REVIEWED BY SYLVIA A. MCSKIMMING, PhD, RN
A Good Death: Challenges, Choices and Care Options
Twenty-Third Publications, Mystic, CT
1998, 57 pp., $6.95 (paperback)
In the introduction to this volume the author states that Americans consider an ideal, good death to be quick, painless, at home, and surrounded by family. He then challenges the reality of this occurring by stating that 85 percent of us die in medical settings, including hospitals, nursing homes, and skilled care facilities. His purpose in this book is to describe more fully the actual experience of dying in these medical settings compared to dying at home and to provide the reader with guidelines to achieve a "good death" regardless of where the death occurs.
Within the space of 57 pages the reader receives a historical review of significant shifts in the focus of healthcare; a description of the issues that someone would face when dying in medical settings; a review of alternative or complementary therapies; a description of arguments for and against euthanasia and challenges to good pain management; a description of the role of spirituality during dying; and hints for obtaining a good death. These chapters are concise and factual.
Although the author states this book is designed to help someone achieve a good death, it is difficult to determine whether the audience for this book is the lay public or professionals. The content provides useful background for someone who needs to understand a context of our current healthcare system, but violates principles of good "patient teaching" — to keep it simple and focus on need-to-know information. Nice-to-know information should be placed at the end or within an appendix. Chapters describing how we die and strategies to obtain a good death would be more focused for lay readers if they were presented first, followed by the chapter on spirituality. While they contain useful information, the remaining chapters are superfluous to the main thesis. They would best be presented within the appendixes.
This book provides little new information for informed healthcare professionals and might be confusing for people looking for a guide to ensuring a quick, painless death at home surrounded by family for themselves and their loved ones. I would recommend this book cautiously to the audience for whom it was intended.
Sylvia A. McSkimming, PhD
Supportive Care of the Dying: A Coalition for Compassionate Care
Copyright © 1999 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.