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The Art of Dying Well: A Practical Guide to a Good End of Life
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Katy Butler
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This “comforting…thoughtful” (The Washington Post) guide to maintaining a high quality of life—from resilient old age to the first inklings of a serious illness to the final breath—by the New York Times bestselling author of Knocking on Heaven’s Door is a “roadmap to the end that combines medical, practical, and spiritual guidance” (The Boston Globe).
“A common sense path to define what a ‘good’ death looks like” (USA TODAY), The Art of Dying Well is about living as well as possible for as long as possible and adapting successfully to change. Packed with extraordinarily helpful insights and inspiring true stories, award-winning journalist Katy Butler shows how to thrive in later life (even when coping with a chronic medical condition), how to get the best from our health system, and how to make your own “good death” more likely. Butler explains how to successfully age in place, why to pick a younger doctor and how to have an honest conversation with them, when not to call 911, and how to make your death a sacred rite of passage rather than a medical event. This handbook of preparations—practical, communal, physical, and spiritual—will help you make the most of your remaining time, be it decades, years, or months.
Based on Butler’s experience caring for aging parents, and hundreds of interviews with people who have successfully navigated our fragmented health system and helped their loved ones have good deaths, The Art of Dying Well also draws on the expertise of national leaders in family medicine, palliative care, geriatrics, oncology, and hospice. This “empowering guide clearly outlines the steps necessary to prepare for a beautiful death without fear” (Shelf Awareness).
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Scribner
Release date
Feb 19, 2019
ISBN
9781501135323
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The Art of Dying Well: A Practical Guide to a Good End of Life Hardcover – 1 April 2019
by Katy Butler (Author)
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A reassuring and thoroughly researched guide to maintaining a high quality of life—from resilient old age to the first inklings of a serious illness to the final breath—by the New York Times bestselling author of Knocking on Heaven’s Door.
The Art of Dying Well is about living as well as possible for as long as possible and adapting successfully to change. Packed with extraordinarily helpful insights and inspiring true stories, award-winning journalist and prominent end-of-life speaker Katy Butler shows how to thrive in later life (even when coping with a chronic medical condition), how to get the best from our health system, and how to make your own “good death” more likely. This handbook of step by step preparations—practical, communal, physical, and sometimes spiritual—will help you make the most of your remaining time, be it decades, years, or months.
Butler explains how to successfully age in place, why to pick a younger doctor and how to have an honest conversation with her, when not to call 911, and how to make your death a sacred rite of passage rather than a medical event.
This down-to-earth manual for living, aging, and dying with meaning and even joy is based on Butler’s own experience caring for aging parents, as well as hundreds of interviews with people who have successfully navigated a fragmented health system and helped their loved ones have good deaths. It also draws on interviews with nationally recognized experts in family medicine, palliative care, geriatrics, oncology, hospice, and other medical specialties. Inspired by the medieval death manual Ars Moriendi, or the Art of Dying, The Art of Dying Well is the definitive update for our modern age, and illuminates the path to a better end of life.
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Review
“Butler’s factual, no-nonsense tone is surprisingly comforting, as are her stories of how ordinary folks confronted difficult medical decisions… Her thoughtful book belongs on the same shelf as Atul Gawande’s best-selling Being Mortal and Barbara Ehrenreich’s Natural Causes.”
—The Washington Post
“A better roadmap to the end… combines medical, practical, and spiritual guidance.”
—Kate Tuttle, The Boston Globe
"A commonsense path to define what a 'good' death looks like."
—USA Today
“An empowering guide that clearly outlines the steps necessary to avoid a chaotic end in an emergency room and to prepare for a beautiful death without fear.”
—Shelf Awareness
“Straightforward, well-organized, nondepressing… Free of platitudes, Butler’s voice makes the most intimidating of processes—that of dying—come across as approachable. Her reasonable, down-to-earth tone makes for an effective preparatory guide.”
