A Review of Last Rights: Rescuing the End of Life from the Medical System

by David C. Cramer, MDiv, MA

At the turn of the twentieth century there was a barrage of socially critical novels and writings condemning the evils of the American industrial age, so much so that a new genre was coined: the “muckraker.” Upton Sinclair’s The Jungle and Frank Norris’s The Octopus are two notable examples that come to mind, addressing the evils of Chicago’s meat packing industry and California’s railways, respectively. It would be tempting to approach Stephen Kiernan’s latest book, Last Rights: Rescuing the End of Life from the Medical System, as a modern-day example of the muckraking genre. As the subtitle suggests, this book does expose many of the evils, or more often incompetencies, of the medical system’s current approach to dealing with gradual dying.

However, some notable differences between Last Rights and the muckraking novel might highlight the wisdom in taking a different approach to this book. First, though Last Rights does contain a couple of fictional stories, the majority of its accounts are unfortunately all too real. Second, though Kiernan is a journalist by trade, he takes a much more personal approach to this book than the sometimes dispassionate, objective journalism that is supposed to be a mark of the trade. He interviews countless individuals who have lost loved ones, even accompanying many to bedside visits and funerals. Finally, and most importantly, Kiernan’s goal is not merely to expose the flaws of the medical system’s approach to dying; instead he goes further by offering potential solutions and alternatives to the current status quo.

Last Rights is divided into seven parts. In part one, Kiernan explains that today people often take longer to die than in the past and argues that hospice and palliative care must accordingly become more viable options. Part two offers a glimpse into the nearly universal stages of gradual death, giving helpful advice for both family and caregivers. Problems with the way the medical system approaches dying are discussed in part three, including some of the many obstacles to change. In part four, Kiernan explores how the aims of the medical system and those of families often collide, explaining how beautiful it can be when the two come together. Then, in part five, he boils down these issues to a word: control. Part six expresses how dying offers an opportunity to learn and to “reaffirm all of life that is noblest, most compassionate, most courageous” (241). Finally, part seven offers a vision for reforming end-of-life care in America.

While Kiernan has a clear agenda in this book, the fact that his agenda is clear makes it trustworthy. And while written from a primarily secular perspective, Last Rights is highly sympathetic to the spiritual aspects of death and dying. It is an enthralling, quick, yet challenging read which is targeted primarily to the popular U.S. audience, though its insights would be of interest to medical professionals as well. Last Rights is thus recommended for those with elderly or terminally ill relatives or close friends, professionals in the medical system, particularly those in geriatrics or intensive care, and those who, like myself, anticipate dying at some point in the future.CBHD  

This review originally appeared in Ethics & Medicine: An International Journal of Bioethics Vol. 24 No. 1, Spring 2008, page 63, and is used by permission.