Last Rights

"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."—Ira Byock, M.D., Professor of Palliative Medicine, Dartmouth Medical School, and author of Dying Well and The Four Things That Matter Most

"Anyone who has stood helplessly by as physicians insisted that a battery of tests and interventions could prolong the life of a loved one, only to see those expensive efforts fail, is certain to be moved by Kiernan's presentation. While his assertion that the American way of dying has changed only during the last 30 years may be debatable, there is no question that the process of dying has undergone a radical makeover. It has become, too often, a parade of last-ditch, state-of-the-art medical interventions, to the direct detriment of the dying person and his or her family and friends. Those who have a terminal illness, Kiernan says, deserve to die quietly, in their own homes, surrounded by loved ones and as pain-free as possible. He makes it sound simple enough, and a lot cheaper than the currently popular, if futile, pricey hospital heroics that prolong little more than misery. The problem is that American medical schools devote more time to teaching students about diseases not even found in the U.S. than to preparing them to work with terminal patients. Doctors, therefore, are ill equipped in every way to accompany a patient down the path to a serene death. A nice polemic, even without practical advice on assuring one's own peaceful demise."—Donna Chavez, Booklist (starred review)