Death may be an unavoidable reality, but the rapid medical advances and technologies of the last fifty years have fostered a denial of this indisputable fact. As Daniel R. Tobin, M.D., writes in his new book, Peaceful Dying, "Perhaps the greatest limitation of Western medicine has been its refusal to acknowledge the inevitability and naturalness of death, and how important a part of life it is. The passion to prolong life and to enhance it is wonderful, to a point . . . But when it doesn’t take into account the simple fact that at some point ife can’t, and shouldn’t, be prolonged, it creates, rather than alleviates, suffering."
In Peaceful Dying, Tobin and co-author Karen Lindsey aim to help readers alleviate their emotional, physical and spiritual fears of dying, and to realize that "the emotions of the dying . . .are not necessarily terrible; indeed, sometimes they can be quite beautiful."
The book serves two purposes: It is a straight-forward, thorough look at dying and the contemporary issues that make this time even more painful for some patients and families. It is also a guidebook for Tobin’s FairCare Health System, which seeks to broaden the range of hospice by offering seriously ill patients support from the moment of diagnosis until the time of death. Although the book is addressed to people living with serious illness, it speaks to others as well, including clinicians, families and friends of the dying.
What Dr. Tobin has accomplished, with the help of his co-author, is a no-nonsense book that offers step-by-step guidance and advice to patients who want to live with dignity until the end. One of the first and most important points the book imparts is that death with dignity is possible -without suicide. Tobin makes a compelling distinction between allowing death its natural rhythm and time, and with helping to hasten that time. He not only encourages readers to "achieve a whole view of dying," but shows how embracing such a point of view can be "profoundly positive" for dying people and those around them.
The book recounts Tobin’s own journey into the work of caring for the dying, illustrating the motives and gentle heart of this generous "patient advocate." As a third-year medical student, Tobin witnessed the tragedy of an 88-year old patient’s technologically driven death, whose requests to die in peace were ignored.
Tobin writes, "All our machines and all our tests could do nothing but make him suffer in the little time he had remaining. Respiratory therapists, five doctors, three nurses, and three medical students all looked down at the floor, dejected. They had failed in the one thing their training had told them mattered -they had not prevented death. I too felt that we had failed Mr. Arnold, but in a very different way."
Realizing that medical schools did not seem to offer students the training and skills needed to help terminally ill patients, Tobin began a mission to "reconcile the contradiction . . . between the physician’s passion to relieve pain and the pain we routinely inflicted on our dying patients."
Tobin’s book includes an insider’s analysis and history of Western medicine’s approach to dying. His fascinating analysis offers plausible explanations of how and why modern medicine came to distance itself from the dying.
Through his work, Tobin seeks to teach readers that "Death isn’t just a benevolent teacher to the dying. The living, too, if they allow themselves to be part of a loved one’s dying, learn valuable lessons." Such spiritual lessons, Tobin explains, are a common theme across time and culture, although American society has strayed from such understanding and lost the concept of "dying well." By reclaiming death as just another stage of living, much as we view infancy and adolescence, Tobin concludes that we can prepare for the final stage of life, and can offer the dying respect and peace.
"[T]he spiritual truths that underlie life can emerge with irrefutable clarity. It’s as if the lessons we were learning the slow way throughout life suddenly become distilled and intensified when we start to dieÉ[the dying] often see the necessity of love, forgiveness, letting go of resentments, and making peace with those who accompanied them through life," he writes.
In Peaceful Dying, Tobin describes six stages of human response to dying: shock, grasping, grief, letting go, healing and serenity. To respond to these stages, as they occur and cycle through each person’s life, Tobin offers a 26-step process for a peaceful death. Tobin describes the FairCare program, which includes a physician-based consultant unit that provides education, counseling, advocacy and coordination of services.
According to Tobin, public and professional response to the book has been positive. He hopes that FairCare will be used as an adjunct, a place to "bridge the gap" between the public and those who care for the dying.
Tobin told Exchange, "The medical field agrees completely that we need change to improve end-of-life care. The Institute of Medicine, the AMA, the American Board of Internal Medicine, and so on, all agree that we need change -and we are all in this together."
Valerie Jean is a poet and teacher in Maryland. Her recent collection of poetry addresses suicide and its aftermath.
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