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Last Rights: Rescuing the End of Life from the Medical System
“This country is fairly crowded with doctors, families, and patients—all possessed of good intentions—failing to achieve the simple goal of allowing people to die with dignity and grace.”
In the 1970s, most Americans died swiftly and of heart attacks, strokes, cancer, or in accidents. But in the past three decades, medical advances have extended our lives and changed the way we die. In Last Rights , Stephen Kiernan reveals the disconnect between how patients want to live the end of life—pain free, functioning mentally and physically, surrounded by family and friends—and how the medical system continues to treat the dying—with extreme interventions, at immense cost, and with little regard to pain, human comforts, or even the stated wishes of patients and families. Backed with surveys, interviews, and intimate portraits of people from all walks of life, from the dying and their families to the doctors and nurses who care for them, this book will be for our time what Elizabeth Kubler-Ross’s books were for a previous generation.
In the 1970s, most Americans died swiftly and of heart attacks, strokes, cancer, or in accidents. But in the past three decades, medical advances have extended our lives and changed the way we die. In Last Rights , Stephen Kiernan reveals the disconnect between how patients want to live the end of life—pain free, functioning mentally and physically, surrounded by family and friends—and how the medical system continues to treat the dying—with extreme interventions, at immense cost, and with little regard to pain, human comforts, or even the stated wishes of patients and families. Backed with surveys, interviews, and intimate portraits of people from all walks of life, from the dying and their families to the doctors and nurses who care for them, this book will be for our time what Elizabeth Kubler-Ross’s books were for a previous generation.
320 pages, Hardcover
First published November 14, 2006
21 people are currently reading
389 people want to read
About the author
Stephen P. Kiernan
9 books1,011 followersStephen P. Kiernan's latest novel is THE GLASS CHATEAU, out June 20 and available for pre-order now.
Stephen's most recent book is UNIVERSE OF TWO, a love story set in 1944, amid the development of the atomic bomb. Charlie is a young math whiz drafted into the Manhattan Project, where his duty tests his morals. His sweetheart Brenda, prohibited for security reasons from knowing what he's doing, sees these ethical hesitations as weakness, and urges him to be a soldier, be a man. After the war, Charlie feels culpable for thousands of deaths, while Brenda feels guilty for making him contradict his conscience. Together they spend the rest of their lives seeking redemption -- and they find it.
Stephen also wrote THE BAKER'S SECRET, the story of D-Day from the French perspective: what it was like to live in occupied Normandy with no rights, little food and less hope, until one day hundreds of thousands of soldiers and sailors arrive to fight for liberation.
He's author of THE HUMMINGBIRD, about a hospice nurse whose husband has returned from his 3rd deployment in Iraq with PTSD, and she is determined to help him heal. It is a story about loyalty, patience, and fierce love.
Stephen's first novel was THE CURIOSITY, a scientific thriller and a love story across two centuries. The book came out in numerous foreign editions, and it is currently in development as a television series.
Stephen worked for decades as a journalist, winning over 40 awards. His first book, LAST RIGHTS, was a nonfiction expose of the overly aggressive medical treatment most people receive in the last chapter of their lives, with many suggestions for ways of providing more humane care. His second non-fiction book, the Silver Nautilus Award-winning AUTHENTIC PATRIOTISM, describes the potential for national renewal through nonpartisan civic engagement and volunteerism.
A graduate of Middlebury College, Johns Hopkins University, and the University of Iowa's Writers Workshop, he lives in Vermont.
Stephen's most recent book is UNIVERSE OF TWO, a love story set in 1944, amid the development of the atomic bomb. Charlie is a young math whiz drafted into the Manhattan Project, where his duty tests his morals. His sweetheart Brenda, prohibited for security reasons from knowing what he's doing, sees these ethical hesitations as weakness, and urges him to be a soldier, be a man. After the war, Charlie feels culpable for thousands of deaths, while Brenda feels guilty for making him contradict his conscience. Together they spend the rest of their lives seeking redemption -- and they find it.
