Gregory L. Eastwood - Finishing Our Story: Preparing for the End of Life

Oxford University Press is a department of the University of Oxford. It furthers the Universitys objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.

Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America.

Oxford University Press 2019

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above.

You must not circulate this work in any other form

and you must impose this same condition on any acquirer.

Library of Congress Cataloging-in-Publication Data

Names: Eastwood, Gregory L., author.

Title: Finishing our story : preparing for the end of life / Gregory L. Eastwood.

Description: New York, NY : Oxford University Press, 2019. | Includes bibliographical references and index.

Identifiers: LCCN 2018031071 (print) | LCCN 2018045637 (ebook) | ISBN 9780190888091 (updf) | ISBN 9780190888107 (epub) | ISBN 9780190888084 (paperback)

Subjects: LCSH: Terminal careMoral and ethical aspects. | DeathMoral and ethical aspects. | BISAC: MEDICAL / Geriatrics. | MEDICAL / Ethics. Classification: LCC R726.8 (ebook) | LCC R726.8.E27 2019 (print) | DDC 616.02/9dc23

LC record available at https://lccn.loc.gov/2018031071

To Lynn, Kristen, Lauren, Kara

I am grateful to Lucy Randall, my editor at Oxford University Press, for her skillful balance of flexibility and firmness and her patient management of the manuscript as well as of me throughout the process of improving it for publication. My wife, Lynn Eastwood, who understands my motivations and is an expert on my quirks, added important reality testing of the manuscript. Nancy L. Zimpher, PhD, former Chancellor of the State University of New York, saw to it that I had some sabbatical time to begin writing the book, which I very much appreciate. Kathy Faber-Langendoen, MD, Medical Alumni Endowed Professor of Bioethics and Chair of the Center for Bioethics and Humanities at SUNY Upstate Medical University, has created an extraordinary environment for professional growth and collegial enrichment, from which I have benefited. In the Center, I am surrounded by wonderful colleagues who have helped me enormously to expand my understandings of bioethics, the humanities, and medicine and health. Finally, I am indebted to all the students over my professional lifetime who have taught me a great deal and to the many patients, their families, and their doctors, nurses, social workers, and other professionals who have enriched my experiences and populated the stories that I carry in my memory and that made possible the writing of this book.

M y grandmother died when I was three years old. I made the ten-hour car trip with my parents from our home in Michigan to Yeagertown, a small town in the mountains of Pennsylvania, where my grandparents lived. I recall nothing of the trip or of the events in Yeagertown, except one thing, and it is my first memory. I am standing, holding my fathers hand, in the front room of my grandparents home, looking at Grandma lying there. Grandpa, my grandparents childrenmy father and his sistersand grandchildren and relatives and friends, all were present. Grandma was in her mid-seventies and had died from a stroke. From the perspective of decades later, I think she had what we call in the current idiom a good death. After her stroke, her death seems to have been anticipated as being imminent and she was in the company of family and friends. She was not hospitalized, there was no diagnostic or therapeutic machinery involved, and the funeral directors fees were modest. Her minister and the church were down the street.

I wrote this book because I think many people are confused and a little put off by the end of life as it is experienced in contemporary America and many parts of the world. The experiences of the end of life and of dying, for the person who dies and for loved ones and friends, have become very different for most people from those associated with the death of my grandmother. The end of life has changed a great deal in recent years and, of course, the changes have been accompanied by enormous benefits, even regarded at times as miracles. But sometimes they also are associated with distress, uncertainty, and conflict. This book is intended to help you understand this important part of your life and prepare for it more deliberately. You may want to ensure that the last part of your life aligns with how you have lived until then or you may want to make some adjustments that differ from how you have lived. Either way, I wish for you more control over the end of your life so as to achieve a more satisfying resolution, for you and for those who matter to you.

To most of us, the end of life and dying may be familiar in ways we do not fully comprehend. Nearly everyone knows a relative or a friend who has died and thus may appreciate some of the issues that have arisen as end of life and dying have changed. Of course, all of us will have first-hand knowledge of the end of our own lives; some readers may be experiencing that right now. And in recent years books, articles, television programs, discussion groups, and the like have opened this important part of life to better understanding and acceptance. Yet we seem to feel more at ease with, and consequently understand better, the other phases of our lifebefore we are born, our infancy and childhood, and the stages of our adult years. We seem less comfortable when we anticipate the end of life. Perhaps this is related to our fears about that phase of life, avoidance of the unknown, and awareness of the finality of death.

So, this book is for people who have questions about the end of lifewhat to expect, how to prepare for it, what to do when you get there. I think this includes almost everybody. This view derives from my involvement in caring for patients; working as an ethics consultant, which includes interacting with patients, their families, physicians, and other health professionals; teaching end-of-life issues to medical and other health profession students; and presenting and discussing end-of-life issues with non-medical audiences.

My intention is to offer, in straightforward language, relevant information, and sometimes my own perspective, about matters that are pertinent to preparing for the process of dyinghow dying has changed and why that is important, what we mean by quality of life and how that relates to end-of-life decisions, what are the implications of making ones wishes known and how to ensure that they are followed, how ethical conflicts that arise in the care of dying patients may be resolved, what palliative care is and when one might consider receiving its benefits, the facts about physician-assisted death and other forms of suicide when dying seems inevitably soon, and what it means to create the final chapter of the narrative of ones own life. To the extent that this is useful, I will be pleased.