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Handbook for Mortals: Guidance for People Facing Serious Illness

BMJ 2000; 320 doi: (Published 26 February 2000) Cite this as: BMJ 2000;320:587
  1. Dingle Spence, consultant in palliative medicine
  1. St Peter's Hospice, Bristol

    Joanne Lynn, Joan Harrold

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    Oxford University Press, £14.99, pp 256

    ISBN 0 19 511662 3

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    A hundred years ago most adults died quickly from accidents or infections. Death and serious illness were everyday occurrences, and most people would have had firsthand experience of the death of a loved one early on in their own life. Nowadays most people have little experience of disease and dying, and many of us will have serious illnesses that linger for months or years before we die.

    Handbook for Mortals attempts to bridge that gap—the gulf between “living with” and “dying of” that is fraught with fear and distress, both for the ill person and for loved ones and carers. The authors face the issue of our own mortality head on, and explore in detail a wide range of end of life issues such as finding meaning in the last few weeks or months, helping family members to make decisions and give care, controlling pain, forgoing medical treatment, coping with events near death, and the dying of children.

    This is a beautifully laid out book, with the prose interspersed with short poems, quotations, poignant photographs, and practical checklists. Another refreshing feature is that, rather than speaking somewhat abstractly in the third person about other people facing serious illness, the authors have addressed the book to “you”: for example, “It isn't easy to talk about disease and dying. And talking specifically about your own dying is both harder and more important to do. Sometimes it is hard because you don't know the words to use.” This technique is particularly powerful as it draws one into the text with a strong sense of the personal, whether from the stance of a carer, an attending professional, or, indeed, the sufferer.

    The authors have managed to achieve a genuine mix of practical suggestions—such as how to get help from community services, how to have a successful conversation with your doctor, how to write a living will or advance directive, and how to plan your funeral—with more esoteric issues around spirituality, having difficult conversations with your family, and how to find meaning in life when there may seem to be none left. There are also a couple of excellent chapters on choosing whether to decline further medical treatment and issues around resuscitation, followed by a thorough explanation of the differences between euthanasia and physician assisted suicide. Sudden death and the death of children is also discussed.

    Handbook for Mortals is written by American authors for a US audience, and, therefore, some of the practical information about healthcare providers, health insurance, etc, is not relevant to Britain. Nevertheless, the general truths addressed in the book are extremely relevant to all of us—the patient, the carer, the professional. Talking about death does not make it happen, though many of us are afraid it may. The Handbook for Mortals goes a long way in helping to manage and dispel those fears.

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