Stephen also wrote THE BAKER'S SECRET, the story of D-Day from the French perspective: what it was like to live in occupied Normandy with no rights, little food and less hope, until one day hundreds of thousands of soldiers and sailors arrive to fight for liberation.
He's author of THE HUMMINGBIRD, about a hospice nurse whose husband has returned from his 3rd deployment in Iraq with PTSD, and she is determined to help him heal. It is a story about loyalty, patience, and fierce love.
Stephen's first novel was THE CURIOSITY, a scientific thriller and a love story across two centuries. The book came out in numerous foreign editions, and it is currently in development as a television series.
Stephen worked for decades as a journalist, winning over 40 awards. His first book, LAST RIGHTS, was a nonfiction expose of the overly aggressive medical treatment most people receive in the last chapter of their lives, with many suggestions for ways of providing more humane care. His second non-fiction book, the Silver Nautilus Award-winning AUTHENTIC PATRIOTISM, describes the potential for national renewal through nonpartisan civic engagement and volunteerism.
A graduate of Middlebury College, Johns Hopkins University, and the University of Iowa's Writers Workshop, he lives in Vermont.
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Displaying 1 - 30 of 35 reviews
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May 26, 2018As I age, end of life issues, either preparing for my own or improving communication, care and loving of family and friends in their last days, is a subject of importance to me. A few years ago I heard Stephen Kiernan speak to this topic in his book Last Rights: Rescuing The End Of Life From The Medical System. Tears dotted my cheeks and my heart ached as he described the many actively dying persons who received less than the compassionate, pain free, dignified dying they deserved. I wanted to do better but also wanted to understand what stands in our way of talking about death, making changes, and working with the medical profession to help us all in this last chapter of living.
I bought the book. I knew I needed some of the wisdom in its pages after being with my parents as they died. But the book sat on my shelves unread. Is there a right time to read this book? When once again I needed it, I could not pick it up as I was already in the process of grieving a close member of my family as she prepared to leave our world. I did my best but if you've ever been in this situation you know how you wonder. Could you have done more? What would have made her final days better? Could communication with the medical profession been better? Did I help her to seek what she needed? Haunting thoughts but I did my best.
Recently I picked up Last Rights: Rescuing The End Of Life From The Medical System. Written in 2006, I feel some things have improved and some things remain the same. Last Rights certainly continues to be relevant in 2018 as it encourages thought, discussion and preparation for those end of life needs we all will encounter in our lives or in others close to us.There is much here that will help me if the need arises again. I will do my best but perhaps I'll do even better.
Each of us will take what we will from these pages. I'll close with this quote that stood out to me.
The rights of the dying, Edmondson says, “are the number one consumer issue in the Untied States.” I believe this continues to be true.
I bought the book. I knew I needed some of the wisdom in its pages after being with my parents as they died. But the book sat on my shelves unread. Is there a right time to read this book? When once again I needed it, I could not pick it up as I was already in the process of grieving a close member of my family as she prepared to leave our world. I did my best but if you've ever been in this situation you know how you wonder. Could you have done more? What would have made her final days better? Could communication with the medical profession been better? Did I help her to seek what she needed? Haunting thoughts but I did my best.
Recently I picked up Last Rights: Rescuing The End Of Life From The Medical System. Written in 2006, I feel some things have improved and some things remain the same. Last Rights certainly continues to be relevant in 2018 as it encourages thought, discussion and preparation for those end of life needs we all will encounter in our lives or in others close to us.There is much here that will help me if the need arises again. I will do my best but perhaps I'll do even better.
Each of us will take what we will from these pages. I'll close with this quote that stood out to me.
The rights of the dying, Edmondson says, “are the number one consumer issue in the Untied States.” I believe this continues to be true.
