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P&S Journal

P&S Journal: Spring 1994, Vol.14, No.2
Doctors in Print


By George M. Burnell '57
Hamlet put it succinctly, "To be or not to be?" and several centuries later, Dylan Thomas counseled his dying father with lyric fury, "Do not go gentle into that good night,/Old age should burn and rave at close of day;/Rage, rage against the dying of the light." Since time immemorial, the living have been ruminating on how to approach life's last threshold.
In his new book, "Final Choices: To Live or To Die in an Age of Medical Technology," based on two decades of clinical experience counseling hundreds of patients and their families facing terminal illness, psychiatrist George M. Burnell'57 offers a thorough and sensitive handbook on how to face the ultimate decision.
Dr. Burnell reminds us that while people live longer today, thanks to modern medical know-how and technology, the quality of life at its end and our sensitivity to the needs and wishes of the dying have deteriorated. "Today over 80 percent of Americans die in hospitals or in institutions...in marked contrast to 50 years ago... when most [Americans] died at home." Whatever their virtues, institutions tend to depersonalize the individual patient; while doctors do their best to preserve life, they often waver when it comes to confronting death, with "little time to see a patient through the end of an illness." Consequently, while this generation's grandparents died in the warmth of the family circle, today's terminally ill are more likely to end life hooked up to a high-tech host of life-sustaining gadgetry with a gurgle in lieu of last words.
As a Michigan social worker put it: "We plan for births, for weddings, for many events in life, but one of the things we don't plan for is our own death. One of the tragedies in the hospital setting is not giving people that opportunity." The book is divided into chapters treating the full range of related issues, from the sociological ("Why Dying Is a Problem Today for You and Your Family") to the philosophical ("Do You Have a Philosophy of Living and Dying?") to the ethical ("What Your Doctor May Not Tell You About Dying") to the legal ("How Does the Law Influence Decisions to End Life Support") to the pragmatic ("Practical Steps to Gain Peace of Mind").
The tone is frank and pulls no punches, as when Dr. Burnell reflects on the conditions of his own mother's passing: "At the moment of her death, my mother was receiving the best care that money could buy. But she was all alone in a private room an
d away from her family. I don't believe that she had as good a death as her father did." Dr. Burnell's declared purpose in writing the book was to provide background information that will prepare patients and their families to make educated and intelligent choices "when the time comes to meet the challenge of life's ending." That purpose is powerfully served by this book.


copyright ©, Columbia-Presbyterian Medical Center

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