What do you think?
Rate this book
The Way We Die Now: The View from Medicine's Front Line
We have lost the ability to deal with death. Most of our friends and beloved relations will die in a busy hospital in the care of strangers, doctors, and nurses they have known at best for a couple of weeks. They may not even know they are dying, victims of the kindly lie that there is still hope. They are unlikely to see even their family doctor in their final hours, robbed of their dignity and fed through a tube after a long series of excessive and hopeless medical interventions.
This is the starting point of Seamus O’Mahoney’s The Way We Die Now, a thoughtful, moving and unforgettable book on the western way of death. Dying has never been more public, with celebrities writing detailed memoirs of their illness, but in private we have done our best to banish all thought of dying and made a good death increasingly difficult to achieve.
305 pages, Kindle Edition
First published May 5, 2016
71 people are currently reading
807 people want to read
Ratings & Reviews
Friends & Following
Create a free account to discover what your friends think of this book!
Community Reviews
Displaying 1 - 30 of 74 reviews
December 14, 2016
O’Mahony is a gastroenterologist and surgeon at Cork University Hospital. He is well placed to survey Western attitudes to death and medical intervention, and also gives personal anecdotes relating to his patients and family members. The main reason I can’t rate this any higher is that I’ve read much more engaging books that cover a lot of the same material, especially Being Mortal by Atul Gawande and The Violet Hour by Katie Roiphe.
I also had trouble relating to the author’s perspective at times. For instance, he dismisses both euthanasia and advanced directives as misguided attempts to maintain control (his reasoning behind the latter seems to be that death never goes how we expect it to). “Death may not be the inevitable conclusion to the broad narrative sweep of one’s life. It is more commonly banal – just another episode.” The cynicism grated on me. O’Mahony may well be right about all of this, but he doesn’t really offer any concrete suggestions in this short book. He just concludes that medicine has its limitations when dealing with death, but so do any of the splinter movements.
[Food for thought, quoted in this book from The Top Five Regrets of the Dying: “(1) I wish I’d had the courage to live a life true to myself, not the life others expected of me; (2) I wish I hadn’t worked so hard; (3) I wish I’d had the courage to express my feelings; (4) I wish I’d stayed in touch with my friends; (5) I wish I’d let myself be happier.”]
I also had trouble relating to the author’s perspective at times. For instance, he dismisses both euthanasia and advanced directives as misguided attempts to maintain control (his reasoning behind the latter seems to be that death never goes how we expect it to). “Death may not be the inevitable conclusion to the broad narrative sweep of one’s life. It is more commonly banal – just another episode.” The cynicism grated on me. O’Mahony may well be right about all of this, but he doesn’t really offer any concrete suggestions in this short book. He just concludes that medicine has its limitations when dealing with death, but so do any of the splinter movements.
[Food for thought, quoted in this book from The Top Five Regrets of the Dying: “(1) I wish I’d had the courage to live a life true to myself, not the life others expected of me; (2) I wish I hadn’t worked so hard; (3) I wish I’d had the courage to express my feelings; (4) I wish I’d stayed in touch with my friends; (5) I wish I’d let myself be happier.”]
April 28, 2016
I found this book to be an honest, frank and open discussion about the difficulties surrounding death, and the fears and dilemmas that confront the Medical and Nursing professions on a daily basis. I have been nursing for over 30 years and I still wonder' what is a good death'? My in laws both literally dropped down dead due to a heart attack( MI) and brain aneurysm that left us with no chance to say goodbye. My parents suffered long drawn out illnesses, cancer of the bowel that resulted in carcinomatosis and Parkinson's Disease, that left my Dad unable to eat, drink, speak and at risk of choking in his own secretions. I had plenty of time to say goodbye, but I would have willingly forgone that dubious pleasure as his illness progressed.
Milton Jones, an English comedian, has stated that being surrounded by family is a major cause of death, and that produces a wry smile, as most deaths occur in busy hospitals or hospices and very rarely do the dying get to die peacefully, at home , with loved ones around them. We are all so busy and scared of confronting the grim reaper. We want to live forever and as medical advances create new ways of extending life for so many groups of people, why should this not be so?
I knit outfits for my local neonatal group, for babies born so early, normal clothes don't fit them. Years ago such infants would not have survived, indeed, some are living from the same criteria that abortions are performed. That entails months of nursing, specialised equipment, and home adaptations in severe cases, special schools and the death of hopes and dreams of a ' normal' future but this is considered progress. The rise of the Swiss clinic Dignitas is an unexpected side effect of these illnesses that a life has been saved, but was it the right and kindest choice?
When I was confronted with a severely ill patient, it was always desirable to have a clear directive about DNAR orders, especially working on ICU wards. That meant you could give the best care, secure in the knowledge that you would not be called upon to perform CPR, crack a few ribs and make a dying persons last moments of life extremely painful. The Liverpool Care Pathway has been discredited, but ironically it gave the opportunity to give good personalised care, away from un necessary medications and fluids, indeed some patients rallied enough to be moved back onto normal wards and survived a poor prognosis.
Religion and rituals help the bereaved. I have always argued that communication is the most important thing you can do for the dying and their loved ones. Ask how they want to be treated, do they want the indignity of resuscitation, would they like an operation or just say, ' That's enough'. Do they want to be nursed at home, some prefer not to be a burden on family but in everything, choice should be available.
This book confronts a difficult situation that we will all experience. It shows that there is no right answer, we all have different expectations and many of us are unduly influenced by medical programmes on television that usually show successful outcomes. But death is not like that, and this book gives no easy answers but does make you think, and if it helps to create more honest conversations with loved ones, it will have done its job.
Milton Jones, an English comedian, has stated that being surrounded by family is a major cause of death, and that produces a wry smile, as most deaths occur in busy hospitals or hospices and very rarely do the dying get to die peacefully, at home , with loved ones around them. We are all so busy and scared of confronting the grim reaper. We want to live forever and as medical advances create new ways of extending life for so many groups of people, why should this not be so?
