Review: Modern Death; how Medicine changed the End of Life by Haider Warraich (2017) Assessment 2 out of 10

A weak Book. I finished it, only because it was a quick read.

There are too many Americanisms, “pass “for “pass away”, “an attending” for “an attending doctor”.  Medical terms are used without definition or a glossary. You wonder, “What was the target audience? Was it assumed the average reader understood them?” Much of the language is poor, a dying patient “finally met her maker”. Are the words being used euphemistically, or does Haider consider that was what, or the deceased thought, was happening?

The weakest sections in a weak book are when the author recounts his experience in interacting with patients, the dying and their families, referring to them, in an over-familiar way.

 Throughout there is a bias towards the US and experience there in Intensive Care Units. Why so many? Not properly discussed.  Increasingly people die (and are born) in hospitals. Despite a majority wanting to die at home, this has become “an inequitably distributed privilege”. The UK is apparently unusual, patients preferring to die in hospices, which are not properly explained, described as “a hospital based hospice facility”(whatever that is). Palliative care is also referred to, but, again, undefined, differences from high intervention medicine explored inadequately.

At times, I was interested:

*“a third of elderly Americans undergo surgery in the last year of life….a fifth in the last month.” Elderly is undefined. Are the figures different for those dying at a younger age?  We are not told.

*the unclear line between removal of life support, terminal sedation (another euphemism), and withdrawal of feeding or liquids

* the chapter on cell death and how this may set an absolute time limit to lifespan

*the “Grandmother Hypothesis” suggesting women’s post-menstrual survival is adaptive. Challenges to the theory are referred to, but poorly explained. To understand them, I consulted Wikipedia, including looking up the competing “Patriarch Hypothesis”.  Haider moves on immediately to inequalities in US health provision, a complete non-sequitur.

* life & death apparently are no longer binary, death equated with being brain dead, described as a legal entity(sic). If this is the now the basis of distinction, isn’t the difference still binary?

* Conflicts over treatment are less frequent where a spouse is the surrogate than children

There is an undercurrent of the superiority of medical opinion, “Physicians, on the other hand, are well versed in the ethical principles that are supposed to be followed …Interestingly a college education doesn’t improve objective understanding of relevant medical issues”…. etc.

How the changing pattern of death reflects demographic change is supported by poorly cited statistics. The chapter on death and religious belief, a fascinatingly complex question, is shallow, the rich literature of death, dying and grief not referred to. The range of legal questions concerning death isn’t properly explored, nor the range of possible solutions adapted. How do attitudes to, and changing legal provision for, sterilization and euthanasia, voluntary or otherwise, and assisted dying tie into cultural, legal and political change generally? Ignored. How these are mirrored, or not, in changing rights to contraception and abortion, missed completely.

There is a good book to be written on Modern Death. This isn’t it

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