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

I believe that the author has a very good understanding of the way humans die these days. It's so different then it was even 50 YEARS ago....is it better? I think not.

An interesting and thoughtful work containing literary and non-fiction references worth pursuing. I don't endorse all his views, but they are worth contemplating. My view is the medical industrial complex costs too much and decreases life quality, shortening lives as well.

Dr.O’Mahony’s view on death and dying, based on candid clinical experience and examined contemporary and historical celebrities, is unique and differ from modern hospice medicine and other rather well known authors, ie Artul Gawandi. Very rewarding experience of reading. Recommend to every heath related person and over 50 years of age, to have courage to face death.

Extremely well written, the author examines the philosophical and spiritual approaches to dying and contrasts them with the overmedicalized approaches today. Futile medical intervention and fear of death have undermined our ability to die with dignity.

The basic premise of the book is good, and there is some decent information in there. However, it is written in a very disorganized manner. The author primarily quotes others in pages of mish-mashed information with no logical flow or order. The book was very difficult to read, which is a shame, because advanced medical care at end of life is such an important topic! There are many other, much better written books on the subject out there!!!!

A good dose of reality countering the notion that medicine is the panacea for all that ails us.

Down to earth, sensible information on the subject to get people thinking towards their future.

Realistic treatise about death

A few days ago I reviewed Kathryn Mannix's book, 'With the End in Sight' which is based on her 40 years experience as a palliative care consultant doctor. An uplifting read which suggests that dying and death can be managed well, gently and with a very meaningful sense of an ending. As she points out, palliative care is still quite a new field, one which many of her medical colleagues often don't seem to value.O'Mahony's book is down to earth with a bump! He does agree with many of the palliative care theses - especially avoiding unnecessary end of life medical interventions which serve only to worsen suffering and engender futile hopes. Of the latter, he suggests, many physicians will conspire with patients and their families as this is much easier than getting them to accept the reality of the situation. He's not very sympathetic to some of the positive language among palliative specialists, pointing out that they most frequently are dealing with patients already fully informed by specialists of their conditions and who are often seeking and accepting help to die without pain, and to prepare for their deaths such as with their various legacies. He contrasts the manic frenzy of a modern general hospital with the peaceful slowness of a hospice, one which can be architecturally beautiful with gardens and interiors like an hotel's. He also points out that only 5% of people in Ireland the the UK die in a hospice. Perhaps I missed it, but he seems unaware that much palliative care while based with hospice specialists takes place at home or in outpatient settings.In recounting his own experiences, O'Mahony describes the chilling deaths of many in hospital. For instance, care homes will often summon an ambulance for a sick residence so that they don't die in the care home; instead, some will die alone and bewildered in a hospital corridor. On wards, incredibly busy doctors and nurses will give most attention to the acute patients who can be healed while often not being able to attend to the basic needs of the dying - things like cleanliness and feeding. And things like kindness and having the time to sit with patients.Relatives often bitterly counter medical advice and demand that more and more treatment be given: junior doctors in particular often give in to such pressure. The author cites the trials by media of cases where relatives have accused doctors of letting patients die unecessarily, even of deliberately hasten their ends. The Liverpool Pathways palliative care initiative was stopped because of such pressures.A particular subject was news to me. The cardiac arrest scenes we see in television series in which the patient is almost always resuscitated by electric shock do not reflect reality. In fact, less than a fifth of patients are brough back from cardiac arrest and many of these will be in a bad way until they die. As lay people we expect miracles and some of us turn to anger if we are denied by reality.The book is also a very interesting look at the cultural aspects of death and dying. Whereas death rightly induces mourning and sadness, until recently in modern times it was taken as a normal part of life - as was suffering. O'Mahony spent some years in England and when he returned to his native Ireland he discovered a world once held together by religious meanings and rituals which framed death replaced by a secular world adrift from traditional ways of living with death. He also examines the writing of four modern anthropologists and philosophers on the modern denial of death (Ernest Becker's phrase), In particular he argues that Ivan Illich's arguments aroung the medicalisation of suffering and death have turned out to be true (despite Illich even today being regarded as a very negligible figure by the majority in medicine and elsewhere).Real death, like real life, can be messy, painful and even terrifying. Most of us can expect to die in hospital amidst the busyness of indifference and blood tests. Most of us can expect to live well past our natural span, sustained by technology. As birth rates continue to fall in Europe and longevity increases, the toll on young people will be immense and the sufferings of the dying old will for the majority, and almost all of the poor, be addressed by growing reliance upon badly paid immigrants. Individuals will continue to demand 'more life' as they have always demanded 'more goods', but this life extension for most will increase suffering. Food for thought as a society and as a person.O'Mahony suggests that we dismantle false promises. 'Empathy' is a buzzword found in workshops and 'thantology' (the study of death) yet the author suggests empathy is logically impossible no matter how warm and fashionable it sounds. Each individual dies differently - partly as a result of how they have lived: a 'good death' is a natural manifestation of a 'good life'. What we, and specifically health professionals, can aim for is no more than kindness. Doctors and nurses should not retreat behind their professional expertise but aim to become human friedns of the dying. The truth is some will die well (O'Mahony cites Wittgenstein and David Hume as examples), others will die in terror. Some will drop dead in a supermarket. Some will die in their sleep of old age (though 'old age' will not appear on the death certificate). Many of us will drift away as we are pumped with morphine.Death and dying are hugely important subjects. Philosophy, theology, psychology, sociology, gerentology, economics, anthropology and now thanatogy all have an interest. Medicine has a part to play but it does seem that the part is too often taken for the whole. In our death-phobic culture, in our individual denial of death, it is a form of cowardice to dump granny in A&E to die invisibly, and then to rage against medical staff who are worn to the bone with giving their all. For you, for me, there's a lot of luck involved in how we get to die. We may die abandoned and frightened in a hospital ward where the staff are facing an emergency in the next bed; a day earlier or later the same staff may have been able to sit with us and help us on our way. The ideology of technical supremacy is never laid so nakedly as a Lie than in the face of death, that most personal and deeply human destiny of us all. There are children dying of starvation in their millions every year which humanity could prevent in an instant; meanwhile, the rich preserve their bodies in 'cyrogenic' warehouses awaiting resurrection when the technology to make them immortal arrives.'The Way We Die Now' is not a comfortable read and nor should it be.