I knit outfits for my local neonatal group, for babies born so early, normal clothes don't fit them. Years ago such infants would not have survived, indeed, some are living from the same criteria that abortions are performed. That entails months of nursing, specialised equipment, and home adaptations in severe cases, special schools and the death of hopes and dreams of a ' normal' future but this is considered progress. The rise of the Swiss clinic Dignitas is an unexpected side effect of these illnesses that a life has been saved, but was it the right and kindest choice?
When I was confronted with a severely ill patient, it was always desirable to have a clear directive about DNAR orders, especially working on ICU wards. That meant you could give the best care, secure in the knowledge that you would not be called upon to perform CPR, crack a few ribs and make a dying persons last moments of life extremely painful. The Liverpool Care Pathway has been discredited, but ironically it gave the opportunity to give good personalised care, away from un necessary medications and fluids, indeed some patients rallied enough to be moved back onto normal wards and survived a poor prognosis.
Religion and rituals help the bereaved. I have always argued that communication is the most important thing you can do for the dying and their loved ones. Ask how they want to be treated, do they want the indignity of resuscitation, would they like an operation or just say, ' That's enough'. Do they want to be nursed at home, some prefer not to be a burden on family but in everything, choice should be available.
This book confronts a difficult situation that we will all experience. It shows that there is no right answer, we all have different expectations and many of us are unduly influenced by medical programmes on television that usually show successful outcomes. But death is not like that, and this book gives no easy answers but does make you think, and if it helps to create more honest conversations with loved ones, it will have done its job.
September 5, 2023
In brief - If the title/idea interests you then you'll probably enjoy it.
This book opens with a good introduction as to what the book is about and what the author intends to cover in it. It suggests that, while there is much in this that is medical, it is to be more personal than medical while covering some recent headline medical issues. For me it felt like a remarkably honest account of a number of interactions that this doctor has had with death and dying patients. I already realised before reading this book that the real taboo subject these days is death and this book has simply born out that feeling.
The book is actually remarkably wide ranging covering literature, culture & religion, celebrity deaths, enquiries into medical/hospital issues as well as the philosophy of death more widely. The initial chapter takes a look at how (& where) our lives usually end in current times. That is followed by a chapter looking at the views of 4 modern day (20C) writers on dying under the general heading of "Hidden death". The current approach of sanitising and hiding death is compared to earlier times when public acceptance was part of life. There is an Irish Catholic background here which influences the book to some degree and so the fact that the book looks into the rituals of death that are now becoming increasing absent such as the Wake is no surprise. The book is peppered with stories about dying including those who are well know as well as those who are quite ordinary people. I certainly found many of these very interesting and often thought provoking.
The book looks at two of the high profile and widely publicised cases of the "Stafford hospital scandal" and the Liverpool Core Pathway. In both cases the author looks at issues that have been well understood in both these cases. However he also looks at aspects that have been less well publicised and understood even. There are critiques of both these issues as well.
Running through this book is an insight into dealing with seriously ill people within the NHS including health workers attitudes to dignity & dying and thoughts on empathy. Hospital and hospice deaths are looked at together, to some degree, with their outcomes. There are some thoughts on the time for syringe drivers, having the "difficult" conversation with patients coupled with the fact that palliative care should be part of most doctors duties. With noting in this that the author states that in his opinion "Our job should be the treatment of illness " and that dangers await if doctors go beyond that. Unsurprisingly advanced directives are considered as well as assisted dying. However the author makes the point that, whether satisfactory legality of actions can be established or not, such ideas cannot take into account the full range of possibilities that may face someone (& their doctors) towards the end of life.
The book ends with "some proposals" the author noting a caveat that, by the end of the work on this book he is "no wiser, but considerably better informed". I found his conclusions simple and worth reading personally. Indeed I found the whole book well worth reading. Some chapters did not interest me quite as much as others however those that did I found rewarding in many senses. Certainly I too am better informed now. Obviously this is not a book for everyone - despite that fact that we will all die at some stage. However for those either within a medical background or those outside with an interest should find this book a worthwhile read.
Note - I received an advance digital copy of this book from the publisher in exchange for a fair review
This book opens with a good introduction as to what the book is about and what the author intends to cover in it. It suggests that, while there is much in this that is medical, it is to be more personal than medical while covering some recent headline medical issues. For me it felt like a remarkably honest account of a number of interactions that this doctor has had with death and dying patients. I already realised before reading this book that the real taboo subject these days is death and this book has simply born out that feeling.
The book is actually remarkably wide ranging covering literature, culture & religion, celebrity deaths, enquiries into medical/hospital issues as well as the philosophy of death more widely. The initial chapter takes a look at how (& where) our lives usually end in current times. That is followed by a chapter looking at the views of 4 modern day (20C) writers on dying under the general heading of "Hidden death". The current approach of sanitising and hiding death is compared to earlier times when public acceptance was part of life. There is an Irish Catholic background here which influences the book to some degree and so the fact that the book looks into the rituals of death that are now becoming increasing absent such as the Wake is no surprise. The book is peppered with stories about dying including those who are well know as well as those who are quite ordinary people. I certainly found many of these very interesting and often thought provoking.
The book looks at two of the high profile and widely publicised cases of the "Stafford hospital scandal" and the Liverpool Core Pathway. In both cases the author looks at issues that have been well understood in both these cases. However he also looks at aspects that have been less well publicised and understood even. There are critiques of both these issues as well.
