At Peace

At Peace

Choosing A Good Death After A Long Life

Book - 2018 | First edition.
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"The authoritative, informative, and practical follow up to BEING MORTAL, on end-of-life care for patients over the age of 65. Most people say they would like to die quietly at home. But overly aggressive medical advice, coupled with an unrealistic sense of invincibility, results in the majority of elderly patients misguidedly dying in institutions while undergoing painful procedures, instead of having the better and more peaceful death they desired. At Peace outlines specific active and passive steps that older patients and their health care proxies can take to insure loved ones pass their last days comfortably at home and/or in hospice, when further aggressive care is inappropriate. Through Dr. Harrington's own experience with his parents and 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 informed his passion for helping patients make appropriate end-of-life decisions"-- Provided by publisher.
Publisher: New York : Grand Central Life & Style, 2018.
Edition: First edition.
ISBN: 9781478917410
Characteristics: xix, 282 pages : illustrations ; 22 cm


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Jul 29, 2019

" ' Science continues to be a channel for magic--the belief that for the human will, empowered by knowledge, nothing is impossible. This confusion of science and magic is not an ailment of a kind that has a remedy. It goes with modern life. Death is a provocation to this way of living, because it makes a boundary beyond which the will cannot go.' "

Apr 08, 2018

Good information and accounts from an MD who knows his stuff. It's another "choosing end of life" senario based on author's experience. A little different from "Being Mortal"yet a needed addition to the new wave taking over the idea that we don't have to lose having a choice and voice in our demise.

Apr 08, 2018

At Peace contains a lot of specific advice about how to plan ahead for the kind of death you want. It is written in a blunt and direct style (which means it is sometimes uncomfortable to read). On the other hand, we are all going to die someday, and if we do not plan while we are competent, we may face a death where the medical-industrial complex forces us through every possible life-saving measure, no matter how miserable and no matter how unlikely to improve either our quality of life or the length of our life.

A friend described this book as a "sequel to Being Mortal," which is not literally true, but I do recommend reading Being Mortal first.

The author discusses the "medicalization of death," including the various procedures that are tried to prolong the life of an elderly person in the ICU. I recommend reading this part; maybe some people want everything possible done, but it sounds like a miserable way to spend one's last days on this earth. For example, he recommends against using CPR for a person who is old, infirm, or suffering from a terminal illness. The chance of surviving until discharge is 0 to 8% (and the chance of returning home neurologically intact is less than that).

Medicine is big business. Dr. Harrington shows what happens when high tech treatments meet assembly line care. Too many invasive procedures are inflicted on the elderly without an appropriate analysis of the risks. He calls it "churning" of elderly consumers. Often the patients who undergo these high tech treatments/procedures end up worse off than if they had done nothing; their quality of life is diminished, and not infrequently they die sooner than they would have without treatment. There is a strong momentum to keep treating every patient aggressively until death; if you do not want that, you have to plan ahead to prevent it (and make sure you communicate your wishes to your family and to your doctors).

The chapter called "The Denial of Old Age; Immortal in America?" raises many interesting points. The most important is this:

If a person reaches the age of 65 in reasonably good health, his or her life expectancy is 19 years. Of those 19 years, 10.5 are likely to be healthy years, and 8.5 are likely to be disabled years. These numbers have been steady for decades. 80% of Americans are living lives complicated by disability for the last year of their lives.

A healthy lifestyle is not a guarantee of life without disability. People who exercise and eat a healthy diet must plan ahead too.

If one reaches age 65 in the presence of a chronic illness, his or her life expectancy is shortened, so those numbers above must be adjusted accordingly.

Dr. Harrington says: for people age 65 or older with a chronic illness, or for people over age 80 who are otherwise healthy, aggressive medical care should be thought through very carefully. Over those ages, the potential to do harm rises, and the potential long term benefit, by definition, declines.

If you are in your 60s or older, even if you are in good health, this book will give you plenty to think about. And if you are younger, you are not off the hook; you will get older (if you are lucky), and you probably have friends and family members who are in their 60s or older.


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