MODERN DEATH

An examination of “our ongoing battle with aging, disease, and death.”

Notwithstanding the dramatic increase in life expectancy over the past century, death has become a taboo subject in polite society. “Never has death been as feared as it is today,” writes Warraich, a cardiology fellow at Duke University Medical Center who expresses the hope that his book will play a part in encouraging a more “honest and open conversation about death” among physicians and among patients and their family members. He explains how advances in the understanding of cellular functioning, coupled with improvements in end-of life treatment such as the ability to resuscitate people with cardiac arrest, have essentially blurred the line between life and death. Consequently, thorny new practical and ethical considerations have arisen regarding quality of life and the right to die: when is it appropriate to terminate the life of a patient in a vegetative coma? Does such a patient have a right to die? If so, who should be empowered to decide when life support should be terminated? Warraich describes how doctors are frequently forced to make such on-the-spot decisions for unconscious patients when relatives are unavailable and in instances where family members disagree. He explains that their training predisposes them to favor life extension even when the prospects of recovery are minimal. The author reviews the well-publicized case of Karen Ann Quinlan to illustrate the conflicts that may arise between doctors and relatives, and he takes an unflinching look at the problem for family caregivers when patients remain at the point of death for prolonged periods. This leads him to a compassionate consideration of physically assisted suicide, instituted when a patient expresses the desire to terminate his or her life rather than suffer a terminal illness. Warraich concludes this sensitive review of a painful subject with guarded optimism that a cultural shift toward open discussion is now occurring.

An important contribution to a serious discussion of profound life-and-death issues.