Running through this book is an insight into dealing with seriously ill people within the NHS including health workers attitudes to dignity & dying and thoughts on empathy. Hospital and hospice deaths are looked at together, to some degree, with their outcomes. There are some thoughts on the time for syringe drivers, having the "difficult" conversation with patients coupled with the fact that palliative care should be part of most doctors duties. With noting in this that the author states that in his opinion "Our job should be the treatment of illness " and that dangers await if doctors go beyond that. Unsurprisingly advanced directives are considered as well as assisted dying. However the author makes the point that, whether satisfactory legality of actions can be established or not, such ideas cannot take into account the full range of possibilities that may face someone (& their doctors) towards the end of life.
The book ends with "some proposals" the author noting a caveat that, by the end of the work on this book he is "no wiser, but considerably better informed". I found his conclusions simple and worth reading personally. Indeed I found the whole book well worth reading. Some chapters did not interest me quite as much as others however those that did I found rewarding in many senses. Certainly I too am better informed now. Obviously this is not a book for everyone - despite that fact that we will all die at some stage. However for those either within a medical background or those outside with an interest should find this book a worthwhile read.
Note - I received an advance digital copy of this book from the publisher in exchange for a fair review
July 1, 2017
One of the most thought provoking books that I have ever read on the taboo subject of death and how modern medicine (and often pressure from relatives and/or the law) makes doctors keep patients alive at all costs with almost no consideration of quality of life (or death). It's apparently very hard to die a "good death" these days, at home surrounded by family and friends. Depressing but a must read and one that I couldn't put down once I'd started it (read it in one evening plus a couple of hours the following morning).
June 25, 2022
A thought provoking book by an Irish doctor, who has many years experience working in Ireland and in the UK’s NHS. In this book, he proposes that modern society has a warped relationship with death. He discusses several concepts such as assisted suicide, when to withdraw care from a dying individual and the general sense of denial people have of their own morality.
October 11, 2018
The Way We Die Now is not the best book I’ve read this year but it may be the most important. In Seamus O’Mahony’s opinion, modern society has forgotten how to deal with death. There are many reasons for this, the collapse of religious belief, the demolition of the extended family, the triumph of the scientific and rational worldview, even our delusions of curing death “real soon now” contribute to our collective denial. Yet death persists. Death remains absolute, sovereign, implacable, terrifying, “majestic and cruel.” Even if we realize our singularity fantasies and greatly extend life death will never be banished. Even the gods die! We must face death, but must we turn it into a carnival of “medical excess?”
I have seen medical excess. My mother was diagnosed with Stage IV Glioblastoma: a form of brain cancer that is so deadly it’s been nicknamed the terminator. Actually, the terminator is flattered by the comparison. Some survived their encounter with fictional terminators. Nobody survives stage IV Glioblastoma: “there is no stage V.” When I heard mom’s diagnosis I looked for actuarial survival statistics. Credible statistics for common fatal diseases are harder to track down than you might expect. I eventually found a paper that cast survival times in a useful form. Median survival was less than three months for younger and healthier patients than my mother. She died about two months after her diagnosis – right on statistical schedule. The universe does not make personal exemptions.
Her death was inevitable, but the expensive, futile, painful and isolating medical gauntlet she endured was not. She just wanted to go home, perhaps to “turn her head to the wall,” perhaps to binge on The Big Bang Theory – she still enjoyed a few silly shows. It doesn’t matter what the dying choose to do with their remaining hours, but it sure as hell matters that we honor their choices and the Way We Die Now makes a compelling case that we are failing “to be brave.” I know I acquiesced to the medial default for my mother; I still feel I should have fought harder for what she wanted.
According to O’Mahony, the medical default is full intervention even when it’s pointless and wasteful. He also notes that doctors are in a no-win situation. If they suggest doing nothing they’re accused of euthanizing patients. If they go full interventionist Rambo they’re inflicting needless suffering and profiting from the dying. Both extremes often end up in court, as if we could fix death with more litigation. Obviously, something in the middle is the best course and O’Mahony argues that doctors should not set the middle course.
Our infantile society needs to grow up and face death like adults. Nothing makes our magical thinking about death clearer than Somerset Maugham’s1 observations about a “dog’s death.” Maugham hoped he was lucky enough to die a dog’s death! A dog’s death is meant to be a horrible thing but is it really worse than human medical excess? When it comes to sick animals we are clear-headed and compassionate. We don’t subject them to futile treatments, we make them comfortable and take away their pain. I once had a cat that came down with pancreatitis. She wasted away on the top of our fridge until one day we took her to the vet. Her death was calm and without terror. My cat had a better death than my mother. I suspect many pets die with greater dignity than their owners. This is fundamentally wrong and we all know it.
There are no easy answers; it sucks to be mortal. We can’t say until we face it ourselves how we should die so how can we dictate to others? I only hope that when my time comes I have it within me to follow the one bit of advice O’Mahony offers that may apply to all us – “be brave.”
Cross posted to: analyzethedatanotthedrivel.org
I have seen medical excess. My mother was diagnosed with Stage IV Glioblastoma: a form of brain cancer that is so deadly it’s been nicknamed the terminator. Actually, the terminator is flattered by the comparison. Some survived their encounter with fictional terminators. Nobody survives stage IV Glioblastoma: “there is no stage V.” When I heard mom’s diagnosis I looked for actuarial survival statistics. Credible statistics for common fatal diseases are harder to track down than you might expect. I eventually found a paper that cast survival times in a useful form. Median survival was less than three months for younger and healthier patients than my mother. She died about two months after her diagnosis – right on statistical schedule. The universe does not make personal exemptions.
Her death was inevitable, but the expensive, futile, painful and isolating medical gauntlet she endured was not. She just wanted to go home, perhaps to “turn her head to the wall,” perhaps to binge on The Big Bang Theory – she still enjoyed a few silly shows. It doesn’t matter what the dying choose to do with their remaining hours, but it sure as hell matters that we honor their choices and the Way We Die Now makes a compelling case that we are failing “to be brave.” I know I acquiesced to the medial default for my mother; I still feel I should have fought harder for what she wanted.
