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Book Reviews   |    
Sacred Dying: Creating Rituals for Embracing the End of Life ? Life and Death on Your Own Terms
Reviewed by Mary Ellen Foti, M.D.
Psychiatric Services 2002; doi: 10.1176/appi.ps.53.7.907
View Author and Article Information

by Megory Anderson; Roseville, California, Prima Publishing, 2001, 364 pages, $23.95 • by L. L. Basta, M.D.; Amherst, New York, Prometheus Books, 2001, 364 pages, $26

Sharing the commonality of topic and tactic, Sacred Dying and Life and Death on Your Own Terms speak to the multiple complexities of achieving a "good death" (1,2) in today's reign of medical technology. That Americans have specific preferences about both how and where they want to die has been documented in numerous studies (3,4). However, despite this research, the end of life is all too often a harrowing experience for patient and family alike. Anderson and Basta offer possible remedies for this problem.

Anderson, speaking to anyone dealing with the death of a loved one, states that Sacred Dying "is about bringing spirituality, through ritual, into the physical act of dying." Basta recommends his work to those "who care deeply about preserving their dignity and sparing loved ones the agony and economic consequences inherent in life-and-death decisions." Although the authors' respective locales and perspectives are very different, they both use storytelling as a means of describing dilemmas and pointing out solutions. Both books recognize the critical importance of facing one's own mortality in order to support and care for a person as they pass.

Anderson is a theologian who honors the experience of dying by using spiritual rituals to help people "leave the body so that the soul can move forward." Most of the deaths she describes occur either in homes or in situations where technological stopgap measures will not be initiated. Basta, by contrast, is a cardiologist. He describes dying patients in high-tech teaching hospitals who are prodded, poked, and cut to "maintain life"—a life that few would choose.

Basta's book is as much a reference as a guide. For the medical student or early-career physician, it teaches the principles of autonomy: paternalism, beneficence, and shared decision-making. The author appreciates the pressures to which doctors must respond—from patients, families, administration, or policy—when caring for a patient for whom cure is not achievable. The book's scenarios depict thorny decisions that patients, families, and physicians might face and outline the ethical principles that can be used to structure responses to questions about the denial or withdrawal of treatment with respirators, feeding tubes, antibiotics, and cardiopulmonary resuscitation. Basta reminds those of us in medicine that the job includes much more than the scientific application of technological innovations. It involves the art of caring for an individual's dignity by being thoughtful, kind, and present.

Like Basta, Anderson focuses on the protection and preservation of an individual's dignity at the end of life. Her approach describes the goal of care as a spiritually sustaining process for the dying person. She shows the reader how to calmly approach the dying person to determine what is most important to him or her. The space between the process of death and the event of death is expanded, if not in time, in spirit. Attention to the person's corporeal and spiritual needs helps transform the experience. Spiritual interventions take many forms: music, aromas, textures, lotions, words, silence, and prayer. Anderson recounts multiple stories that exemplify her methodology.

Sacred Dying and Life and Death on Your Own Terms offer practical tools, though vastly different, in their appendixes and other end matter. Anderson includes works from the scriptures and other sacred texts, poetry, readings, and prayers. The selections represent most of the major religious rites of the world. Her bibliography is replete with sound readings on general death and dying, spiritual concerns, rituals, religious traditions, multicultural traditions, the afterlife, practical concerns, ethical issues, music, and the psychology of death. Basta presents an extensive glossary of medical terminology, an advance care planning template complete with specific end-of-life scenarios, and some 350 references.

Hospital-based medical personnel—physicians, nurses, social workers, medical students, and others—will appreciate the familiar structure and texture of Basta's work, which resonates with personal experience while clarifying complex ethical issues. Critical care providers will be encouraged by Anderson's competent description of ways to soothe patients with the ancient balm of spirituality. Therapists of all disciplines who work with patients and families on issues connected with terminal illness will refer frequently to both books and be rewarded.

Because most of us are troubled by the thought of our own passing, we are ill prepared to aid and support a patient or a loved one on their last voyage. Each of these books helps us to calmly appreciate the truth that "to everything there is a season, a time for every purpose under heaven: a time to be born, and a time to die" (Ecclesiastes 3:1-3), and in so doing, we become more able to bear witness to death.

Dr. Foti is assistant professor of psychiatry at the University of Massachusetts Medical School in Worcester.

Emanuel E, Emanuel L: The promise of a good death. Lancet 351(suppl II):SII21- SII29, 1998
 
Steinhauser KE, Clipp EC, McNeilly M, et al: In search of a good death: observations of patients, families, and providers. Annals of Internal Medicine 132:825-832,  2000
[PubMed]
[CrossRef]
 
Emanuel LL, Barry MJ, Stoeckle JD, et al: Advance directives for medical care: a case for greater use. New England Journal of Medicine 324:889-895,  1991
[PubMed]
[CrossRef]
 
Fried TR, van Doorn C, O'Leary JR, et al: Older persons' preferences for site of terminal care. Annals of Internal Medicine 131:109-112,  1999
[PubMed]
[CrossRef]
 
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References

Emanuel E, Emanuel L: The promise of a good death. Lancet 351(suppl II):SII21- SII29, 1998
 
Steinhauser KE, Clipp EC, McNeilly M, et al: In search of a good death: observations of patients, families, and providers. Annals of Internal Medicine 132:825-832,  2000
[PubMed]
[CrossRef]
 
Emanuel LL, Barry MJ, Stoeckle JD, et al: Advance directives for medical care: a case for greater use. New England Journal of Medicine 324:889-895,  1991
[PubMed]
[CrossRef]
 
Fried TR, van Doorn C, O'Leary JR, et al: Older persons' preferences for site of terminal care. Annals of Internal Medicine 131:109-112,  1999
[PubMed]
[CrossRef]
 
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