thank you very much for this great review.

    1. SHON: Good point. It's a tricky landscape to negotiate.