—Publishers Weekly
“This book is filled with deep knowledge and many interesting experiences. It is a guide for staying as healthy and happy as possible while aging, and also shows how important it is to be medically informed and know our rights in the communities where we live, in order to stay in charge of our lives and therefore less afraid of the future. Katy Butler has written a very honest book. I just wish I had read it ten years ago. You can do it now!”
—Margareta Magnusson, author of The Gentle Art of Swedish Death Cleaning
“The Art of Dying Well is a guide to just that: how to face the inevitable in an artful way. Katy Butler has clear eyes and speaks plainly about complicated decisions. This book is chock-full of good ideas.”
—Sallie Tisdale, author of Advice for Future Corpses
“In plain English and with plenty of true stories to illustrate her advice, Katy Butler provides a brilliant map for living well through old age and getting from the health system what you want and need, while avoiding what you don't. Armed with this superb book, you can take back control of how you live before you die.”
—Diane E. Meier, MD, Director, Center to Advance Palliative Care
“No, you won’t survive your death, but you can live until the very last moment without the pain and humiliation that inevitably accompany an over-medicalized dying process. Katy Butler shows how, and I am profoundly grateful to her for doing so.”
—Barbara Ehrenreich, author of Natural Causes
“This is a book to devour, discuss, dog-ear, and then revisit as the years pass. Covering matters medical, practical, financial and spiritual – and, beautifully, their intersection – Katy Butler gives wise counsel for the final decades of our ‘wild and precious’ lives. A crucial addition to the bookshelves of those seeking agency, comfort and meaning, The Art of Dying Well is not only about dying. It’s about living intentionally and in community.”
—Lucy Kalanithi, MD, FACP, Clinical Assistant Professor of Medicine, Stanford School of Medicine
“The Art of Dying Well is the best guidebook I know of for navigating the later stages of life. Katy Butler’s counsel is simple and practical, but the impact of this book is profound. A remarkable feat.”
—Ira Byock, MD, author of Dying Well and The Best Care Possible, Active Emeritus Professor of Medicine, the Geisel School of Medicine at Dartmouth
Praise for Katy Butler and Knocking on Heaven's Door
“This is a book so honest, so insightful and so achingly beautiful that its poetic essence transcends even the anguished story that it tells. Katy Butler’s perceptive intellect has probed deeply, and seen into the many troubling aspects of our nation’s inability to deal with the reality of dying in the 21st century: emotional, spiritual, medical, financial, social, historical and even political. And yet, though such valuable insights are presented with a journalist’s clear eye, they are so skillfully woven into the narrative of her beloved parents’ deaths that every sentence seems to come from the very wellspring of the human spirit that is in her." -- Dr. Sherwin B. Nuland, author of How We Die: Reflections of Life’s Final Chapter
“Knocking on Heaven’s Door is a thoroughly researched and compelling mix of personal narrative and hard-nosed reporting that captures just how flawed care at the end of life has become." -- Abraham Verghese ― New York Times Book Review
“This is some of the most important material I have read in years, and so beautifully written. It is riveting, and even with parents long gone, I found it very hard to put down. ... I am deeply grateful for its truth, wisdom, and gorgeous stories—some heartbreaking, some life-giving, some both at the same time. Butler is an amazing and generous writer. This book will change you, and, I hope, our society." -- Anne Lamott ― author of Help, Thanks, Wow
"Shimmer[s] with grace, lucid intelligence, and solace." -- Lindsey Crittenden ― Spirituality and Health Magazine
"[A] deeply felt book...[Butler] is both thoughtful and passionate about the hard questions she raises — questions that most of us will at some point have to consider. Given our rapidly aging population, the timing of this tough and important book could not be better." -- Laurie Hertzel ― Minneapolis Star Tribune
"This braid of a book...examines the battle between death and the imperatives of modern medicine. Impeccably reported, Knocking on Heaven's Door grapples with how we need to protect our loved ones and ourselves." ― More Magazine
"A forthright memoir on illness and investigation of how to improve end-of-life scenarios. With candidness and reverence, Butler examines one of the most challenging questions a child may face: how to let a parent die with dignity and integrity. Honest and compassionate..." ― Kirkus Reviews
