Review of The Art of Dying Well

I was first introduced to the Art of Dying Well  through a Facebook post of a friend who was going through a harsh chemotherapy to treat his cancer. The title of the book is provocatively enticing especially for someone like me who, since the fatal illness of his mother, became very interested in learning about the concepts of death, consciousness, spirituality, meditation, and transcendentalism. 

Title: The Art of Dying Well
Author: Katy Butler
Publisher: Scribner
Publication date: 2019
Number of pages: 288 pages
Genre: Nonfiction, Memoir, Medical
Availability: Amazon

In the The Art of Dying Well: A Practical Guide to A Good End of Life, author Katy Butler was literally faithful to the title of her book: she spelled out exactly what the art of dying well is all about. She provided a solid self-help guide to help people live healthy and die in a dignified and humane way. The central argument of the book is that modern high technology medicine can rob us of our right to shape our death and die peacefully. Indeed, Butler does not engage in ad hoc criticism of the modern medical establishment. She does acknowledge its importance in treating people with various illnesses. However, for individuals with incurable illnesses, Butler argues, high technology medicine can only result in  stripping patients of a peaceful death among their family and loved ones. 

Butler longs for those days when death takes place at home among family and friends and not in antiseptic rooms where dying is stripped of its cultural rituals. Butler blames fast medicine for “reducing dying to a medical procedure and stripping it of dignity and humanity”. As Butler rightfully argues, “the dying often can’t say their last words, because they’re sunk in chemical twilights or have tubes down their throats. Relatives pace the halls, drinking bad co􀐐ee from vending machines, often shocked to hear for the frst time, in a drab conference room, that someone they love is so close to dying.”

The thing with high technology medicine or what Butler calls  ‘conveyor belt medicine’ is that it does not focus on the person as a whole. Each doctor or specialist reduces the patient to their specific ailment and does not look at the entire picture or context. As Daniel Pink argues in A Whole New Mind, there is now a movement that is gaining in traction in the medical establishment known as narrative medicine, one  that highlights the importance of patients’ stories and narratives. In narrative medicine, computerized diagnostics of illnesses are not enough. They need to be complemented with patient narratives, that is, their own voice. Butler echoes the same message in the Art of Dying Well. For her, conveyor belt medicine “rewards cure far better than care”, and it “does things to people not for them, and turns them into passive bystanders to their own death”.

Trajectories of end of life

Butler outlines four common trajectories to end of life: Niagara Falls, Looping Decline, The Dwindles, and the Stair Step Down. The first three trajectories were first conceptualized by renowned geriatrician Joanne Lynn .

1. The Niagara Falls Trajectory:

“This pathway is marked by months to years of high functioning, followed by a rapid decline of a few weeks or months. It is common in kidney failure without dialysis and in cancers treated once or twice.”

2. Looping Decline: 

“This pathway is marked by months to years of high functioning, followed by a rapid decline of a few weeks or months. It is common in kidney failure without dialysis and in cancers treated once or twice.”

3. Stair Step Down:

“Long and short plateaus are punctuated by sudden, drastic drops in functioning. Each “new normal” is worse than the one before. This pattern is common in people who have repeated strokes or vascular dementia, and in the old and frail who undergo repeated hospitalizations that set o􀐐 delirium (hallucinations and prolonged cognitive confusion) or otherwise inadvertently cause harm.”

4. The Dwindles: 

“Strength and vitality fade away, along with appetite and interest in living. Small maladies accumulate, senses fail, muscles weaken, and over time the body just wears out. The need for help with daily life may last as long as a decade. This trajectory is common in dementia, extreme old age, and kidney failure with Dialysis.”

Butler divides the health stages of later life into the following stages: Resilience, Slowing Down, Adaptation, Awareness of Mortality, House of Cards, Preparing for a Good Death, and Active Dying. For each stage, she provides practical tips and pieces of advice to help you “step off the conveyor belt of fast medicine when it no longer serves you”.

Quotes from The Art of Dying Well

“As energy becomes a precious and limited resource, simplifying is a survival skill. I’ve learned to beware of “the disease of one more thing”—the attempt to squeeze just one more movie, dinner, car trip, or party into a weekend. My husband and I 􀐙nd that when we do less, we enjoy what we do do, more. We try to let go of the unimportant and stick with what gives us the most meaning, comfort, and joy.”

“There is no right way to die. Dying people may be angry or irritable, afraid or worried, sad or accepting, or any of the above at different times.”

Other books by Katy Butler

Knocking on Heaven's door

Title: Knocking on Heaven’s Door
Author: Katy Butler
Publisher: Scribner
Publication date: 2014
Number of pages: 352 pages
Genre: Nonfiction, Memoir, Medical
Availability: Amazon