Last Rights: Rescuing the End of Life from the Medical System

most people of mature years are loathe to think of what their final weeks or months are likely to be like. This book puts many of these issues in perspective, and I would put it in the category of "required reading" for everyone over fifty. The author has rich experience of dealing with people who either were reasonably well prepared for their last days, or were not prepared at all. This book can help put you in the right category...

Our Mother recently passed away peacefully in the care of Hospice and my Brother. We had opted for Hospice in the final stages of her long and wonderful life. Last Rights gave us so much useful and comforting information during this time. We Highly recommend Last Rights!

This book is excellent for elderly persons and for those with serious illnesses. Kiernan's main point is that death in America is increasingly gradual rather than sudden, and is typically preceded by a long period of illness. Yet most doctors have almost no training at all in the care of terminal patients. The result is that patients frequently suffer unnecessarily. Be warned that some of the stories Kiernan tells of patients' last days in ICUs are nothing short of horrifying. I was stunned to find out that it is common practice for patients who are clearly already dead to have their clothes cut open and their hearts defibrillated and injected with adrenaline.

The American medical system is presently in a state of ever-diminishing returns. Costs keep rising, but health is not substantially improved; in fact, in many cases health is worsened by the aggressive medical interventions so common today. My husband and I spend a substantial chunk of our incomes on insurance for ourselves and our son. Are we getting our money's worth? I don't think so. Kiernan's book makes clear that a large part of the reason is that doctors are too cowardly to face a patient and admit that there isn't much more they can do. The fact is, though, that everyone dies sooner or later. I certainly hope that when my own time comes, I will die pain-free in peaceful surroundings, with music playing and someone there to hold my hand.

As a lawyer myself, I felt that Kiernan had too little to say on the contribution of lawyers to the problem of terminal illness and quality of care at the end of life. I think that one important change that needs to be made is a simple state or federal law that forbids suing a doctor for malpractice if he chooses not to implement certain treatments. I would propose that this list include: all forms of open-heart surgery, including cardiac bypass; heart defibrillation after cardiac arrest; CT and MRI scans; chemotherapy for persons who are over age 70 or who have other serious illnesses; and ICU treatment for persons over age 70 or who are terminally ill. Doctors would still be free to order these treatments if they felt that they were clinically necessary or desirable, but they would no longer have to live in fear of being sued if they don't take every step imaginable.

If you are considering surgery or other high-tech medical treatment, I would suggest pairing this book with The Last Well Person: How to Stay Well Despite the Health-Care System.

This book was just what was needed to reassure our family that our decision for Hospice care was the right course for our elderly parent's end of life. It contained so many good suggestions that we were able to act upon. It helped us all cope with our loss, both before and after the actual death.

I recommend this book HIGHLY if you are facing a similar situation. The constant focus is on Quality of life and comfort during one's last days, just what my father wanted! Very reassuring!

This is a "Must Read" for everyone! As an R.N with 32 years experience (12 yrs critical care & 7 yrs In-Patient Hospice) it is my privilege to endorse this book. Mr. Kiernan has clearly and accurately documented what is a reality that will ultimately affect every single one of us. In both scope and depth Mr. Kiernan has spoken the truth. He has not embellished, exaggerated or dramatized any detail of his book. Every human being deserves to die in peace (spiritual and emotional) and free from pain. This is a goal which is attainable but I can assure you that your chances of experiencing this are not good in any of today's modern acute care hospitals or nursing homes. (There are always exceptions). Hospice care is the only option and that is primarily because hospice is not a place but a philosophy of care. All physicians can manage the care of an acutely ill person but only a few physicians are qualified to manage your care if you are dying because the vast majority of physicians do not recognize or they refuse to accept that there is a difference. Please read this book. It could be one of the most important things you ever do both for yourself and for those whom you love.

Barb Lyons, R.N.