“Katy Butler’s science background and her gift for metaphor make her a wonderfully engaging storyteller, even as she depicts one of our saddest but most common experiences: that of a slow death in an American hospital. Knocking on Heaven’s Door is a terrible, beautiful book that offers the information we need to navigate the complicated world of procedure and technology-driven health care.” -- Mary Pipher ― author of Reviving Ophelia and Seeking Peace: Chronicles of the Worst Buddhist in the World
"Katy Butler's new book—brave, frank, poignant, and loving—will encourage the conversation we, as a society, desperately need to have about better ways of dying. From her own closely-examined personal experience, she fearlessly poses the difficult questions that sooner or later will face us all.” -- Adam Hochschild ― author of King Leopold’s Ghost and To End All Wars
"This is the most important book you and I can read. It is not just about dying, it is about life, our political and medical system, and how to face and address the profound ethical and personal issues that we encounter as we care for those facing dying and death. [This book's] tenderness, beauty, and heart-breaking honesty matches the stunning data on dying in the West. A splendid and compassionate endeavor." -- Joan Halifax, PhD, Founding Abbot, Upaya Institute/Zen Center and Director, Project on Being with Dying: Cultivating Compassion and Fearlessness in the Presence of Death
"This beautifully written and well researched book will take you deep into the unexplored heart of aging and medical care in America today. With courage, unrelenting honesty, and deepest compassion, ... Knocking on Heaven’s Door makes it clear that until care of the soul, families, and communities become central to our medical approaches, true quality of care for elders will not be achieved." -- Dennis McCullough ― author of My Mother, Your Mother: Embracing "Slow Medicine,'" the Compassionate Approach to Cari
"Butler’s advice is neither formulaic nor derived from pamphlets...[it] is useful, and her challenge of our culture of denial about death necessary...Knocking on Heaven’s Door [is] a book those caring for dying parents will want to read and reread. [It] will help those many of us who have tended or will tend dying parents to accept the beauty of our imperfect caregiving." -- Suzanne Koven ― Boston Globe
"Knocking on Heaven's Door is more than just a guide to dying, or a personal story of a difficult death: It is a lyrical meditation on death written with extraordinary beauty and sensitivity." ― San Francisco Chronicle
"[Knocking on Heaven's Door is] a triumph, distinguished by the beauty of Ms. Butler's prose and her saber-sharp indictment of certain medical habits. [Butler offers an] articulate challenge to the medical profession: to reconsider its reflexive postponement of death long after lifesaving acts cease to be anything but pure brutality." -- Abigail Zuger, MD ― New York Times
About the Author
Katy Butler’s articles have appeared in The New York Times Magazine, The Best American Science Writing, and The Best American Essays. A finalist for a National Magazine Award, she lives in Northern California. She is the author of Knocking on Heaven’s Door and The Art of Dying Well.
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Product details
Publisher : Scribner (1 April 2019)
Language : English
Hardcover : 288 pages
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SevenSevens
5.0 out of 5 stars A rare book and a must read for everyone
Reviewed in India 🇮🇳 on 20 February 2023
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Not everyone is comfortable talking about death and the medical journeys that many of us or our loved ones go through. This book is insightful and comforting to have read if we are to ever feel challenged by life as we face death
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Hank Dunn
5.0 out of 5 stars Read it NOW and again and again.
Reviewed in the United States 🇺🇸 on 5 December 2019
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“Dying peacefully in your own bed takes a lot of planning and preparation. Dying in an ICU, hooked up to machines, most often, is the accident.” I have said this repeatedly in my over 35 years as a nursing home, hospital and hospice chaplain. Katy Butler fleshes this out in "The Art of Dying Well: A Practical Guide to a Good End of Life."
A peaceful passing is not accomplished only by arranging for hospice and pain management in the last two or three days of life. Ms. Butler says the preparation starts years before. Of course, the obvious practical steps are important, like completing a “Living Will” and “Durable Power of Attorney for Healthcare.” I say “obvious,” but precious few people actually take the small number of minutes needed to complete these documents. So, perhaps, not so obvious, therefore, it needs to be said again, and again. Butler takes this preparation for dying well to a whole new level, way beyond pieces of paper.
