Jeff Spiess. Dying with Ease. Rowman, 2020.
Dying with Ease is subtitled A Compassionate Guide for Making End-of-Life Decisions. Compassion, like beauty, may be in the eye of the beholder, but this book is a fairly detailed book on what to expect when you or someone you are close to is dying. It is very practical.
Spiess is a hospice doctor. His job is caring for people who are probably going to die within a span measured in months at the most. His problems seem to come when people, whether the patient or someone close to the patient, have not made decisions concerning end of life matters. This especially concerns power of attorney and someone who is authorized to speak for the patient in making medical decisions.
This could be called What to Expect when You’re Dying, but that might seem to be a grim echo of a well-known book on the beginning of life, What to Expect when You’re Expecting. Still, that is what the book is.
For the most part, the author describes the experiences of different patients and their families when faced with dying. Because he mostly deals with terminally ill patients, he describes what different people do when they come to terms with the fact that they will be soon be dead.
The author tries to be careful to not make recommendations. Some people, for example, have Do No Resuscitate (DNR) orders. Others do not. He seems to prefer DNRs. He criticizes what he calls “pro-life” people who do not like DNRs. In most cases he tries to understand. But if someone really is pro-life, then they probably feel like a DNR order is giving permission to have someone be killed. One can quibble over whether it is, but it looks that way to some people.
For some reason the term pro-life is always written in scare quotes. The only other time the book uses quotation marks for words or phrases is when offering a definition. Having said that, it is probably safe to say that there is not another book like this out there, even if it is skeptical of “pro-lifers.”
Dying with Ease notes that not all hospices are the same. Some are founded with different ethical or religious beliefs. Some have certain facilities that others may lack. Some, Spiess says, use a kind of cook book approach to all patients when more flexibility is needed for individual symptoms and personal needs. Included, then, are some ideas for finding the right hospice for the patient.
The father of a friend recently died, and my friend had challenges with the hospice his father was placed in. For one thing, his father had been selected for testing a promising treatment of his cancer. He was on his way to recovery when he came down with pneumonia, and it appeared that the hospital he was sent to had written his father off in spite of the promising therapy. Between the hospital and the hospice, he had to tell them that his father did not have a DNR order—it was indeed in writing that he did not—but the staff kept saying that he did.
They also recommended what they called a black box medication. It was a medication that occasionally worked but had side effects that were often fatal. Now Dr. Spiess tells us there is no such thing as a euthanasia pill, but when my friend told a nurse about the medication, she called it the kill pill. That is my friend’s experience. I am sure he is not making it up.
Still, Dying with Ease can certainly be helpful to health care workers and maybe some people facing their own death or the death of someone close. The author notes that even though we all die, many people (he says Americans, but I suspect other nationalities are similar) try to avoid even thinking about it. What he hopes to do with the book is to have people come to terms with the fact that we all die. The title is perhaps suggestive of euthanasia, which he discusses because it is legal in some jurisdictions, but what he is referring to in the title is not physical ease, but mental peace and some stability for those left behind. If we recognize that we all will die, then the question becomes how will we prepare to die?
Certainly this includes such things as wills, living wills, medical orders. But it likely also includes making peace with people and forgiving people, if necessary. It may include discussing what to be done with your body: donate to science, burial, cremation, composting, for example. Are there any things you would like or not like in a memorial service? For example, my own mother hated wakes. She asked when she died that there not be a wake or an open casket. That was something our family understood, and it was easy enough to comply with.
He notes five things that most of us will say or should say in some way as we are aware of death approaching: “Forgive me,” “I forgive you,” “Thank you,” “I love you,” “Good-bye.”
Perhaps the most effective parts are those that discuss the question of fairness about death and what it is like to die. Many people when faced with a terminal illness resist the idea because it does not seem fair. They are too young. Life has been too hard. Whatever. Basing his presentation on the Book of Ecclesiastes, Spiess helpfully notes how we can begin to deal with the question of fairness, whether for ourselves or another.
There is a chapter titled “What Does It Feel Like to Die?” Again, he deals not with the physical issues. After all, some die after months or years of struggling with a disease. Others die peacefully in their sleep. What does it feel like mentally?
He takes another hint from Ecclesiastes in examining what it might feel like to be dying. He suggests the reader do an exercise. It would be unfair to the author to describe the exercise here except to say that it is simple and eye-opening, and perhaps loosely based on the last chapter of Ecclesiastes. Little by little, usually, we let go of things in life, until finally there is nothing left. I would recommend this book for that chapter alone.
As many others have reminded us since time began and as already mentioned, Spiess reminds us numerous times that everyone dies. Our youth-centered culture seems to be in denial about this, but it is so. As Pascal said, “As men have been unable to cure death, misery, ignorance, they have bethought themselves to ignore them, so as to be happy.” Memento mori.
Unlike Death is But a Dream, or Proof of Heaven—both written by doctors—or Becoming Starlight or Great Cloud of Witnesses Speak, there are no accounts of near death, pre-death, or life after death experiences. The book takes into account what people with different beliefs might do in preparing for death or what kind of memorial they want, but this book strictly is about what one might do in this present, material world.
Spiess also emphasizes something for those of us who are alive and well and who do not at the moment have a terminal friend or loved one. He asks as simple question: What will your legacy be? By this he means more than willing your property to your heirs. How will you be remembered? That includes people remembering how you died.
In one succinct quotation Spiess sums up what has become his perspective. After all, he is a doctor. He has promised to do no harm. But he works with people who are dying. (He does tell of three people who outlived their “terminal” diagnosis, but these instances are quite rare.) It is simply this: “Dying is not a problem to be solved; it is a mystery to be experienced” (116).
While Dying with Ease will likely be read mostly by medical personnel, it can be used as well by patients, their loved ones, and their advocates to look a little closer at the mundane and mortal side of the mystery.