In recent years there has been increased attention on care at the end of life. Events such as the very public death of Terri Schiavo in 2005, and the misrepresentation of proposed provider payment for advance-directive counseling as “death panels” during the healthcare reform debate have contributed to this increased attention. As the baby-boomer generation continues to mature, and the incidence of people living with chronic and eventually fatal illnesses increases, improving end-of-life planning will be essential.
Advance care planning means different things to different people, and the lay public is largely unfamiliar with the concept. In general, advance care planning means taking steps to plan for the end of one's life, including writing an advance directive to physicians, establishing a durable power of attorney for healthcare, and in some situations completing state-specific paperwork regarding your resuscitation desires. Advancing medical technology, which can often physically sustain a human body for a prolonged period, has highlighted the need for thorough planning.
The intended audience of Sooner or Later: Restoring Sanity to Your End-of-Life Care is people facing a life-threatening illness and/or their families. The reader will probably need at least a high school education to understand the content, and have a least a basic understanding of how the United States healthcare system works. The author indicates that the purpose of the book is to guide the lay person and his or her family through the end-of-life planning process. Early in the book he briefly reviews the myriad treatment options that may be offered at the end of life, and these options are explored in greater detail later in the book. The early sections, like the entire book, are based on the author's experience and anecdotal knowledge; there are only 2 citations given in the book, both at the end.
The book describes a series of planning steps, which range from living with a terminal illness, to helping explore goals via a series of reflective questions, to education related to life support, and finally to what it means to receive hospice care. The most beneficial component of the book—keeping in mind that the intended audience is not healthcare providers—is chapter 4, which lists questions designed to help the reader make informed decisions about the benefits and burdens of treatment. Although the book is not written for healthcare providers, the content would serve to familiarize clinicians with basic and general concepts about end-of-life planning. However, there are a plethora of books about this topic that are written by palliative care experts specifically for healthcare providers that would serve as better educational references.
At a very basic level, the material in this book is well selected and meets the goal of educating the intended audience about end-of-life planning. The book flows nicely and progresses logically from one topic to the next. While the book does describe some generally accepted end-of-life planning principles, the content is based on the author's knowledge and experience, rather than the medical literature. The writing style is clear and concise, which, when combined with the book's large print, makes it easily readable.
Planning for the end of one's life can cause a variety of emotions, ranging from anger to sadness, in both patient and family. Some people may find the process overwhelming; others may engage in it with enthusiasm. Before recommending this book to anyone with a life-limiting illness, or their family, it is important to understand their ability to comprehend the content and to emotionally tolerate what can be a difficult task. It is also important to know local community resources (eg, hospice programs, palliative medicine clinics, legal aid clinics) in the event the person or the family needs additional assistance once they began reading the book.
Footnotes
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The author has disclosed no conflicts of interest.
- Copyright © 2011 by Daedalus Enterprises Inc.