The book is organized in seven chapters, each covering a phase from our healthy years to our final days. The chapters are: 1. “Resilience”; 2. “Slowing Down”; 3. “Adaptation”; 4. ”Awareness of Mortality”; 5. “House of Cards”; 6. “Preparing for a Good Death”; and 7. “Active Dying”. Each chapter starts by helping the reader identify whether he or she is in this phase… “You may find this chapter useful if…” and there is a list of signs marking that particular phase. For example, if “You can’t walk a half a mile unaided, unscrew a jar, or pick up a dining room chair” you may benefit with the information in chapter 5 “House of Cards.”
A recurring section in all but the last chapter is “Finding Allies in…”. These are healthcare professionals in every field from preventive medicine, physical therapy, house call programs, to hospice. Nurture your “tribe” too. While you are healthy, take care of your friends, neighbors (especially your younger ones), people in your faith community and family members—you may need to call on them someday.
Omitting “Finding Allies” from the “Active Dying” (the last hours or days of life) chapter says to me, if you haven’t been developing these relationships by your last days, it may be too late. Family and friends are really needed in this last phase. Could you ask your next-door neighbor to pick up some meds at the pharmacy if you have never met them? Build your tribe long before you need them.
If one waits until just a few days before dying to start preparations to have a peaceful death, it may be too late. A HUGE problem hospices face is last-minute admissions. It is a problem because it can take a several days to get all the necessary medical equipment into a patient’s home and find the best way to get pain under control. We are back to my “dying peacefully takes a lot of planning and preparation.”
Not to be overlooked in preparing for a peaceful end is the spiritual side of life. This may or may not be religious in nature. Butler points the reader toward many spiritual traditions with examples of prayers and rituals. Those who do not consider themselves to be religious will find resources here. The chaplain in me really appreciates this aspect being included in a book called “A Practical Guide”. Saying goodbye at the end of life IS a spiritual journey.
In the end, Butler turns to a healthcare system which makes dying well so much harder. The way our system works in the United States is doctors and hospitals are paid for doing stuff. The more aggressive the treatments… the more machines used… the more tests ordered and more needle sticks… the more providers are paid. We (through Congress and Medicare/Medicaid) have no problem spending $7,000 a day on a dying elderly patient in an ICU but cannot find the money for more physical therapy to help another old person live independently. A doctor can order pills for a frail patient that cost hundreds of dollars but can’t help them get food. Katy Butler, appropriately, encourages all of us to become activists in changing the way we care for, not just the dying, but those living with frail health throughout our declining years.
Get the book. Read it now. Read it again every time you find yourself moving from one of Butler’s phases to the next.
Hank Dunn, author of "Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures, and the Patient with a Serious Illness"
29 people found this helpful
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M. R. Reynolds
4.0 out of 5 stars A very good read
Reviewed in the United States 🇺🇸 on 9 November 2022
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I live in a Christian senior community where death is no surprise or shock to anyone. Each individual chapter in the book has a good summary of that chapter's key points. One of the most important points in the book is to accept your mortality and don't blindly accept riding on the carousel of repeated circular trips to the E.R. (the gun and knife club). The good end of life part is when you know you are about to cash out in life's check out lane (my words) seek to surround yourself, if you can, with peaceful surroundings and family, which you won't find in the E.R. or in most intensive care units. Near the end of the book the author delicately mentions details about some who seek to hasten their death. One star off my rating because the author, also near the end of the book, dwells on non-Christian traditions.
5 people found this helpful
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A CPA and CFP® professional
5.0 out of 5 stars I didn't choose to be born, and I don't choose to die
Reviewed in the United States 🇺🇸 on 30 September 2019
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I've read a lot of books on end-of-life planning lately. I'm doing a unit with my clients on "Getting Your Affairs In Order" just as a sort of "yep, checked that box" sort of thing. No one is imminently dying, as far as I know. But that's the thing with being a planner: you don't actually KNOW when, so best to know this stuff ahead of time in case you need it.
