DYING WELL the Prospect for Growth at the End of Life

A doctor who specializes in caring for the dying recounts the stories of his patients and their families in order to illustrate how good medicine can help people face death, resolve conflicts, and facilitate death with clarity and peace.

This study of how to die well displays uncommon vitality. Byock, president elect of the American Academy of Hospice and Palliative Care, is a gifted storyteller. Beginning with his own father's terminal illness, he details without scientific cant the process of decline that awaits most of us. The case studies, which form the humanistic soul of this work, never devolve into the maudlin or saccharine. Life on the edge of the great crossing is explored in all its sadness and pathos, but Byock also makes room for wisdom, hope and even the joy of final understanding. By recounting the passages of patients in his Missoula, Mont., practice, Byock makes a forceful case for hospice care and against physician-assisted suicide. He demonstrates how the physical pain and emotional despair of the dying may be handled. The family constellation of the terminally ill is also analyzed, with emphasis on a hospice's ability, through its doctors, nurses, psychologists and social workers, to help those left behind. Not only is this book informative, especially the question-and-answer section at the end, it is also insightful. Readers will sense Byock's personal growth as his understanding of final issues flowers through a 20-year specialization. Byock recalls his growth from a callow resident to a concerned son and, finally, to a healer with a mission. Whether it's the middle-aged mother who must resolve disillusionment with her sister, the bitter father of three who achieves serenity or the gutsy teenage girl with a rare genetic disease, the people whose sojourns Byock recounts receive from him the dignity they merit. German rights to Kinder Verlag; author tour.
Copyright 1996 Reed Business Information, Inc.

A hospice doctor's wrenching stories of dying patients and their families, which dramatically illustrate his belief that the transition to death can be one of life's most meaningful experiences. Byock, a specialist in palliative care who directs a hospice in Missoula, Mont., has chosen stories that represent a wide range of experiences, each focusing on some aspect of human growth. Pseudonymns are used throughout except for Byock's moving account of his own father's death and the story of the Merseal family, whose dying son was the subject of a 1996 HBO documentary. What is crystal clear in all of them is that the full experience of dying is not captured from a purely medical perspective. Without proper medical care, dying can be agonizing, but relief of physical pain, which Byock contends is always possible, is by no means the whole picture. In his experience, emotional pain is more intense and requires more skillful intervention. Dying well, says Byock, involves reaching certain landmarks, which he encourages his patients to achieve: asking forgiveness, accepting forgiveness, expressing love, acknowledging self-worth, and saying good-bye. One of the hardest to read of Byock's stories describes the death of Terry, a 31-year-old mother with cancer who cannot reach these landmarks and suffers greatly. Her story also illustrates the fine distinction between hastening death and ensuring comfort. Byock, who argues that the euthanasia debate has distracted our attention from more logical and humane approaches, is not afraid to give his considered opinions about assisted suicide, vegetative states, and feeding tubes. Often reminiscent of Michael Kearney's recent Mortally Wounded (p. 1029), which described that doctor's work with patients in an Irish hospice, this is another powerful argument in favor of the hospice movement and rejection of the Kevorkian approach. -- Copyright ©1996, Kirkus Associates, LP. All rights reserved.

Many terminally ill people fear that their last days will be spent as burdens to their families, helpless, without dignity, and in unbearable pain. Often, the only alternative to such a death seems to be assisted suicide. In either situation, the dying person and family members are denied the opportunity to make the most of their remaining lives. Byock, a hospice physician practicing in rural Montana, learned well the possibilities for dying while caring for his father, who died from pancreatic cancer during Byock's medical training. This book tells the story of his father's final illness and those of hospice patients Byock has helped through the dying process. Focusing on the clinical, emotional, and spiritual aspects of death, the stories emphasize Byock's unshakable belief that physical and psychological suffering can always be alleviated through the devoted efforts of hospice caregivers. He offers realistic yet compassionate answers to the hard questions asked by dying patients, their families, and a society unwilling to accept that all life eventually comes to an end. Highly recommended for all collections.?Karen McNally Bensing, Benjamin Rose Inst. Lib., Cleveland
Copyright 1997 Reed Business Information, Inc.

The title identifies the main point of this book: that dying well, not a "good death," should be one's goal at life's end. Byock is a leader in the hospice movement and an experienced frontline physician, and he focuses on the continuous aspect of dying rather than the one-shot of death. First, he stresses, pain must be controlled, and then fear and loneliness reduced. Death, he reminds, is as much a natural part of human life as birth, and both can promote growth and understanding. He describes 12 case histories at length, including that of his father, a rural general practitioner. He punctures many myths as he demonstrates that it is not illegal to die at home, that death by starvation is not necessarily painful, and that addiction to painkilling drugs is not a serious problem for a dying person. Ever honest, he even cites one case in which pain, despite his claims that it can always be controlled, really could not be. William Beatty