KEN HILLMAN A Good Life to the End: Taking control of our inevitable journey through ageing and death. Reviewed by Suzanne Marks
Ken Hillman gives us a practical, wise and compassionate analysis of the physical and mental challenges of approaching death.
Despite the certainty that we will all face it, we live in a death-denying society and most of us are ignorant of the realities of ageing. Too many of us will die in hospital intensive care units (ICUs), hooked up to life-supporting but non-life-restoring devices. The professor of intensive care at the University of New South Wales, Hillman asks why so many elderly people linger in pain and confusion in ICU when all they want is to die in peace at home in the comforting presence of their loved ones.
Hillman has worked in intensive care since its inception. And he is appalled by the way the ICU has become a place where the frail, the soon-to-die and the dying are given unnecessary operations and life-prolonging treatments without their wishes being taken into account. In his opinion, this is generally because most doctors are either not trained for or have insufficient experience of recognising when patients should be directed into palliative rather than emergency/intensive care. Furthermore, hospitals are not always appropriate places for the dying as they are designed for healing, and thus equate death with failure.
In her famous book On Death and Dying, Elizabeth Kubler-Ross asked: ‘Why is it so hard to die well?’ Hillman’s book presents a thoughtful, medically factual, realistic and compassionate response to this question.
His subtitle is significant. He sets out the harsh realities of what is going on in our bodies as we age:
While its external signs might be disguised with creams, diets and surgery, behind these, the clock still ticks. The signs of ageing are part of a biologically programmed process which signals that time is drawing to a close for the networks that run our bodies, such as the nervous, endocrine and immune systems.
Chapter Two is entitled ‘Ageing is Not For the Weak’ and is both challenging and enlightening. Here Hillman describes the physiology and deterioration of each organ and system in our bodies as we age. Starting with the skin, where the first external signs of ageing appear, he moves on to hair, our internal ‘plumbing systems’, our bones, the liver, senses, heart, and so on.
I found this graphic depiction of the realities of ageing confronting: but was my response simply further evidence of our cultural unpreparedness to face our departure from this world?
The faint-hearted may also blanch at Hillman’s stark descriptions of the various maladies and risks we are heir to as we age, and the further difficulties we face when we end up in hospital. Nevertheless, take courage and plough on. Your efforts will be rewarded with the knowledge of how best to manage the realities of our bodies’ physical and mental ageing processes, and the extent to which we can sidestep the shortcomings of the hospital and medical systems that too often want to consign us to ICU when what we need and long for is the more gentle approach of palliative care.
In later chapters we learn of the risks to which the elderly are especially vulnerable – falls, for example – as well as informative statistics for different age groups, genders, living situations, and their likely outcomes:
I am treating an increasing number of men over the age of seventy years who fall off ladders while continuing to do minor repairs around the house. Some of these die and most spend at least three or four days on high level support in an ICU. Maybe it’s time to conduct public awareness campaigns or perhaps to issue ladder licences to those aged over seventy.
He goes on to suggest a range of strategies to limit the risk of falls, which too often result in severely diminished mobility and/or death.
He devotes a whole chapter to the frightening possibility that we may lose the ability to decide for ourselves how and where we want our lives to end. As an educative measure, he presents a range of practical courses of action, emphasising, for instance, the importance of preparing an Advanced Care Directive explicitly stating our preferences, and the sorts of questions we should address in it, including our values.
As a result of reading this challenging book, and after much procrastination, I am finally preparing, in consultation with my daughters and general practitioner, an Advanced Care Directive, which I will also place with my hospital and hospice of choice. In this way, when the time comes, I will have ensured that my ‘end of life’ is a ‘good one’, and will happen according to my wishes, principles and values.
Hillman’s message can be summarised as the more we understand and accept the physical and mental realities of ageing, the better equipped we are to achieve ‘a good life to the end’. To this end his book serves us well.
Ken Hillman A Good Life to the End: Taking control of our inevitable journey through ageing and death Allen & Unwin 2017 304pp $29.99
Suzanne Marks is a member of the Board of the Jessie Street National Women’s Library and the Sydney University Chancellor’s Committee. Her professional life has been in equity, human rights and conflict resolution.
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Thank you Suzanne Marks for such an captivating review. How can we not read it?
Sue’s review is both thoughtful and informative. In California it is important to give relatives and your doctor copies of an advance directive. Hospital fear legal suits. My poor Mom twice pulled out of her stomach feeding tubes. She wanted to die but the nursing home refused my requests for fear of being sued. She did not have back then in Baltimore decades ago, an advance directive.