According to O’Mahony, the medical default is full intervention even when it’s pointless and wasteful. He also notes that doctors are in a no-win situation. If they suggest doing nothing they’re accused of euthanizing patients. If they go full interventionist Rambo they’re inflicting needless suffering and profiting from the dying. Both extremes often end up in court, as if we could fix death with more litigation. Obviously, something in the middle is the best course and O’Mahony argues that doctors should not set the middle course.
Our infantile society needs to grow up and face death like adults. Nothing makes our magical thinking about death clearer than Somerset Maugham’s1 observations about a “dog’s death.” Maugham hoped he was lucky enough to die a dog’s death! A dog’s death is meant to be a horrible thing but is it really worse than human medical excess? When it comes to sick animals we are clear-headed and compassionate. We don’t subject them to futile treatments, we make them comfortable and take away their pain. I once had a cat that came down with pancreatitis. She wasted away on the top of our fridge until one day we took her to the vet. Her death was calm and without terror. My cat had a better death than my mother. I suspect many pets die with greater dignity than their owners. This is fundamentally wrong and we all know it.
There are no easy answers; it sucks to be mortal. We can’t say until we face it ourselves how we should die so how can we dictate to others? I only hope that when my time comes I have it within me to follow the one bit of advice O’Mahony offers that may apply to all us – “be brave.”
Cross posted to: analyzethedatanotthedrivel.org
October 23, 2016
I feel a bit awkward saying that I like this genre of book, but I think it is the type of book everybody should read and discuss with their friends and family. Seamus O'Mahony is a gastroenterologist who has worked hospitals in England and Ireland and is able to draw on his own personal experiences of dealing with many patients at the end of their lives. In this book, he looks at the way we die, and how there is a myth around the good death, the one we picture of dying peacefully in bed in white linens, holding a loved ones hand and quietly slipping away. In reality for many patients, death may be painful, and drawn out by unnecessary and expensive treatments that may not gain any additional time or benefit for the patient.
It did bring me close to tears on several occasions, after witnessing my dads death this year and made me think about what I would want for myself if I were able to any input. He describes how although now doctors are much better at discussing prognosis with patients and families there still needs to be a better system of being honest about risk benefits of undergoing further treatments/procedures and having honest discussions about facing death.
It did bring me close to tears on several occasions, after witnessing my dads death this year and made me think about what I would want for myself if I were able to any input. He describes how although now doctors are much better at discussing prognosis with patients and families there still needs to be a better system of being honest about risk benefits of undergoing further treatments/procedures and having honest discussions about facing death.
June 10, 2016
I read this marvellous book in less than 48 hours, which is unusual for me. I'm reviewing it for Medical Humanities and have written much of my review. I'm not being paid for the review (except in that I got a free copy of the book), and I'm not even sure it will be open access. Once I've written and submitted the review, which probably won't appear for about six months (that being the way of journals), I'll write something that doesn't overlap, post it on the BMJ site, and add a note here.
March 14, 2020
This was a fine book. A lot of the points were incredibly interesting and I learned a lot. However, there were moments where I felt like there were aspirations of grandeur, linguistically, that oversimplified and generalized.
February 8, 2020
Dr. O’Mahony is frustrated. Anyone who has ever worked with the public in any capacity will be able to sympathise. The overwhelming majority of people are decent but a small minority can make life very tiresome.
He wants to adopt a common-sense approach to death and bring an end to what he calls the big lie. A conspiracy of delusion in which the doctors, patients, and family indulge themselves. A belief that somehow death can be conquered when it can't. Death is messy, very messy and often terrifying. There is no easy neatly wrapped solution here.
His basic premise is we should demedicalise death for the elderly and terminally ill. Return to a ‘tame death’, Turn our face to the wall and drift off. Stop treatment and let nature take its course. He describes needless (and painful)interventions which result in extending years but leave the patient raving.
His most striking belief (and I think his most apt) is that 75 is more or less long enough of a life. One should really be ready to go after that, stay away from acute hospitals and head towards palliative or hospice care. He is quite opposed to assisted suicide nevertheless which is a thorny subject but his reasons are sound.
After my experience with my own parents, I tend to agree. Though, when it's my time, who knows what my attitude will be?
A very Irish centric book which I have to recommend obviously, hailing myself not only from Cork also but called O’Mahony. My bias aside I think this is a worthwhile read for anyone of any nationality.
He wants to adopt a common-sense approach to death and bring an end to what he calls the big lie. A conspiracy of delusion in which the doctors, patients, and family indulge themselves. A belief that somehow death can be conquered when it can't. Death is messy, very messy and often terrifying. There is no easy neatly wrapped solution here.
His basic premise is we should demedicalise death for the elderly and terminally ill. Return to a ‘tame death’, Turn our face to the wall and drift off. Stop treatment and let nature take its course. He describes needless (and painful)interventions which result in extending years but leave the patient raving.
His most striking belief (and I think his most apt) is that 75 is more or less long enough of a life. One should really be ready to go after that, stay away from acute hospitals and head towards palliative or hospice care. He is quite opposed to assisted suicide nevertheless which is a thorny subject but his reasons are sound.
After my experience with my own parents, I tend to agree. Though, when it's my time, who knows what my attitude will be?
A very Irish centric book which I have to recommend obviously, hailing myself not only from Cork also but called O’Mahony. My bias aside I think this is a worthwhile read for anyone of any nationality.
February 27, 2022
I’ve wanted to read this for some time as I loved another book by this author, Can Medicine be Cured? I’ve been doing some work in a children’s hospice for the last six months and this felt a good time to start reading about death.
I thought the first half was very interesting looking at cultural and societal shifts away from the ritual of religion around death and how hospitals and moreover medicine has stepped in to replace it. The medicalisation of death is something I’ve felt very drawn into as a doctor.