Like most books I've read on this topic, Katy Butler's "Art of Dying Well: A practical Guide to a Good End of Life" is sort of mixed up between talking to caregivers and the person who will be doing the dying. Some messages are easier to read when you imagine yourself as the caregiver, of course, but anything you learn in the course of being a caregiver you can pivot to use for yourself when the need arises.
Talking about death starts out stilted and hard, but quickly becomes sacred. It's like imagining a childbirth, all gross with blood and feces and unattractive uses of sexual parts. When you're distant from the occasion it's unseemly to give TMI. But when it's YOU having a baby, or your spouse, well: we want to know ALL the tricks for avoiding tears on the perineum, how to roll the nipples, what sort of car seat you want to have installed in advance.
Reading about death is much the same. In fact, one quote that stuck with me was "I didn't choose to be born, and I don't choose to die." It's a contemplation of the limits of our powers. Sometimes we're just swept along with these great forces and control is an illusion. You can meditate on that for yourself if you wish, it leads to useful places.
This entire book leads to useful places, in my opinion. Knowing when to post a MOLST on the fridge, knowing when NOT to call 911 (and what to do instead): this is useful information for most of us. It gives you some language to help interpret what doctors are trying to tell you, which I found helpful. She does this at various stages. When they say you're ill, asking what the progression of the disease will look like is more helpful, in some ways, than their estimate of how long you'll live. (The doctors routinely over-estimate how long you'll live, by the way. They may be thinking 3 to 6 months and tell you 6 months because they want you to have hope. But it can screw up planning!)
I'm a financial planner and this book isn't a clear win for the financial piece of it. That's Harry Margolis' "Get Your Ducks In a Row". But I liked this book better than the trollishly named "Advice for Future Corpses". Recommended.
25 people found this helpful
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SassyFpT
5.0 out of 5 stars Very important read for everyone
Reviewed in the United States 🇺🇸 on 5 June 2021
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This is a book anyone should read. There are important actions everyone needs to take in order to make sure that your wishes are being met. There is sudden illness and health crisis and emergency where you may not be able to tell doctors and family what you want or don't want to happen now. There are wishes for your death that on my you know and maybe you have not even given thought, but you should. Age is no deterrent for death. It can happen just like that to you at your age right now.
Being prepared is not only good for you, but will aid your loved ones and your doctors. You could be in an accident and there suddenly are questions and critical decisions that only you can make, but if you are unconscious or unable to think, who then will know what it is you want to happen? Don't leave these possibilities undecided or in strangers hands, or worse burden your loved ones with such life or death death decisions.
This book is great, will take you through the steps everyone should take while in good health.
I'm chronically ill and I have long planned my last days, weeks or months, but this book explained much I didn't know and realize that I still needed to do and understand. This book is on my Kindle right up front, I often go back to read some sections again to make sure I have taken all the actions needed so my death will be following my wishes. Death may not be pain free and peaceful, it may be a struggle, but I know that at least my wishes have been made clear and everyone that needs to know my wishes knows them.
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RLL
5.0 out of 5 stars Great "how to" book
Reviewed in the United States 🇺🇸 on 11 February 2023
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Similar to Atul Gawande's "Being Mortal", this book is, indeed, practical. It not only tells you about end-of-life problems, it tells you what to do and how to do it. If you don't want to die in a hospital devoid of friends and family, I would first read "Being Mortal" and then read "The Art of Dying Well".
