The Good Death

In The Literature……….Marilyn Webb The Good Death: The New American Search to Reshape the End of Life 

New York: Bantam, 1997.

    
Physically, Marilyn Webb’s book is big enough nearly five hundred pages; but it seems much larger in what it covers the vast and conflicting scene surrounding death in America today. From one perspective, it documents Webb’s personal journey, occasioned by deaths in her family, in which she learns to appreciate and work with the wondrous event of a human passing. But her path takes her (and us) over a highly variegated landscape: more than a dozen death stories (from “dying hard” to a “good death”), medical practitioner-researchers struggling to reinvent the dying process through management of pain and suffering, hospice programs of varying effectiveness, stories from heroic survivors of the Quinlan and Cruzan cases, the Supreme Court attempting to draw a line between legal and illegal forms of assisted death, and the inside of Jack Kervorkian’s rusty white van. Some episodes raise considerable dismay: patients beyond recovery are shunned during rounds at a renowned teaching hospital; a hospice doctor shows no remorse for the severe undertreatment of pain in a dying AIDS patient; the increasing dementia of an Alzheimer’s patient destroys a family and impoverishes his wife while doctors time and again employ heroic means to prolong his life. This aspect of Webb’s book presents a tragic saga of ineptitude and obtuseness, of a medical fanaticism more damaging than that of the pro-life advocates who hounded Nancy Beth Cruzan’s last days.On the other hand, there is reason for hope. We eavesdrop on conversations with energetic medical researches and activists like Kathleen Foley, Joanne Lynn, William Breitbart, and Balfour Mount who are working hard to improve end-of-life care, supported by foundations such as Robert Wood Johnson and the Project on Death in America. Webb takes us with her through her own shattering growth experience in a weekend workshop with Elisabeth Kubler-Ross. We seem to become participants in the inspiring death experiences of a Catholic priest and a Buddhist practitioner. Such wealth of personal narrative, the fruit of the author’s insight and immense effort, is supported throughout by authoritative reviews of the literature on relevant topics such as medical ethics, law, and hospice. Perhaps the most useful of these surveys deals with pain and symptom management; her half dozen pages summarizing Dr. Foley’s principles and rules of pain treatment should be taken to heart and memorized by every clinician. The Good Death, then, seems to combine the virtues of a gripping short-story collection and an encyclopedia on end-of-life care. Assurance of reliability comes from the fifty pages of documentary citations and from the imprimatur provided by two introductory essays from doctors who tend to occupy opposite sides of the assisted-suicide fence, Joanne Lynn and Timothy Quill. Webb presents her incidents, characters, and squabbles with a very even hand, refusing to take sides as the narratives develop. The opinions expressed are those of her sources; the perceptive reader is trusted to draw appropriate conclusions. The rather utopian recommendations at the book’s end represent the author’s judgments, some of which will not elicit unanimous agreement.In its sheer competence and scope, however, The Good Death, points up a big social problem not in view of what it sets out to do, but because of what it omits. It is a study, after all, of affluent America’s search for an agreeable demise. No mention is made of the concerns and circumstances of those populations that are by definition forgotten: the poor, the homeless, members of underprivileged minorities, or those who die as unwilling wards of the State in lunatic asylums or prisons. (Who would read such a book if anyone were mad enough to publish it?) The reading public will probably feel satisfied that Webb has made a clean sweep of her area: surely no hidden corners remain! Those concerned with correctional health care may nevertheless read this book with profit. They will feel that no one out there is even thinking about end-of- life care in prisons; they will have to think for themselves. More to the point, the model of the “good death” presented by Webb is not altogether out of reach even for prisons; it is normative (more or less) for human beings and thus presents itself to corrections as a worthy goal to aim for. As such, it offers a useful catalog of challenges felt by the society in general for which correctional health care people will have to work out suitable responses. Finally, the several personal narratives will provide concrete insights into the variety of human ways of dying. Readers need only to crank up the intensity of these stories to allow for the increased pathos that comes with dying behind bars.

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