Family caregivers save the American health system $450 billion annually.

It’s care provided mostly by women. It consists of long hours, no pay, and high stress.

This is just one of the side-effects of medical advances that keep people alive much longer than they lived even a generation ago. And in many cases it keeps people alive in situations that are worse, even deplorable for sentient beings.

It leaves them in the alien surroundings of hospitals often without the authority to determine their own treatment, or desire to be left without treatment.

And it leaves doctors in an uncomfortable position having to negotiate conflict between family members, something they have no training in. And in many societies, doctors are the target of physical violence for who they are, for what they earn, and for sometimes just being in the wrong place at the wrong time.

And when the patient dies, the doctor often sees it as his or her fault.

In this book we learn that loneliness increases mortality by 50% although nobody knows why.

In the US there are now more than two million people who outlive all friends and relatives. The chief defence we have against nothingness is family and up until the end it holds up quite well, Dr. Warraich opines.

Still, modern medical science has created new challenges by keeping people technically alive when in fact they are dead. Has modern science done more to defer death than to extend meaningful life? It would seem so.

It is important for doctors to view their patients as people stuck in a place they’d rather not be.

“Death stealthily commands and controls every aspect of our lives.” This seems to hold true for the physician as for the patient. ( )

This is not an easy book to read. if I didn't have a mother who is suffering from severe dementia and if I was five or 10 years younger, I probably would've left this book on the library shelf. There are a number of books that discuss decisions and scenarios around the end of life. The author is a doctor who has experienced patients and families dealing with the imminent prospect of death.

I can't say that I've gained any new insights for encouragement from this book. I have experienced end-of-life situations so while I appreciate the book, I know what we're all in for. I think what upset me the most is the probability that we will die alone and not in our homes. The end-of-life generally means the end of control – – our care is at the whim and sensitivity of others – – those who may work in a hospital, hospice center or nursing home.

My fervent hope, especially as I get older, is that we allow more dignity for the dying in their last hours. If you have been seriously considered end-of-life scenarios for your loved ones work or yourself, you should read this book. ( )

Well written study of a tough subject; it is another brilliant effort by a Pakistani writer,
like Guwande.
Reads well because he uses anecdotes well. ( )

In this very valuable book, Dr. Warraich examines how death has changed, and discussing the implications of those changes for all of us. We will all die, and most of us will be involved in the deaths of others. But the way most of us die has changed drastically over the past century. Before then, death usually came quickly, at home, and was usually definitive -- the heart stopped, and so did life. But now death tends to be gradual, and to happen in the arms of the medical industrial complex of hospitals, nursing homes, and hospices. It is also, oftentimes, much harder to define - is someone dead when brain function cannot be detected, even if the heart continues to beat and the lungs to breathe? These changes pose problems for patients and care-givers, problems that all too often are not anticipated in advance. Dr. Warraich recommends over and over that people discuss and think about the way they want their lives to end before the crisis comes, and this book provides an enormous amount of information. It that sense, it can be liberating -- I did not find the book at all depressing (though it is painfully sad in some places). Dr. Warraich relies on extensive research and on his experience as a physician to make his points, a deeply satisfying combination. ( )