Modern Death

Starred review from December 5, 2016
Warraich, a physician, writer, and clinical researcher, thoughtfully investigates the often alarming realities of death in early 21st-century America. For many it will be a “drawn-out slow burn” from a chronic illness, and where that end occurs depends largely on race and economic status. As medicine improves, it has paradoxically made death “more harrowing and prolonged today than it has ever been before.” For Warraich, the person who more than any other “would come to define modern death” was Karen Ann Quinlan, whose coma triggered a fight over keeping her on life support—a contentious battle that ended with a 1976 New Jersey Supreme Court decision that momentously introduced “the patient and the family member into medical decision making.” Around the same time, brain death was defined in a way that has made many modern deaths protracted for the patient, uncertain for the medical team, and heart-wrenching for grieving families. Dying may now include a health-care proxy, a living will, and advance directives to accommodate the patient’s wishes for their own death. as Warraich eloquently explores the act of dying, he urges the public to talk more about it and pleads for “resuscitating many of the aspects of death that we have lost.” Agent: Don Fehr, Trident Media.

December 15, 2016
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.

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February 1, 2017

Warraich (cardiology, Duke Univ.) provides an engaging look at the ways modern medical technologies shape the end of life, with perspectives and illustrations drawn from his ongoing work as a clinician. He begins where few books on this topic do, with an explanation of cellular death and its role in the death of a human being. Then he talks about "do not resuscitate" orders and explores the role of "advanced directives" and the ways in which they create clearer options for families, as well as the difficulties faced when decisions are delegated to others through power of attorney orders or "substitutionary decision making." The author also discusses controversial issues around assisted suicide from a physician's point of view. He further notes how the Internet and other social media technologies have influenced how we grieve. VERDICT While other texts have covered issues of medicine and the end of life, Warraich's goes beyond when discussing the role the digital sphere plays in grief and memorialization. Readers of Sharon R. Kaufman's And a Time To Die and Sherwin B. Nuland's How We Die will find an engaging and updated outlook in this work.--Aaron Klink, Duke Univ., Durham, NC

Copyright 2017 Library Journal, LLC Used with permission.

December 1, 2016
So often now, the price for prolonging life is dying poorlytethered to technology in antiseptic rooms, largely lonely, isolated, and feeble. Warraich, a physician in training, believes that modern death has become too medicalized, even sterilized. Dying in your own bed is an increasingly uncommon occurrence. Only about 20 percent of Americans expire at home. Meanwhile, dying in hospitals and nursing homes escalates. Warraich's discussion of death incorporates expected elementsCPR, DNR (do not resuscitate), flat EEGs, Karen Quinlan, advance directives, euthanasia, organ donation, the toll on family and caregivers, the right to dieas well as some surprising and creepy componentszombie cells, the Lazarus phenomenon (autoresuscitation), and tumor necrosis factor alpha (a sort of molecular Grim Reaper). A chapter on the role of religion and spirituality in the end-of-life experience is excellent. Warraich endorses religion's ability to help temper the terror of impending death. Psychiatrist Elisabeth Kubler-Ross observed that dying nowadays is more gruesome in many ways, namely, more lonely, mechanical and dehumanized. She expressed that opinion in 1969. The situation hasn't gotten any better. Warraich's thoughtful book may help.(Reprinted with permission of Booklist, copyright 2016, American Library Association.)