September 30, 2014
"Last Rights" is an alarming report on how our current health system fails those who are dying. Most Americans want meaningful closure...dying at home, free of pain,among friends and family, with their affairs in order.But many are instead dying among strangers after enduring avoidable pain and suffering pointless indignities.
In past years death came suddenly in the form of heart attacks, strokes, and accidents. But now lives end slowly with congestive heart failure, lung disease, diabetes, Alzheimer's, and the greatest killer...cancer. Because hospitals continue to treat the final stages of gradual dying as if it were sudden trauma, we need the hospice philosophy which places the patient at the center of care. It includes not only medical concerns, but also emotional and spiritual issues, with the goal of living fully to the last moment surrounded by family and friends.
Kiernan includes touching stories of people who experienced nightmarish deaths but also those whose last days were happy and peaceful.I hope the suggestions made in this book are embraced so that millions of Americans benefit from it.
In past years death came suddenly in the form of heart attacks, strokes, and accidents. But now lives end slowly with congestive heart failure, lung disease, diabetes, Alzheimer's, and the greatest killer...cancer. Because hospitals continue to treat the final stages of gradual dying as if it were sudden trauma, we need the hospice philosophy which places the patient at the center of care. It includes not only medical concerns, but also emotional and spiritual issues, with the goal of living fully to the last moment surrounded by family and friends.
Kiernan includes touching stories of people who experienced nightmarish deaths but also those whose last days were happy and peaceful.I hope the suggestions made in this book are embraced so that millions of Americans benefit from it.
April 8, 2022
4.5 stars A fascinating look at the need for the US medical schools to put more time into preparing doctors to provide patient-centered end of life care, the need for reorganization of the medical treatment process in view of the lengthening of the dying process over the past 50 years. The book does a terrific job of explaining the benefits of the hospice system and palliative care in a patient-focused scenario. The statistics given are truly startling, especially when comparing the training provided in US medical schools vs those in Canada/Europe. I would love to see an updated edition of this book, since it was written in the early 2000s.
July 8, 2022
This book was first published in 2006, and I read it in 2022. I say this upfront because some of the bits about cultural climate and the statistics and data facts may read as slightly out of date. But in my opinion, the way things have changed in the USA during the intervening years (not least of which, we all lived through a deadly global pandemic) actually prove Kiernan's point.
I picked up this book because I have a deep personal interest in the topic of how we die. Not like, car accident versus leukemia. More like, I have a terminal disease or I have an emergency. How are decisions about my health care made, and what is my quality of life in the last stages of that life?
I have an advance directive and a health care proxy. But Kiernan chillingly makes the point that -- while it is commendable that I have taken that step -- there is a high chance that they will go unheeded by medical professionals (EMTs, emergency room and ICU nurses and doctors, etc.).
Kiernan shares many stories of lives that end peacefully, lovingly, with proper support for family care givers and compassionate and meaningful company for the dying. That also includes a distinct lack of emergency health care; rather, it is palliative, with a focus on brief extensions of life (say, a radiation treatment so the dying person could take one last trip to the golf course) and pain management.
He then goes on to present the case why our medical system is not at all equipped to actually provide that kind of peaceful transition from life to death for the vast majority of Americans. And it has much less to do with the lack of health care coverage than you would expect.
After having watched a beloved mentor die of Parkinsons Disease, and my Nana waste away from emphysema and other complications, I have very strong feelings about the way I'd like to spend my last months or years on life (i.e., not like that). I have also witnessed their primary caregivers gain weight, live in exhaustion, sacrifice every other aspect of their life, and develop their own health issues -- all in service of the dying. This is seriously messed up.
Kiernan's book presents a solution to this, which is thoughtful, premeditated, hospice. Not hospice as many know it -- where people go to live out their last 10 or so days of life. No, this stage of care can last months, and allows the dying to not only die in peace and comfort, but gives them the time and space to make amends, say goodbye, plan their funeral, etc.
