Dying Well: The Prospect for Growth at the End of Life
Paperback – ISBN 1-57322-05105
In 1997, too many Americans were dying in hospitals, often in pain, often alone. Progress has been made in alleviating pain and expanding hospice and palliative care for people nearing the end of their lives. Yet, even today, too many people are dying badly! The stories in Dying Well enable readers to imagine that wellbeing is possible through these most difficult times of life. This book remains as vital and valuable to individuals and their families today as it did when it was first published.
“The wisdom embedded in Dying Well is every bit as relevant today as when Byock first put pen to page twenty years ago.” —Professor Harvey Chochinov, author of Dignity Therapy
“Dr. Ira Byock was one of the earliest voices calling for crucial change in the way we treat the dying. On the 20th anniversary of Dying Well, we find ourselves with a long way still to go, making its lessons as relevant today as they were at first publication. This groundbreaking book is a classic that should be on everyone’s bookshelf, whether patient, family, or physician. The twelve case histories described in Dying Well provide readers with necessary insights to guide them through this challenging passage. Dr. Ira Byock, a mentor to this movement, remains a critical and brilliant voice for change.” —Jessica Nutik Zitter, MD, MPH, author of Extreme Measures: Finding a Better Path to the End of Life
“Before Being Mortal and When Breath Becomes Air, there was (and remains) Ira Byock’s prescient and unforgettable Dying Well. With the deep sensitivity of Abraham Verghese and the profound humanism of Atul Gawande, Ira Byock’s Dying Well remains the ‘go to’ guidebook for all mortals and their loved ones. After 20 years, this classic remains required reading for all patients, medical students, doctors, nurses, and anyone that will face mortality, in other words, required reading for all humanity.” —Angelo Volandes, MD, MPH, co-founder & President ACP Decisions
“This book is more relevant than ever. The country has been primed by more attention being paid to how we die, and at the same time to the ills of our healthcare system. Ira shows us how much better things could be. Not with exotic knowledge or more information, but by doing what we already know how to do. Given the nature of the subject, that means that Ira’s counsel has the power to affect every single one of us. Thrilling and daunting too, I realize, but far better than the alternative! And, thanks to Ira, we have a playbook.” —BJ Miller, M.D. senior advisor to the Zen Hospice Project
“Ira Byock’s book Dying Well was a remarkable and path-breaking book when it was first published 20 years ago. Since then it has remained the gold standard of books teaching us how to live deeply to the end. He is a truly humane guide speaking warmly to a country that is just now beginning to break the taboo and needs to talk meaningfully about living and dying well.” —Ellen Goodman, co-founder and Director of The Conversation Project
“Dr. Byock’s profound insight into living and dying has been a source of strength and practical approaches for thousands of people. This powerful book about his work and wisdom reveals what it means to die well. It is written by the most renowned clinician in the end-of-life care field.” —Rev. Joan Jiko Halifax, author of Being with Dying
“Dying Well has never been more relevant. We live in a society that still is in need the medicine Dying Well prescribes: compassion, wisdom, connection and the relief of suffering. Ira’s words are a balm for how to live and die with respect and dignity.” —Sensei Koshin Paley Ellison, Co-Founder of the New York Zen Center for Contemplative Care and author and editor of Awake at the Bedside.
“I was death-naive before I read Dr. Ira Byock’s book, Dying Well when my father was in his early 80s and in his final, painful decline. It introduced me to the possibility that with appropriate support, dying did not have to be a chaotic, fear-ridden and painful experience. In fact, families could be well-supported and death could even be meaningful. I found it immensely reassuring, informative and helpful when I was beginning my research for Knocking on Heaven’s Door. Dying Well, since its first publication, has, opened a door in our culture and allowed people to stop pretending death doesn’t exist and instead explore the meaning and practices of good dying. We have so much further to go until we give all Americans a chance for a humane and sacred passage from life to death. Dr. Byock’s work has opened up many people, family by family, to options they didn’t know were possible.” —Katy Butler, author of Knocking on Heaven’s Door and A Good End of Life (forthcoming in 2018.)
