BOOK AND MEDIA REVIEWS

strategies to manage ebbs and flows in revenues. The authors provide approaches to negotiating contracts with insurance companies. In terms of quality assurance, the book explains various methods to evaluate outcomes. Schatman and Campbell’s text may be the most detailed and practical of its kind. It is well written and provides strong evidence for its arguments. Drawing on the expertise of pain medicine specialists with backgrounds in psychology, physical medicine and rehabilitation, and anesthesiology, the book cohesively makes a case for the implementation of MPRPs.
Devi E. Nampiaparampil, MD VA Central California Health Care System Fresno devichechi@hotmail.com
Financial Disclosures: None reported.

TO DIE WELL: YOUR RIGHT TO COMFORT, CALM, AND CHOICE IN THE LAST DAYS OF LIFE
By S. H. Wanzer and J. Glenmullen 209 pp, $24.95 Cambridge, MA, Da Capo Press, 2007 ISBN-13: 978-0-7382-1083-4 We cannot banish dangers, but we can banish fears. We must not demean life by standing in awe of death. David Sarnoff

DURING THEIR LIVES, MOST PERSONS PREFER TO AVOID THINKing about their final destination, but when that destination nears, they begin to grapple and to agonize over concerns and issues that they had previously and intentionally avoided. To Die Well, by Drs Wanzer and Glenmullen, brings needed hope and comfort to those who are near death and to those who attend the dying and are responsible for ensuring that a good death is possible. The book will appeal to patients, their families, and their caregivers. The text is an easy read, allowing one to return to specific chapters to review details that might be fleeting in the narrative. The book is organized around a constellation of factors that surround the dying person, including their rights, needs, and reasonable expectations. Accordingly, the book includes several useful appendices that help inform and educate. I would consider this book as recommended reading for all. Because it will be a source of comfort for anyone approaching death, it will be pragmatic and supportive for loved ones, providing compassionate options and choices.

Early chapters introduce readers to the concepts of “turning points” in the care of the dying person. The first turning point is the realization that further efforts for curative interventions are unreasonable and that ongoing attention needs to promote comfort and pain control. It is difficult to ensure that the dying person’s rights and needs are in sync and aligned with the expectations of all concerned. Eventually, the journey progresses to the point at which the second turning point is reached—where the decision is made to avoid needless suffering and “allow” a merciful death. Such decisions are not made lightly, and the authors explain and illustrate the safeguards that must accompany this turning point. Once the point has been reached, the fundamental question remains as to how one handles death and monitors the process with compassion. The authors remind readers of options for hastening death (such as use of helium) that have been used in the past and examine the associated problems with such interventional measures. This second turning point is affected by special circumstances, including the presence of irreversible cognitive decline and the importance of accurately differentiating between the sadness normally expected at the realization of impending death and true depression in persons who are not medically terminal. Readers are reminded that many of the decisions made around the time of dying can be greatly facilitated and often made easier by the presence of advance directives, such as living wills. The authors emphasize that advance directives allow the dying person the fullest autonomy and control at a point in their lives when the tough choices have already been made and that such documents can still allow changes during the last stages of life. This is a fascinating book, rich with clinical stories. The authors point out that the Oregon experiences with assisted dying need ongoing evaluation to monitor and to prevent possible abuse. They contend that the controversy surrounding the second turning point occurs in fewer cases than widely imagined. Ultimately, readers are provided with a vademecum for death that is gently and compassionately written and will serve those nearing their final destination.
Jack Yensen, PhD, RN Athabasca University Centre for Nursing and Health Studies Vancouver, British Columbia jyensen@shaw.ca
Financial Disclosures: None reported.

©2008 American Medical Association. All rights reserved.

(Reprinted) JAMA, April 16, 2008—Vol 299, No. 15

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