2 people found this helpful
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Beth
5.0 out of 5 stars You MUST READ this - practical, realistic, not morbid, accurate - see the other reviewers
Reviewed in the United States 🇺🇸 on 26 April 2019
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As a married, no children, baby boomer, I THOUGHT I had done everything legally necessary to prepare for our aging in place in an urban area. I have had the privilege of being at the deaths of my mother (65) at my age of 34, my father (87) at my age of 56 - both are at home, one with hospice, one without but an understanding physician who gave us adequate sedation. I also attended the date of my mother-in-law(91) - I was 62 yrs old then, in a hospice home in LA, Calif, in lieu of my only-child husband who was recovering from a brain infection occurring at the same time she became seriously and terminally ill. I myself have had numerous serious illnesses beginning in my late 20s, survived and am still here having interacted frequently over the years with the medical system for myself and family members. Upon retiring, I served as a hospice volunteer for 2 years in urban Montgomery County MD near NIH. I disagree with the hospice chaplain's review of this book. We have all our legal documents, advanced medical directive, DNRs, but I learned yet again, we need other directives I had never heard about. I will buy this on audio so my husband can listen to this as we make our frequent drives to our second home in a rural tidewater area on the Chesapeake Bay. This is a practical, positive guidebook. You should also read Atul Gawande's "Being Mortal" at the same time.
15 people found this helpful
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K. Mundie
5.0 out of 5 stars A Thoughtful Guide for End of Life Planning
Reviewed in the United States 🇺🇸 on 20 April 2022
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I originally got this book out of the library but realized I needed to buy it because it would be a book I would return to again and again while dealing with eldercare issues for my parents and in-laws.
The book is an excellent and up to date guide for the various stages of growing older and what older adults can do to live as independently and comfortably for as long as possible. The book as realistic tips and advice yet also takes into account the emotional elements to growing older and moving from independent living to interdependent living and then acceptance and care for the very end of life.
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chriswy
5.0 out of 5 stars An invaluable guidebook
Reviewed in the United States 🇺🇸 on 19 February 2019
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Several years ago I entered my eighth decade still vital and vibrant until a cancer diagnosis divided my life into before and after. Up until then I had lived with little thought I would grow old and a confident reliance on the best modern high-tech medicine had to offer. My diagnosis was a wakeup call to live a better life. My treatment, though effective, was a confrontation with the limitations of modern medicine in the face of an aging and increasingly fragile body.
Katy’s first book, Knocking on Heaven’s Door, along with her public persona in the Slow Medicine movement, opened my mind to a new way of thinking about living, dying and the changing role of modern healthcare in an evolving, more patient-oriented, landscape. The Art of Dying Well is a new and much-needed companion for those of us on the far side of our midyears. It is practical - a map, a handbook, an ally - as we explore paths to resilience, decline, adaptation, acceptance, preparation and peaceful passing in an increasingly impersonal and over-medicalized healthcare system. My brand new copy, already inked, dog-eared and tattered is now beside me as I navigate my own journey forward. An excellent resource.
215 people found this helpful
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Scott S.
5.0 out of 5 stars Read if you think you might die
Reviewed in the United States 🇺🇸 on 10 May 2022
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This book is chock full of practical and thoughtful ideas and advice. It’s written in clear terms and doesn’t shy away from the mechanics of death and dying. The stories shared are Illuminating and often moving. I came away feeling validated about my helping friends and family as they died. I’m also thinking about what I want for end of life care.
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The surprising comfort of a new book about death
Review by Michael Dirda
March 20, 2019 at 12:15 p.m. EDT
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The woods decay, the woods decay, and fall,
The vapours weep their burthen to the ground,
Man comes and tills the field and lies beneath,
And after many a summer dies the swan.
So begins Tennyson’s haunting poem “Tithonus,” a meditation on death as part of the natural order of things. Natural, that is, for everyone except Tithonus, to whom the gods granted immortality but not eternal youth. Thus he grows older and older, ever more feeble with each passing day, yet can never die.
Today, “Tithonus” seems an uncanny prevision of much contemporary medicine. Drugs and radiation, chemotherapy, ventilators, feeding tubes, medical drips and monitors — all these may be worth enduring when a reasonable hope exists for a return to the world outside the intensive care unit. But, suggests Katy Butler in “The Art of Dying Well,” for more dire cases, when there is no cure for the cancer or one is already old and frail, alternative courses of action may be preferable. Some noninvasive treatments and gentler medications may allow a life with dignity, even if a shorter one, and avert the suffering and purgatory of a living death.