Reading this book was an emotional journey. I was moved to tears many, many times as I recalled the last days of my dear friend and my Nana. This book is a cry for reform, absolutely. But it also offers hope for those of us who thought there was no path to a peaceful death.
We all need to think about and talk about our death and the deaths of those we love the most, so that they are as easy as possible on everyone involved.
Highly recommend.
I picked up this book because I have a deep personal interest in the topic of how we die. Not like, car accident versus leukemia. More like, I have a terminal disease or I have an emergency. How are decisions about my health care made, and what is my quality of life in the last stages of that life?
I have an advance directive and a health care proxy. But Kiernan chillingly makes the point that -- while it is commendable that I have taken that step -- there is a high chance that they will go unheeded by medical professionals (EMTs, emergency room and ICU nurses and doctors, etc.).
Kiernan shares many stories of lives that end peacefully, lovingly, with proper support for family care givers and compassionate and meaningful company for the dying. That also includes a distinct lack of emergency health care; rather, it is palliative, with a focus on brief extensions of life (say, a radiation treatment so the dying person could take one last trip to the golf course) and pain management.
He then goes on to present the case why our medical system is not at all equipped to actually provide that kind of peaceful transition from life to death for the vast majority of Americans. And it has much less to do with the lack of health care coverage than you would expect.
After having watched a beloved mentor die of Parkinsons Disease, and my Nana waste away from emphysema and other complications, I have very strong feelings about the way I'd like to spend my last months or years on life (i.e., not like that). I have also witnessed their primary caregivers gain weight, live in exhaustion, sacrifice every other aspect of their life, and develop their own health issues -- all in service of the dying. This is seriously messed up.
Kiernan's book presents a solution to this, which is thoughtful, premeditated, hospice. Not hospice as many know it -- where people go to live out their last 10 or so days of life. No, this stage of care can last months, and allows the dying to not only die in peace and comfort, but gives them the time and space to make amends, say goodbye, plan their funeral, etc.
Reading this book was an emotional journey. I was moved to tears many, many times as I recalled the last days of my dear friend and my Nana. This book is a cry for reform, absolutely. But it also offers hope for those of us who thought there was no path to a peaceful death.
We all need to think about and talk about our death and the deaths of those we love the most, so that they are as easy as possible on everyone involved.
Highly recommend.
January 15, 2018
This book is very easy to read, yet sometimes disturbing to read at the same time. I kept thinking back to my own father's death and how relatively easily my family decided what to do and the medical professionals who let us process, advised us, and aided our ultimate decision.
After the death of my aunt this past summer (she decided to forego any further dialysis treatments), I have a clearer picture of what may lie ahead with my mother, who didn't completely understand her sister's decision. I know to start that dialogue now.
After the death of my aunt this past summer (she decided to forego any further dialysis treatments), I have a clearer picture of what may lie ahead with my mother, who didn't completely understand her sister's decision. I know to start that dialogue now.
July 14, 2025
Last Rights was written by Stephen P. Kiernan and published in 2006. While reading this book, I kept wondering if the health care system has changed with respect to end-of-life care. And, if so, what are the major changes? The personal stories Kiernan used in writing this book are so touching, especially the stories of Betty and Art Brault. Reading this book brought back memories of my last conversations with my dad that took place in the courtyard of a nursing home. It also brought back memories (and questions) about the end-of-life care of a dear friend who lost his wife one month before he died. And lastly, it brought back memories of two hospitalized patients who appreciated the steps I took to protect their privacy rights during their final days… Written by a favorite author, Kiernan’s book is both well-researched and well-written. It may be dated, but I highly recommend it as this topic is so important.
September 12, 2008
This book is a fair assessment of many of the problems with dying in the U.S. right now. Although I hope that some of it is out-of-date (ignoring advanced directives is unconscionable), it addresses many of the inadequacies of physician education, public awareness, and physician-patient communication that make end-of-life care so often an alienating, painful experience. When we as medical practitioners can overcome our fears of patients' reactions, of our own feelings, and of professional censure, and patients can learn that using more medical care than they need can be worse than using less (the author beautifully states that "Medicine and love are not the same thing"), we can begin to change a culture that is systematically bad for the people it is supposed to serve. Many hurrahs for all who raise a voice that the restrictions on use of hospice are woefully misaligned with good patient care!