The second half of the book dropped off though for me and it felt a bit padded out. Overall though I’m glad I read it but it doesn’t quite stand up to others on this subject.
I thought the first half was very interesting looking at cultural and societal shifts away from the ritual of religion around death and how hospitals and moreover medicine has stepped in to replace it. The medicalisation of death is something I’ve felt very drawn into as a doctor.
The second half of the book dropped off though for me and it felt a bit padded out. Overall though I’m glad I read it but it doesn’t quite stand up to others on this subject.
November 5, 2017
The author is a practicing physician in Ireland. He takes this opportunity to look at death and how we handle it. He makes some interesting points and some good advice about how to handle this difficult time in anyone's life. Having just gone through this process with my father, I disagree with some of his conclusions and am glad that my father died at home as he wished, no matter how difficult it was for us. It was well worth our effort to be with him through this whole process. It was still an interesting read.
August 16, 2016
3.5 but probably read too quickly
March 13, 2024
Ett slags kontemplation över samhällets och vårdens valhänthet kring döden. Inga egentliga svar utan mer kloka tankar. Lysande, rekommenderas!
August 10, 2025
This was a thought provoking read and quite beautifully written. The author masterfully disects the way society looks at death in all its facets. I'll be thinking about this for a while.
January 21, 2021
The title of this book, on first reading, said to me “this is a book that needed to be written and everyone needs to read’…
However the book is more about accepting death and whether or not we wage war on it, rather on ‘how we die now’ perse.
The book focusses mostly on cancer, which I guess is because it deals with people who have warning about their death and can plan it, to some extent. It provides example, after example, after example of people who refuse to face death (or their spouses) and those who go to court in an attempt to gain a controlled ‘medical assisted’ death. But the book fails to really demonstrate how this move is not really of benefit to them or the health industry. Mostly the book weighs too heavily on the description of the patient’s fight, rather than the implications.
The repetition of examples, such as elderly nursing home residents presenting to ED, meant I found myself skipping pages from about page 150 onwards (out of 270 pages). The book could have been edited down to about 2/3 of what was finally published then it would have more impact, without the excessive repetition.
The author draws on examples of deaths (well really these are examples of acceptance/ or not, of death) from two professions. Philosophers and medical doctors. He starts with philosophy as historically many famous ones (Socrates etc) embraced death, then he summaries the deaths of at least 10 famous philosophers, who all lived in the 15th or 16th century. At a time with little available medical treatments. He concludes the philosophers did not all embrace death and the deaths were varied, some embracing and some not. So it was not really about how they died, which would have clearly been without hospitals or medicine, but if they accepted death or tried to fight it.
The author then repeats the process for doctors, whom he declares are the most knowledgeable about their condition so they can make the most educated assessment of their prognosis. Again he concludes they are a varied bunch and where not homogenous in their approaches to death ( really their acceptance of it).
I found the deep dives into these 2 professions tiresome and largely irrelevant. Not sure why he included a chapter on how doctors accept / don’t accept death with way too many examples.. then concludes that they are varied and some accept death and others don’t. This conclusion comes as no surprise to me, but it really was to him! Ie it is established and fairly well known that psychologists, who are experts in relationships and counselling, report the same divorce rate as the rest of the population. This is of no big surprise as they are a diverse group within a profession! So it doesn’t surprise me that medical professionals will also follow that trend and have the same variation… yet the author struggles to grasp this! He states that medical doctors have access to all the knowledge to make an educated assessment of their prognosis, so I guess he expected them to be rational and reasonable at the end, to accept death and move to a comfortable hospice and die surrounded by loved ones. But of course many are determined to live and battle on, only to die in an acute hospital ward, alone.
Personally, I would prefer to read the accounts of alternative groups, as this group profess to often defeat cancer using alternate means, ie eating organic food and embracing spiritual rituals. So then, do the people who reject scientific methodology die peacefully surrounded by crystals? Or are they much the same as everyone else, a diverse group after all?
However the book is more about accepting death and whether or not we wage war on it, rather on ‘how we die now’ perse.
The book focusses mostly on cancer, which I guess is because it deals with people who have warning about their death and can plan it, to some extent. It provides example, after example, after example of people who refuse to face death (or their spouses) and those who go to court in an attempt to gain a controlled ‘medical assisted’ death. But the book fails to really demonstrate how this move is not really of benefit to them or the health industry. Mostly the book weighs too heavily on the description of the patient’s fight, rather than the implications.
The repetition of examples, such as elderly nursing home residents presenting to ED, meant I found myself skipping pages from about page 150 onwards (out of 270 pages). The book could have been edited down to about 2/3 of what was finally published then it would have more impact, without the excessive repetition.
The author draws on examples of deaths (well really these are examples of acceptance/ or not, of death) from two professions. Philosophers and medical doctors. He starts with philosophy as historically many famous ones (Socrates etc) embraced death, then he summaries the deaths of at least 10 famous philosophers, who all lived in the 15th or 16th century. At a time with little available medical treatments. He concludes the philosophers did not all embrace death and the deaths were varied, some embracing and some not. So it was not really about how they died, which would have clearly been without hospitals or medicine, but if they accepted death or tried to fight it.
The author then repeats the process for doctors, whom he declares are the most knowledgeable about their condition so they can make the most educated assessment of their prognosis. Again he concludes they are a varied bunch and where not homogenous in their approaches to death ( really their acceptance of it).
I found the deep dives into these 2 professions tiresome and largely irrelevant. Not sure why he included a chapter on how doctors accept / don’t accept death with way too many examples.. then concludes that they are varied and some accept death and others don’t. This conclusion comes as no surprise to me, but it really was to him! Ie it is established and fairly well known that psychologists, who are experts in relationships and counselling, report the same divorce rate as the rest of the population. This is of no big surprise as they are a diverse group within a profession! So it doesn’t surprise me that medical professionals will also follow that trend and have the same variation… yet the author struggles to grasp this! He states that medical doctors have access to all the knowledge to make an educated assessment of their prognosis, so I guess he expected them to be rational and reasonable at the end, to accept death and move to a comfortable hospice and die surrounded by loved ones. But of course many are determined to live and battle on, only to die in an acute hospital ward, alone.
