Discussion Questions About the Art of Dying Well by Katy Butler

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The Art of Dying Well: A Applied Guide to a Good Cease of Life

By Katy Butler

a review by Pam Munter

Whatever book near death and dying is actually virtually life and living. This axiom is echoed in Katy Butler'southward The Art of Dying Well: A Practical Guide to a Practiced Terminate of Life (Scribner, 2019). Her articulate volume joins the spate of best-sellers on this theme, most recently Atul Gawande's Being Mortal, Barbara Ehrenreich's Natural Causes, and Paul Kalanithi's When Breath Becomes Air. Butler offers stride-by-step rules to follow as nosotros march toward extinction, from building resilience in ane's 50s, to the stop-stages of actively dying. Like taxes, death may be inevitable merely it tin can be planful, allowing a near-orderly difference with no unfinished business.

"We alive in a fourth dimension when advanced medicine wards off death far better than it helps the states prepare for peaceful ones." Similar Ehrenreich, she advocates taking responsibility for living better today and for maintaining as much command equally possible over the process of dying. Some of her early on advice is overly familiar: practise regularly, eat well, cutting out smoking, cultivate friendships, pursue passionate interests, file an advanced directive and establish a power of attorney. Other suggestions seem limited if not laughable, such as getting to know neighbors who could become caregivers afterward on. "Can you lot turn neighbors into friends, and friends into honorary siblings?" She edges into God language now and again, dissonant in her otherwise secular flow of information and guidance. In one chapter, she even provides prayers from several religions. In this, she narrows her audition and may alienate others.

Butler traces life'southward downturns in consecutive chapters. In "Slowing Down," the refuse is more felt than seen—achiness, bug with vision, hearing. Information technology's here she begins to rail against unnecessary testing and hospitalizations. "In all things, don't let the cure be worse than the illness." Reducing screenings, she says, tin help avoid over-medicalization, which is sometimes economically driven, and non always in the patient's best interests. Rather than divide the body into specializations, she says a geriatrician is invaluable, a doc with a more global perspective, specializing in the diseases associated with aging.

The "new normal" continues its downward shift when it becomes credible "getting better" is non likely. "Disability sometimes arrives suddenly in the form of a stroke, and more often comes on little cat feet, as an accumulation of minor impairments." Her suggestions hither are pragmatic: reconfigure the house for "aging in identify," reduce the daily stressors. If that's not feasible, consider a move to assisted living. At nearly every stage, nevertheless, she reiterates the importance of staying every bit agile as possible and of planning ahead early on for the inevitable.

At the stage in which it appears life is nearing an end, palliative intendance is added to the repertoire, easing pain and suffering without further attempts to effect a cure. It's "the preeminent medical marry for anyone who wants to live a good life while coping with a debilitating illness." Research shows people who seek this level of care accept fewer health crises and spend less time in the hospital. Curiously, it's only at this late stage that she mentions the imperative search for meaning. Contemplating what matters, optimally, needs to occur not merely when ane is given a concluding diagnosis, just throughout the grade of one's life. And nevertheless, she reports that hospice nurses take told her, "People dice as they've lived." If there's no previous soul-searching, no emotional intimacy (with self or others), information technology'due south unlikely such an exploration volition exist productive or even salutary.

In each chapter, Butler employs stories and anecdotes to illustrate the trajectory toward death. Some of them are helpful while others seem too long and interfere with the flow. Her prose is sufficiently bright and explanatory that lengthy examples are distractions. Toward the stop, she veers offline into suggestions for caregivers, which seems a departure from the how-to focus for the dying person. When she maintains her stiff mission and focus, the book is a practical, even inspiring, guide for dying. Yet, it's unlikely that this would remain on a bookshelf for future reference. Would someone in his/her 50s continue to refer to this volume over decades? Probably not.

Her most noteworthy contribution is to underscore the importance not only of advance planning (and working through deprival, no small feat) only the need for families to talk among themselves about this issue well before at that place's a medical need to do so. "Dying is not an emergency. You can prepare for it, you can cooperate with information technology, and y'all tin can depict on wells of fortitude and love that yous may not know existed within you lot." Her warning virtually over-medicalizing the dying patient is every bit much a political statement as a moral one. Those who work with the dying are often the everyman paid workers in the medical food concatenation just no less committed to the well-being of the patient.

In days of yore, death had prescribed rituals, often religious in origin. People didn't live every bit long as they do today and commonly died at dwelling. Now fewer than a tertiary do. Death, she writes, "has largely been pushed into the upper reaches of the life span." Is this a good affair? Wisely, she lets the reader decide. Butler thinks more than healthcare dollars should be spent to help people dice peacefully than spending money to prolong life for its own sake.

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Pam Munter has authored several books including When Teens Were Nifty: Freddie Stewart and The Teen Agers of Monogram (Nicholas Lawrence Press, 2005) and Almost Famous: In and Out of Show Biz (Westgate Printing, 1986) and is a contributor to many others. She's a retired clinical psychologist, onetime performer and film historian. Her many lengthy retrospectives on the lives of often-forgotten Hollywood performers and others have appeared in Classic Images and Films of the Golden Age. More recently, her essays and short stories have been published in more than 100 publications. Her play Life Without was produced by S2S2S, and nominated four times past the Desert Theatre League, including the Bill Groves Honor for Outstanding Original Writing and Outstanding Play (staged reading). She's a Pushcart nominee and has an MFA in Creative Writing and Writing for the Performing Arts. Her memoir, As Lonely As I Want To Be, was published by Adelaide Books in 2018.

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