January 13, 2008
I read this for my Death and Dying class a couple of semesters ago and feel obligated to get the word out. With this book the author exposes devastating flaws in the way our medical system approaches and handles death and dying patients. He argues for a more holistic approach, embracing hospice the like. As a social work student and a member of a generation whom will be dealing with a dramatic increase of aged persons, I find this book really highlights some invaluable issues.
October 30, 2019
It's kind of funny that this is the last one of Stephen's books that I have read, although I purchased it right after publication (2006). I guess I was subconsciously steering away from the topic. This book is filled with great anecdotes of people who have faced the end of their lives in various ways. It is very insightful in recognizing that today, most of us will end our lives in a gradual fashion, and we have some choice in our processes and attitudes. I am hopeful that we have made significant progress in our state (Vermont) with end-of-life care and palliative care. I hope Kiernan can look over his book and see that some of his recommendations have been implemented and implemented well. I hope this is true in other states as well.
March 8, 2022
This book will shake the reader's beliefs in the medical profession. The book deals with death and the desire to die gracefully if those words can be used together. Having experienced the death of several family members and using hospice, I am thankful that many of the issues discussed were not part of my experience. I did experience the determination of the nurses to keep a family member alive with the minimal use of pain killing drugs. To say the least, I had to be determined to keep the desires of the patient met in spite of the nurse. The book will shake the reader's thoughts about dying. Everyone should read this book because eventually, the reader will be faced with decisions of dying.
September 15, 2017
Good starting point for conversations for those dealing with elderly or terminal family members and their medical team. Some material is outdated, but for the most part these are things that need to be considered. More focus is on the terminally ill; it would be nice to find something that helps with those who need care for other problems brought on by the aging process that are not illness-related.
November 10, 2019
Excellent guidance regarding the journey into a good death. A must read for everyone. Since our society considers death a taboo conversation this book brings the subject in to the light of must-have conversations with those we care about; thoughts, wishes, desires.
January 11, 2022
I’ll give this a star for every time I cried because oh boy. If you feel like you’re hurting for something important to advocate for, read this book. I don’t know how death and dying is so ignored when it’s something everyone experiences, but this book gave me hope that grief can be meaningful.
August 18, 2020
A rare 5-star rating! I wish every American would read this. It has changed my view of the end of life, and the way we handle it.
May 22, 2023
The author keynoted hospice conference in fall 2010. Subtitle is "rescuing the EOL from the Medical System." I wrote a detailed summay for my 2011 HCI CE, which can be found in my Word documents.
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April 15, 2024There’s some really good writing in this book especially the Jack part but I am just not feeling and am struggling to read the rest. I don’t know whose fault that is so I’m not rating it
September 4, 2014
If you have ever witnessed a loved one as they go through their last days or know others who have, or if you have heard about assisted suicide - this book is for you. If you're a parent and are thinking about how to prepare yourself and your family for your last days and dying with dignity and surrounded by love and light and music - this is the book for you! What a remarkably well written book about a very powerful and emotional and political issue. Between the moving stories of those who went through a death or health scare/incident to even reading about the author's own personal experiences with the deaths of his parents - this book moves you. It should move you to think about and consider how you want to live your last days and what is in place, or not, to insure that your wishes are met. What does it mean to have in place DNRs and other medical documents and who do you share them with and when. The other mind opening aspect of this book - is your doctor or team of doctors more interested in trying to help you live longer or to truly listen to you and let you be the captain of your own ship and determine what treatments, care, supports you want, especially if your time is limited. Everyone should read this book even though it is a tough topic, but we all must talk about our wishes and desires and feel comfortable doing so. This book is a must read!!