Personally, I would prefer to read the accounts of alternative groups, as this group profess to often defeat cancer using alternate means, ie eating organic food and embracing spiritual rituals. So then, do the people who reject scientific methodology die peacefully surrounded by crystals? Or are they much the same as everyone else, a diverse group after all?
May 1, 2018
This was an uncomfortable read, which is precisely the author's point. This is a topic we avoid and sweep under the rug, and it leads to many problems with how we treat the elderly, for example.
I took issue with the author's obvious disdain for secularization. For the most part this was very low-key, but every so often there was a passage that made me bristle and want to argue with him. I disagree very much with his stance on physician-assisted suicide, but he did make some valid points that make me want to explore the issue more thoroughly.
I don't share his dismissal of modern trends in gene therapy, etc., nor of his obvious disdain for socialized medicine. I think the problem is exactly what he describes: the expectation at large that every patient should always get the maximum intervention possible, which results in tremendous unnecessary strain on what people don't often realize are limited resources.
This is where the big attacks on socialized healthcare come from: Denying your infant born without 90% of its brain pointless treatment so it dies in 4 months instead of today is seen as heartless, when in fact it's just rational. Even in a purely free market, the number of doctors, beds, etc. are still limited, even if you're paying yourself. You are using up a resource for a pointless endeavor that could actually benefit another patient, simply to meet your high expectations that everything be done regardless of its efficacy.
The author comes close to the point, but misses it, I think. It's not the fault of socialized medicine that the system is inefficient. It would run perfectly fine if we didn't have to tiptoe around every potential controversy for "killing grandma" and having "death panels".
It's simply a symptom of a larger societal issue that we think living in a democracy implies every topic is democratic, including our medical care. We need to relearn how to defer to experts, and allow doctors to deliver bad news and make tough decisions free of emotional entanglement. Similar to how colleges have morphed under pressure to treat students like customers, healthcare needs to recognize this troubling pattern and make corrections and stop catering to the unrealistic expectations of the uninformed.
So I guess we agree that socialized medicine isn't perfect, and that is has obvious flaws due to this trend of over-treatment. But I think the answer isn't in the American system, either, and instead lies in fixing a broken culture.
This was the most enjoyable read I've had where I've been distinctly uncomfortable throughout, for sure. It made me think, and it was a topic where I didn't have to agree with the author fully to listen to what he had to say. He made some very valid points that make me rethink some of my own opinions.
It pays to read something by someone you don't fully agree with, and it's very worthwhile to think about the topic of death that we try to avoid at all costs.
I took issue with the author's obvious disdain for secularization. For the most part this was very low-key, but every so often there was a passage that made me bristle and want to argue with him. I disagree very much with his stance on physician-assisted suicide, but he did make some valid points that make me want to explore the issue more thoroughly.
I don't share his dismissal of modern trends in gene therapy, etc., nor of his obvious disdain for socialized medicine. I think the problem is exactly what he describes: the expectation at large that every patient should always get the maximum intervention possible, which results in tremendous unnecessary strain on what people don't often realize are limited resources.
This is where the big attacks on socialized healthcare come from: Denying your infant born without 90% of its brain pointless treatment so it dies in 4 months instead of today is seen as heartless, when in fact it's just rational. Even in a purely free market, the number of doctors, beds, etc. are still limited, even if you're paying yourself. You are using up a resource for a pointless endeavor that could actually benefit another patient, simply to meet your high expectations that everything be done regardless of its efficacy.
The author comes close to the point, but misses it, I think. It's not the fault of socialized medicine that the system is inefficient. It would run perfectly fine if we didn't have to tiptoe around every potential controversy for "killing grandma" and having "death panels".
It's simply a symptom of a larger societal issue that we think living in a democracy implies every topic is democratic, including our medical care. We need to relearn how to defer to experts, and allow doctors to deliver bad news and make tough decisions free of emotional entanglement. Similar to how colleges have morphed under pressure to treat students like customers, healthcare needs to recognize this troubling pattern and make corrections and stop catering to the unrealistic expectations of the uninformed.
So I guess we agree that socialized medicine isn't perfect, and that is has obvious flaws due to this trend of over-treatment. But I think the answer isn't in the American system, either, and instead lies in fixing a broken culture.
This was the most enjoyable read I've had where I've been distinctly uncomfortable throughout, for sure. It made me think, and it was a topic where I didn't have to agree with the author fully to listen to what he had to say. He made some very valid points that make me rethink some of my own opinions.
It pays to read something by someone you don't fully agree with, and it's very worthwhile to think about the topic of death that we try to avoid at all costs.
February 22, 2023
This book, now having read a few palliative care books, is visibly weaker and probably a bit more introductory and self-serving.
Dr O'Mahony in the beginning highlights that his book is a perspective on death and dying from a non-specialist's experience. I was excited to see what his views were. The introduction I thought was very good and set up the book well. However, this book quickly devolves into the cliché of non-focused, stream-of-consciousness, anecdotal, info-dumping soup.
I found the focus of the book hard to pin-point, it seemingly tried to talk a bit about everything - death and dying is too broad a topic to just 'go with the flow'. I also didn't feel like his anecdotal stories were always relevant or meaningfully explored enough. Those moments were placed between factual information, it made the writing jarring to read. Dr O'Mahony also has a slightly more cynical view to modern palliative care and doubts about whether we can truly (to paraphrase) reclaim death and dying from the medical institutions. That was an interesting and refreshing take, but again it could have been explored even more...