The author Katy Butler (Camille Rogine)
Butler isn’t a doctor, but she is a professional science writer and author of the widely admired “Knocking on Heaven’s Door,” a critique of our broken medical system told through case histories and an account of her father’s traumatic last years. Not surprisingly, then, this “practical guide to a good end of life” delivers on its subtitle, offering detailed advice on dealing with — in poet Philip Larkin’s phrase — “age, and then the only end of age.” Butler’s factual, no-
nonsense tone is surprisingly comforting, as are her stories of how ordinary folks confronted difficult medical decisions. In short, if you’re coming up on three score and 10 or have already passed that biblical term limit for earthly existence, you will want to read “The Art of Dying Well” and keep it handy, if only for its lists of what to do as one’s physical condition changes.
Overall, Butler’s advice can be summed up in the Boy Scouts’ motto: Be prepared. If you’re merely approaching the end zone, do all you can to preserve your well-being. Exercise. Keep your weight down. Eat lots of vegetables. Control your blood pressure, cholesterol and sugar, ideally without medications or with the smallest dosages possible. Stay mobile, but watch out for falls. Be sure, too, that your financial and medical records are organized, comprehensible and digitally accessible to the appropriate people in case you are incapacitated.
‘Old Age: A Beginner’s Guide’: What you really need to know about life’s later years
After all, accidents and unexpected diagnoses happen, and no one knows when or from where the blow will fall. While you can, think through possible medical futures, however unpleasant. Do you wish to be kept alive no matter what, at any cost? Are there procedures you want nothing to do with? Whatever you decide, make sure that your family, friends and medical advisers are aware of your desires — and that you and they have the proper documentation to implement them. These start with a durable power of attorney for health care, so that someone you trust can make decisions if you can’t. You should also set up a living will or advance directive as a guide to what you want and don’t want if you land in the emergency room. Better still, consider the somewhat similar POLST or MOLST — physician or medical orders for life-sustaining treatment — which is more scrupulously honored by hospital personnel because it is signed by your doctor.
In general, Butler tends to be wary of the medical establishment. Pharmaceutical companies, hospitals, physicians and nursing homes make money on drugs and high-tech procedures, often overprescribing the former and automatically recommending the latter. Butler suggests that palliative care, milder, less invasive protocols and physical therapy are often underutilized, work well or well enough, and avert the ravages and often devastating aftereffects of expensive Hail Mary treatments.
(Scribner)
Throughout “The Art of Dying Well,” Butler stresses the vital importance of having what she calls a “tribe.” A tribe can be one’s extended family but might also include the neighbors you socialize with, or your bridge club and fishing buddies, or members of your church — in short, the people you care about and who care about you. What matters is that a tribe’s members are mutually sustaining: They help each other out. Loners don’t do well in old age.
Ditch the quest for eternal life and just enjoy the days you have
The need for a support circle grows particularly important for those who hope to die at home. Hospice care is invaluable — and Butler recommends starting it sooner than most people do — but its visiting providers are overworked, underpaid and too few. So you will need friends, family or hired caregivers to give you painkillers and sips of chicken soup. Of course, a rational society would properly tax its obscenely super-rich if only to pay better, more appropriate wages to hospital and hospice nurses, physician assistants and the aides in dementia wards and long-term nursing facilities. When you need to have your soiled linen changed, you will bless the one who does it.
The actively dying, Butler reminds us, are frequently troubled by unfinished business: They have regrets, want forgiveness, fear being utterly forgotten. Above all, they yearn to know that their lives had meaning. Some solace may be found in having been part of an enterprise larger than oneself — a religious faith, the education of children, the advancement of some area of art, science or scholarship, civic activism, the care of the sick and dying. There will, nonetheless, always be regrets.
Butler’s “The Art of Dying Well” covers much I haven’t touched on, including aging in place, Medicare, assisted suicide and last rites. Her thoughtful book belongs on the same shelf as Atul Gawande’s best-selling “Being Mortal” and Barbara Ehrenreich’s “Natural Causes.”
Michael Dirda reviews books each Thursday in Style.
THE ART OF DYING WELL
By Katy Butler
Scribner. 274 pp. $26
