Dying Well

Abstract

Julia Neuberger brings to her book a wealth of experience—personal and professional—on the last stages of life and into death. She has seen dying as a close relative, as a caregiver, as a Rabbi, and as someone responsible for commissioning health services. Such insights result in very practical suggestions on how to improve support for the dying. Although recently bereaved herself, Neuberger's approach remains unsentimental and matter-of-fact. Her descriptions of sensitive care represent good clinical practice. The experience she describes is full of hope, hope that others may experience the care given to her loved ones. Her frankness brings the book to life. This book is aimed at the lay reader, but it has much to interest professionals who care for the dying. For specialists in palliative care, she suggests her other book on caring for people of different faiths, as it is a more detailed guide to the practicalities of different rituals and customs. However, the concise way she tackles the different faiths of the world in Chapter 5 means that this chapter can stand alone as a reference for doctors and nurses across health care, whether in the community or in hospital practice. The section on Chinese customs, with its history of Confucianism, Taoism, and Buddhism, is fascinating. It follows on the sensitive section on Buddhism, which explains why some patients are so terrified of being sedated and why they prefer to live with pain as they face their end. She also tackles the vexed issue, so much in the news, of euthanasia. She clearly describes the Rubicon that is crossed: “Euthanasia demands the active participation of doctors and nurses in the killing of their patients. And, despite the degree of sympathy they may feel for the patients whose lives have become unbearable, the role of health care professionals should not be one of actively seeking a person's death. Indeed, the role of the health care professional should be to care for the needs of the person whilst alive, and to seek his or her welfare.” But this is not said lightly, for she is deeply sympathetic to suffering and clearly feels we should all strive at all times to relieve all of it that we can. Although Rabbi Neuberger clearly differentiates such deliberate killing from the withdrawing or withholding of futile treatments, I would take issue with the term passive euthanasia, as it is misleading. For here the patient is dying of their disease, all efforts to intervene are becoming futile and those around, including the patient if able to be involved, accept that “natural death” is occurring. But deciding which interventions should be withdrawn is not easy. Perhaps every nursing and medical student should read Neuberger's sensitive description of Sally Vincent's experience of watching her father rendered speechless by a stroke, but yet his identity shone through in the sound of his sneeze and how, with all care given, he died of natural causes seven days later. Such a story underlines vividly the importance of those who love someone when difficult decisions have to be made. In the first chapter, we are introduced to the history of ideas about death from the Biblical writings to the recent horrors of the last century. It was the euphemism of “shell shock” that did not utter the terror the survivors had seen, but left them to return from war like living dead. Then came the death camps of the Holocaust, the recent massacres, and so much more. In the pages of this short book, we are challenged to think about how and where people really die, and to think about our own dying in realistic terms. In Chapter 2, Neuberger deals with grief in all its forms and emphasizes the need for children to be involved in the whole experience of a person dying, not excluded or alienated in their misery at their loss. She then goes on to outline what each and every one involved can do to help the situation of a person who is dying. She ends the book with a challenge to all—education about death, about human reactions to loss and grief, should be taught in schools as part of preparation for life, for coping with the realities that everyone will face and to help the next generation do a better job of care and compassion. This book is well researched from other writings and life experiences. It is superbly written—it is a good read, an easy read, and yet a thought-provoking read, too. May it reach the aim in its title, to enable more to have a “good” (or less bad) death.