The Way We Die Now: The View from Medicine’s Front Line

Irish gastroenterologist O’Mahony adopts an extraordinary view of end-of-life care in the 21st century, exploring the difficult conversation that many doctors have come to avoid in a world of consumer-friendly medicine. O’Mahony persuasively argues for telling dying patients “things they do not want to hear,” thereby becoming the “amicus mortis” who “tells you the bitter truth and stays with you to the inexorable end.” He writes from his own experiences with people dying in hospitals, as well as those of friends and family. O’Mahony also reflects on the accounts of writers and philosophers, including Phillipe Ariès, Ernest Becker, Christopher Hitchens, Ivan Illich, and Susan Sontag. He tracks the medical movement toward living wills and assisted suicide as “informed by a passion for personal autonomy: for control,” eloquently reasoning that “human agency has replaced the powers of nature, ‘majestic, cruel, and inexorable.’ ” Death is messy and always will be, he notes, and “eventually, inevitably, nature, or the syringe-driver, takes control.” The “over-medicalization” of modern dying is at the core of O’Mahony’s criticism; he maintains that doctors might better help their dying patients by giving up “the quest to conquer nature” and returning “to a core function of providing comfort and succor.” O’Mahony’s clear-eyed analysis is important, poignant, and immensely humane. (July)