“Through masterfully crafted stories Dr. Ira Byock’s book Dying Well broke new ground upon its initial release in 1997 by portraying the transformational message that death can be peaceful and beautiful when well managed. His words were an inspiration to me then, a hospice physician seeking a mentor for my new role tending to both life and death for my patients. Dr. Byock’s vision of living and dying well is needed now more than ever as we still struggle to provide better care to the dying and to create a new societal attitude toward death. Dying Well is not only a guidebook for navigating the end of life, but also a case study for medical providers in caring for the entire lifecycle of our patients. Read Dying Well for the first time or read it again to recall the uplifting message that growth is always possible, even in the most hopeless of situations—a message that speaks as deeply to each of us now as in the past.” —Karen Wyatt, MD, author of What Really Matters: 7 Lessons for Living from the Stories of the Dying
“The field of palliative care has grown exponentially with more than 68% of hospitals with greater than 50 beds having a palliative care program and with the expansion of palliative care services into the outpatient and community programs. But the challenges to patients’ accessing palliative care remain and millions of people with serious illness do not receive the care they need. We need them to demand such care by learning about palliative care and how it is associated with a better quality of life, and a true value based care program. That is why Dying Well is even more relevant today that when it was published. It offers a way forward for the public to engage in talking about dying that gives them the opportunity to learn what is possible and understand that they can make choices in their medical care to enhance their quality of life living as fully as possible and dying well.” —Kathleen M. Foley, M.D., The Society of Memorial Sloan Kettering Cancer Center Chair
How-To Editors Recommended Book
On his deathbed, faced with creditors and unpaid bills, Oscar Wilde said despairingly, “I am dying beyond my means!” If only the poor, beleaguered genius had read this book! None of us gets out of here alive, but reading this book will lessen your fear of the ultimate end and give you some guidance about enjoying your life to the fullest right up until your final moment. Do people really enjoy life in the face of death? People do. The stories of individuals in Dr. Byock’s book will move and inspire you to change your feelings about the end of your life, and also your feelings about your life in the present.
The title identifies the main point of this book: that dying well, not a “good death,” should be one’s goal at life’s end. Byock is a leader in the hospice movement and an experienced frontline physician, and he focuses on the continuous aspect of dying rather than the one-shot of death. First, he stresses, pain must be controlled, and then fear and loneliness reduced. Death, he reminds, is as much a natural part of human life as birth, and both can promote growth and understanding. He describes 12 case histories at length, including that of his father, a rural general practitioner. He punctures many myths as he demonstrates that it is not illegal to die at home, that death by starvation is not necessarily painful, and that addiction to painkilling drugs is not a serious problem for a dying person. Ever honest, he even cites one case in which pain, despite his claims that it can always be controlled, really could not be.
From Kirkus Reviews
A hospice doctor’s wrenching stories of dying patients and their families, which dramatically illustrate his belief that the transition to death can be one of life’s most meaningful experiences. Byock, a specialist in palliative care who directs a hospice in Missoula, Mont., has chosen stories that represent a wide range of experiences, each focusing on some aspect of human growth. Pseudonymns are used throughout except for Byock’s moving account of his own father’s death and the story of the Merseal family, whose dying son was the subject of a 1996 HBO documentary. What is crystal clear in all of them is that the full experience of dying is not captured from a purely medical perspective. Without proper medical care, dying can be agonizing, but relief of physical pain, which Byock contends is always possible, is by no means the whole picture. In his experience, emotional pain is more intense and requires more skillful intervention. Dying well, says Byock, involves reaching certain landmarks, which he encourages his patients to achieve: asking forgiveness, accepting forgiveness, expressing love, acknowledging self-worth, and saying good-bye. One of the hardest to read of Byock’s stories describes the death of Terry, a 31-year-old mother with cancer who cannot reach these landmarks and suffers greatly. Her story also illustrates the fine distinction between hastening death and ensuring comfort. Byock, who argues that the euthanasia debate has distracted our attention from more logical and humane approaches, is not afraid to give his considered opinions about assisted suicide, vegetative states, and feeding tubes. Often reminiscent of Michael Kearney’s recent Mortally Wounded (p. 1029), which described that doctor’s work with patients in an Irish hospice, this is another powerful argument in favor of the hospice movement and rejection of the Kevorkian approach.
Life on the edge of the great crossing is explored in all its sadness and pathos, but Byock also makes room for wisdom, hope and even the joy of final understanding.
The Washington Post
Throughout, his expertise, clearsightedness and empathy are clear…Dying Well“… succeeds brilliantly in its intention, which is to advise and comfort the dying and those close to them.”
In our hearts, we all realize that we are not going to live forever. There are people we love whom we bury. We have a choice as to how to deal with this. We can pretend that it can never happen and hope to be hit by a bus, or we can follow Byock’s lead and consider the end of life as potentially full of growth and enlightenment as any other time. After reading “Dying Well” you may not be so afraid.
Card Catalog Description
Nobody should have to die in pain. Nobody should have to die alone. This is Ira Byock’s dream, and he is dedicating his life to making it come true. The longtime director of a hospice in his hometown, and a prominent spokesperson for the hospice movement, Dr. Byock believes that the possibility for us all to die well is just around the corner: the day is at hand when no pain among the dying will be considered unmanageable. He shows us that much important emotional work can be accomplished in the final months, weeks, and even days of life. Dying Well brings us to the homes and bedsides of families with whom Dr. Byock has worked, telling stories of love and reconciliation in the face of tragedy, pain, and conflict. It provides a blueprint for families, showing them how to deal with doctors, how to talk to friends and relatives, and how to make the end of life as meaningful and precious as the beginning. Here is a book like no other on the subject: hopeful, clearsighted, and life-changing.