I think the biggest problem for me was that there wasn't really a linear flow, or a timeline or obvious progression. I didn't feel like I was being taken on a journey. There were observations that at times were quite insightful, but the rest didn't really evoke anything new or emotive.
I appreciate the addition of the book in the conversation but I am also glad to see that we now have better books that deal with subject matter in a more helpful way.
Dr O'Mahony in the beginning highlights that his book is a perspective on death and dying from a non-specialist's experience. I was excited to see what his views were. The introduction I thought was very good and set up the book well. However, this book quickly devolves into the cliché of non-focused, stream-of-consciousness, anecdotal, info-dumping soup.
I found the focus of the book hard to pin-point, it seemingly tried to talk a bit about everything - death and dying is too broad a topic to just 'go with the flow'. I also didn't feel like his anecdotal stories were always relevant or meaningfully explored enough. Those moments were placed between factual information, it made the writing jarring to read. Dr O'Mahony also has a slightly more cynical view to modern palliative care and doubts about whether we can truly (to paraphrase) reclaim death and dying from the medical institutions. That was an interesting and refreshing take, but again it could have been explored even more...
I think the biggest problem for me was that there wasn't really a linear flow, or a timeline or obvious progression. I didn't feel like I was being taken on a journey. There were observations that at times were quite insightful, but the rest didn't really evoke anything new or emotive.
I appreciate the addition of the book in the conversation but I am also glad to see that we now have better books that deal with subject matter in a more helpful way.
June 10, 2022
Interesting, however too philosophical and repetitive in parts. It also reads much like a treatise on death, rather than a study of it, which can be off-putting in parts.
Although much of O’Mahoney’s arguments are well-founded, some are circular. For example, in talking about breaking bad news to patients, the author describes a conversation with Dr. Susan Block, a palliative care specialist: “"You have to understand", Block told me, "A family meeting is a procedure, and it requires no less skill than performing an operation." Apart from the self-regard of this assertion, it is indicative of a rather worrying trend: namely, the notion that palliative care specialists such as Block are the most skilled and best trained to have the Difficult Conversation. I do not believe that doctors can be taught to do this. There are as many different Difficult Conversations as there are patients. It is a private mystery that only many years of practice teaches.”
O’Mahoney states that breaking bad news is a skill “that only many years of practice teaches”, however he disparages Block for saying that palliative care specialists are the most skilled and best trained for this. This is nonsensical, as being a palliative care specialist by nature guarantees significant experience in breaking bad news.
Overall, a book with some interesting ideas, however written confusingly and, at times, quite condescendingly.
Although much of O’Mahoney’s arguments are well-founded, some are circular. For example, in talking about breaking bad news to patients, the author describes a conversation with Dr. Susan Block, a palliative care specialist: “"You have to understand", Block told me, "A family meeting is a procedure, and it requires no less skill than performing an operation." Apart from the self-regard of this assertion, it is indicative of a rather worrying trend: namely, the notion that palliative care specialists such as Block are the most skilled and best trained to have the Difficult Conversation. I do not believe that doctors can be taught to do this. There are as many different Difficult Conversations as there are patients. It is a private mystery that only many years of practice teaches.”
O’Mahoney states that breaking bad news is a skill “that only many years of practice teaches”, however he disparages Block for saying that palliative care specialists are the most skilled and best trained for this. This is nonsensical, as being a palliative care specialist by nature guarantees significant experience in breaking bad news.
Overall, a book with some interesting ideas, however written confusingly and, at times, quite condescendingly.
February 26, 2018
A refreshing, if often repetitive, look at how and where we actually DO die (i.e., in hospital, under duress), as opposed to the literature about how and where we SHOULD die (i.e., at home, in comfort, in an atmosphere of reconciliation and moral uplift--in short, in a controlled setting and on a controlled timeline, in accordance with a vision of a so-called "good death"). O'Mahony is Irish and he writes from that point of view (I'd never heard of a syringe-driver before), but the UK and NHS do have their analogues to Terri Schiavo, the death with dignity movement, etc.
I particularly appreciated his discussion of famous thinkers/essayists (e.g., Montaigne, Sontag) who wrote about death but then did or did not die according to their own visions of a good death.
He describes hospital-based end-of-life measures (e.g., PEG feeding) as technical panaceas for existential problems (p. 14).
Useful as counterpoint to the "loftier" thinking and writing about the "good death" and rational approaches to death (e.g., advance directives). Unfortunately, his Epilogue, which supposedly contains some "modest proposals" for changing our approach to death, is only four pages long and and offers only a few immodest, abstract proposals (e.g., we need to respect others; medicine needs to educate the public about its limitations, particularly at the end of life).
I particularly appreciated his discussion of famous thinkers/essayists (e.g., Montaigne, Sontag) who wrote about death but then did or did not die according to their own visions of a good death.
He describes hospital-based end-of-life measures (e.g., PEG feeding) as technical panaceas for existential problems (p. 14).
Useful as counterpoint to the "loftier" thinking and writing about the "good death" and rational approaches to death (e.g., advance directives). Unfortunately, his Epilogue, which supposedly contains some "modest proposals" for changing our approach to death, is only four pages long and and offers only a few immodest, abstract proposals (e.g., we need to respect others; medicine needs to educate the public about its limitations, particularly at the end of life).
June 28, 2018
This is the third author I've read lately who is a doctor from the UK (well, this guy is Irish) and BOY HOWDY they are a grumpy lot. But it is interesting to read about the experiences of doctors working in a socialized medicine setting. I feel rather sorry for them. As the saying goes, “You can please some of the people all of the time, you can please all of the people some of the time, but you can’t please all the people all of the time".
Really liked this bit:
"We cannot, like misers, hoard health; living uses it up. Nor should we lose it like spendthrifts. Health, like money, is not an end in itself; like money, it is a prerequisite for a decent, fulfilling life. The obsessive pursuit of health is a form of consumerism and impoverishes us not just spiritually, but also financially. Rising spending on health care inevitably means that we spend less on other societal needs, such as education, housing and transport. Medicine should give up the quest to conquer nature, and retreat to a core function of providing comfort and succour."
