Book Review: Peaceful Dying - Daniel R. Tobin, M.D.

Peaceful Dying

The step-by-step guide to preserving your dignity, your choice, and your inner peace at the end of life

Daniel R. Tobin, M.D.
with Karen Lindsey
Perseus Books
1998, 208 pp.

One consequence of the secularization of modern society has been it’s relative unwillingness to approach the question of death and dying and so it has remained quite a subject of taboo and denial. Despite the theosophical movement's efforts to promote the concepts of karma and reincarnation, it was not until people like Elisabeth Kübler-Ross, M.D., who presented her concept of five stages of dying, that widespread discussion of the problem got underway.

By 1998, when Dr. Daniel Tobin’s book was published, there was already an extensive literature on the subject, but comparatively little material dealing with the more practical problems from the standpoint of the medical system. Much has been done since then, but this groundbreaking book remains relevant and of great practical value.This practical guide to planning end of life care is based on the FairCare program for peaceful dying which Dr. Tobin developed at the V. A. Hospital in Albany, New York.

One consequence of this lack of awareness of the reality has been the often inhumane and insensitive treatment of people with terminal illnesses in the health care system. Dr. Tobin has had vivid practical experience with this stark reality, which motivated him to develop a more humane, compassionate approach to end of life care. As Tobin observes:

‘’I have great respect for traditional medicine and its practitioners, the doctors and nurses whose lives are spent trying to heal people. But the limitations of their training often keep fine health care workers from being helpful to their dying patients. At the same time, the public’s fear of dying and the tendency of many patients to request drastic treatments in a vain effort to defeat death have created an unhealthy situation. It is time for mainstream medicine to take on the work of meeting the physical, emotional, and spiritual needs of dying patients as part of routine health care. It is my hope that the FairCare concepts will help bridge the gap that so often exists between doctors and patients in end-of-life situations. If this can be achieved, the living that you do throughout your dying can be, if you let it, some of the most meaningful and joyful living you’ve ever experienced. I hope this book helps you live that kind of dying’’ (Introduction, xiii).

‘’Perhaps the greatest limitation of Western medicine has been its refusal to acknowledge the inevitability and naturalness of death, and how important a part of life it is. The passion to prolong life and to enhance it is wonderful, to a point. It is probably responsible for most of the great advances of modern medecine. But when it doesn’t take into account the simple fact that at some point life  can’t,  and shouldn’t be prolonged, it creates, rather than alleviates, suffering. If we in medicine cannot accept dying as a natural part of living and embrace the dying process, we neglect people when they are most vulnerable, most alone, and most desperately in need of love, comfort, and a very specific kind of care. With the best of intentions, we sometimes inflict on our patients treatments that are extremely painful, and we neglect their real needs’’ (p. 11).

Below is the list of 26 steps which are developed in the book, aimed which enable the dying person to be more aware of what they are experiencing and thus to make more informed and pro-active decisions in order to face the process of dying with more peace and serenity.

Part One: A Look at the Dying Process

1. Dying as a Natural Part of Living
2. The Human Response to Dying

Part Two: The Steps of FairCare: Positive Living, Peaceful Dying

3. Individuality of Disease, Individuality of Choice

Step A: Recognizing Individuality of Disease, Individuality of Choice

4. Taking Control of Your Life

Step B: Confronting, Expressing, and Diminishing Fear of Dying

Step C: Slowing Down Time and the Mind

Step D: Creating Positive Days

5. Coming to Terms

Step E: Talking to Your Doctor -- The Early Stages

Step F: Talking to Your Family

Step G: Coming to Terms with This Reality

Step H: Seeking Counseling and Support

6. Practical Matters

Step I: Selecting Advance Directives

Step J: Considering Other Practical Concerns

7. Your Spiritual Destiny

Step K: Examining Spiritual Views on Living and Dying

8. The Turning Point

Step L: Being Ready

Step M: Shifting to Care

Step N: Ensuring Your Family Support

Step O: Talking to Your Doctor Again

Step P: Dealing with the Suicide Question

9. Preventing Pain and Isolation

Step Q: Deciding Where to Die

Step R: Getting Relief for Your Pain

Step S: Dealing with Physical Changes

Step T: Nurturing Your Body, Mind, and Spirit

Step U: Telling Your Story

10. Finding Peace

Step V: Embracing Love as the Meaning of Life

Step W: Achieving Peace of Mind

Step X: Helping Plan Your Funeral or Memorial Service

Step Y: Preparing Your Loved Ones for Their Bereavement

Step Z: Dying With Tranquility

Appendices

Appendix 1: The FairCare System and the Life Institute

Appendix 2: Summary of FairCare Concepts

Appendix 3: Living Wills and Health Care Proxy Forms

Appendix 4: Additional Resources and Reading