December 14, 2015
If we could give half stars, I'd give this book 3.5 stars. But, since we can't do that, I think this is closer to really good versus good. Unlike many other non-fiction books, this one is written by a journalist. So, instead of an expert on a topic trying to write a book, this book is written by a writer who is passionate about the topic. The book starts out strong. Full disclosure--I never would have read this book on my own, but it's next month's book in one of my book clubs, so I tackled it. I thought the book would depress me, but I found it to be mostly uplifting.
About halfway through, the book lost steam for me. If I wasn't reading this for my book club, I would have abandoned ship at that point. I persevered and was glad I did. For me, once the author describes the deaths of both of his parents, the book turned around.
This book contains lots of terrific illustrative stories and examples regarding good and horrific ways of dying in the USA. My only complaint is that the book needs editing--it becomes repetitive and would be much better if 50-100 pages were cut.
About halfway through, the book lost steam for me. If I wasn't reading this for my book club, I would have abandoned ship at that point. I persevered and was glad I did. For me, once the author describes the deaths of both of his parents, the book turned around.
This book contains lots of terrific illustrative stories and examples regarding good and horrific ways of dying in the USA. My only complaint is that the book needs editing--it becomes repetitive and would be much better if 50-100 pages were cut.
March 11, 2013
So-so. I get that this was a really smart guy that almost didn't make it. He was in a coma, and his brain shouldn't have been working. So he attributes what happened to him as a heaven. But it is so unlike any other account of near-death experiences that I wonder about it. The heaven he experiences has a beautiful woman, but where are all the other people? He talks about a higher form of consciousness "there," and is clearly ecstatic about it, but if that's all heaven is, it sounds like it would be boring for a lifetime. I, for one, am hoping to see a few other people when I get wherever it is I am going.
March 3, 2015
My father had a serious health scare. I was told once to be prepared for him to die. I spent several months in hospitals and waiting rooms and became far mmore familiar than I wanted with things like pain control, DNRs, power of attorney, and to what extent he wanted to be subjected to life saving measures.
This was a very intense read. It's hard to believe that, for all of the training doctors go through, so little focus is on dying, patient choices, and pallative care.
It will make you seriously rethink your personal beliefs on death and dying.
This was a very intense read. It's hard to believe that, for all of the training doctors go through, so little focus is on dying, patient choices, and pallative care.
It will make you seriously rethink your personal beliefs on death and dying.
April 23, 2015
In a time of gradual death experiences rather than sudden death experiences, this book is a fascinating preparation for end of life issues that all of us will face with our loved ones and ourselves. I have met the author, and he inscribed my book, "Peace and blessings to the last second". That is definitely the objective of this book.
December 31, 2012
Being a hospice nurse I was lucky to hear this man speak!!! He is incredible and totally gets it!! It's hard for families and pts at the end of life, but this book shows that it doesn't have to be a bad experience. Hospice is not scary it's help! Please Please read this book!!!
May 21, 2008
A Weinstein recommendation. Powerful, and painful at times, to read. The book helped inform and guide me at a critical time in my life, placing me on a firmer ground to cope with an immense loss.
June 19, 2008
not quite a sad read... interesting how this book confirms some of my thoughts on dying and how we treat people. I would say that this book for the people ready to "let go" and not for the fighters.
July 31, 2008
A little repetitive at times, but definitely worthwhile.
November 18, 2008
Everyone who will die should read this book.
January 31, 2011
Written by a journalist, it explores death, dying, and grief on a personal and medical professional level. Insightful!!!
January 9, 2011
Lots of anecdotal evidence that supports health care reform and "end-of-life" discussions with our doctors.
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August 12, 2016Just makes realize just how screwed up our health system actually is.
March 19, 2014
Verrrry interesting . . . attitudes towards death and dying constantly evolve.
Displaying 1 - 30 of 35 reviews