Really liked this bit:
"We cannot, like misers, hoard health; living uses it up. Nor should we lose it like spendthrifts. Health, like money, is not an end in itself; like money, it is a prerequisite for a decent, fulfilling life. The obsessive pursuit of health is a form of consumerism and impoverishes us not just spiritually, but also financially. Rising spending on health care inevitably means that we spend less on other societal needs, such as education, housing and transport. Medicine should give up the quest to conquer nature, and retreat to a core function of providing comfort and succour."
February 28, 2018
some interesting and even funny anecdotes (e.g., about his Irish uncle who enjoyed funerals so much he travelled all over going to those of people he barely knew or didn't know at all.
i was also pleased to learn that the eminent philosopher David Hume [independently, I assume] arrived at just about exactly the same idea of death that I find the most comforting -- i.e., being dead will be about the same as before i was born, which i don't remember finding to be all that upsetting.
beyond that, he says the same things many times and not always convincingly. I got why pulling out all the stops to do anything possible to ward off death in the extremely old and unwell can be unwise and just prolong suffering, but never understood his negativity toward advance directives and hospice care. Seemed skeptical that they would actually work in medical care system, but i could have used more in the way of evidence to that effect and/or suggested alternatives.
i was also pleased to learn that the eminent philosopher David Hume [independently, I assume] arrived at just about exactly the same idea of death that I find the most comforting -- i.e., being dead will be about the same as before i was born, which i don't remember finding to be all that upsetting.
beyond that, he says the same things many times and not always convincingly. I got why pulling out all the stops to do anything possible to ward off death in the extremely old and unwell can be unwise and just prolong suffering, but never understood his negativity toward advance directives and hospice care. Seemed skeptical that they would actually work in medical care system, but i could have used more in the way of evidence to that effect and/or suggested alternatives.
November 13, 2019
It seems from reading other reviews I am the lone voice in the wilderness about this book. For the main partI though it was just dreary. I didn't feel that the author covered the individual aspects in any depth or in a way that would engage the minds of his readers. As a retired nurse I have encountered most of the medical interventions around death and he has a point that there is a move towards medicalising death, staving off its approach in unnecessary and undignified ways. However I don't think he has given other subjects the depth or critical review they deserve. The Liverpool Care Pathway - is summarily dismissed in a few short paragraphs, The outrages at Stafford are almost glossed over. Maybe I am being unfair to him perhaps it not in what he says but in the disengaged tone of the book thatthe problems I have with this book are created.
May 14, 2018
Would give this three and a half stars if I could.
While I definitely don't agree with all of O'Mahony's thoughts on death and dying (especially his condescending views on advanced directives - something I think every single person should have - and his absolutely insulting ones on assisted suicide), this was a fascinating and well-articulated look into how death has changed over the years and centuries. I especially appreciated the insight into death within hospitals, though the UK hospital system is broken up much differently than the American hospital system, as well as the vignettes into the deaths of academics and philosophers from Christopher Hitchens to Seneca. Worth a look purely for historical value alone.
While I definitely don't agree with all of O'Mahony's thoughts on death and dying (especially his condescending views on advanced directives - something I think every single person should have - and his absolutely insulting ones on assisted suicide), this was a fascinating and well-articulated look into how death has changed over the years and centuries. I especially appreciated the insight into death within hospitals, though the UK hospital system is broken up much differently than the American hospital system, as well as the vignettes into the deaths of academics and philosophers from Christopher Hitchens to Seneca. Worth a look purely for historical value alone.
June 1, 2020
The concept of dying should not be a scary thought. As it is the only constant in our lives. However when one is healthy, they rarely think about death. It is often a distant topic that only comes to mind when someone close to them dies. Even then it's not their death that comes to mind but the already deceased.
With technological advancements in health care, human life (in concept of breathing and a beating heart) can be prolonged indefinitely, however is that living?
Towards the end of life Morden medicine can do anything they can to sustain life. Most of these interventions are painful, expensive and often scary to the family. Where is the dignity in that? How do you want to die?
With technological advancements in health care, human life (in concept of breathing and a beating heart) can be prolonged indefinitely, however is that living?
Towards the end of life Morden medicine can do anything they can to sustain life. Most of these interventions are painful, expensive and often scary to the family. Where is the dignity in that? How do you want to die?
January 2, 2018
“The Way We Die Now” is not the first book I’ve read on the modern death. It is hard to compare O’Mahony’s book against “When Breathe Becomes Air” or “Being Mortal,” but it does serve a purpose. There is a surprising theme on how we have removed the underlying kindness in how we treat the dying. That, above the other recommendations/observations made by O’Mahoney, is the most thoughtful takeaway from this text.
This entire review has been hidden because of spoilers.
January 29, 2017
Conclusion of the book, (remember the author is a Medical Dr. in Ireland) "Medicine and our culture, would be healthier and happier if we stopped expecting medicine to solve our existential and spiritual problems, if we stopped thinking of our bodies as machines, and if we gave up our fantasies of control and of immortality."
August 21, 2017
The book starts exceptionally strong, particularly the sections about health care where the writer has a lot of pertinent knowledge and experience. It started flagging towards the end as it degenerates into a literature review, many of which I've previously read.
January 28, 2018
Surprising how educational and fascinating this book really was. Written by a medical professional and based on his real life experiences. Covers the full gamut of what’s really involved. Medically, emotionally and legally. Highly recommend.
October 31, 2018
An interesting insight into the medicalisation of death, the way individuals face death, and how society as a whole has become squeamish about the whole thing, from a doctor's perspective. A bit repetitive at times, like the author was struggling to reach the word count.
Displaying 1 - 30 of 74 reviews