Purchased this book after reading a copy of it lent to me by a friend. Thought provoking read, some good insights into something we will all face. Particularly interesting coming from someone inside the medical world. His observation that medical people in the main do not tend to put themselves through the litany of medical procedures if they become seriously ill is very telling. Some of the chapters dragged on a bit and it could be structured better, but overall the shared information and opinions, along with it's thought-provoking message made it worthwhile. And I'm speaking with my wallet, as I bought two copies to share with friends myself.

Disclaimer: I worked for Dr O'Mahony once upon a time - 2009; I haven't had any professional or personal dealings with him subsequently.I really enjoyed the book. It's deeply personal but also very professional. It manages to be both of these things, and to do it well enough that people from all walks of life will benefit from reading it.Dr O'Mahony doesn't pull his punches: some of what he writes will upset or anger people. Those are the ones who most 'need' to read this book. Alas, I suspect that they will be busy reading something else.

Superb book - not in the slightest depressing and written in easily understood language. I dip into it and always read far more than I intended as it is so enlightening. I also use it as a reference and go back and reread sections. All medical professionals and associated staff should read this book, even those not involved in end of life care. It clarified so much and gave a medical opinion, Very well done.

Yes, this is a tough subject to think about both for ourselves and our loved ones but his basic premise that we have medicalised death to such an extent that we are in danger of losing our humanity is one I totally agree with. As he says, we have outsourced dying to hospices, and they do a wonderful job, but GPs, hospitals, care homes and the public must sit up and think about how we approach the death of our loved ones and ourselves. I know this book rambles a bit and could be more tightly written, but so what it is none-the-less very powerful. I believe this should be obligatory reading for all healthcare professionals when they are training and death is something we must talk about more in families and in public.