With the End in Mind: Dying, Death and Wisdom in an Age of Denial

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I very rarely give a book five stars, but this was so moving, eloquent, informative, poignant, and beautifully crafted that anything less felt unfair. With a tsunami of death coming soon as the baby-boomers die, there really wont be enough staff trained in this particular way. It also helps people to enjoy each day as it arises, instead of fearing a sudden and unexpected onset of dying, because usually, death approaches us gradually. Unfortunately in our society we seem to have become afraid of dying and being able to talk to people facing death. Although anecdotal, this was presented by Mannix as the usual method in The Netherlands: doctors brainwashing patients into believing that their lives became too hard to bear and that there are better options than living and suffering to the painful end.

I hope my close family will agree to read this book, unfortunately it is only in English which prevents some other part of my family from its benefits.When the news came a year ago out of the blue, my medical friends recommended this book to me and my family as their Peter (not medical) died peacefully of rapidly advancing cancer after a short remission.

However the writing is frequently poetic and has a gentle directness that for me made it an excellent read. She makes a compelling case for the therapeutic power of approaching death not with trepidation but with openness, clarity and understanding. In With the End in Mind , she shares beautifully crafted stories from a lifetime of caring for the dying, and makes a case for the therapeutic power of approaching death not with trepidation, but with openness, clarity, and understanding. Kathryn Mannix is a doctor who has spent almost all her career in palliative care with patients who are at the very end of their life and most of this book tells the stories of some of those people.I like her approach to her patients and families, and wish she could be my doctor when the time comes. Starting in cancer care and changing career to become a pioneer of the new discipline of palliative medicine, she has worked in teams in hospices, hospitals and in patients’ own homes to deliver palliative care, optimising quality of life even as death is approaching. I shed a few tears but it s not gut wrenching and Mannix weaves the light and dark strands of her experience with finesse.

I wish I had read this book when it was published, I would have helped some patients and their families better. It’s so hard to learn lessons from others, we often think we’re different though, it won’t happen to me - in this case that’s faulty thinking. Again, I would have found this less troubling if Mannix had been upfront about it: instead, she claims that 'many of us in palliative care roles are exasperated by the trenchant, black-and-white opinions of the campaigners for either view [on euthanasia]' but makes her own views pretty clear when she says at the end of the chapter on the Netherlands that 'Once the euthanasia genie is out of the bottle, you must be careful what you wish for', echoing familiar 'slippery slope' arguments. My life in palliative care has shown me that the process of dying is made less frightening and more peaceful, the better prepared we are. Mannix’s introductions to each section and chapter, and the Pause for Thought pages at the end of each chapter, mean the book lends itself to being read as a handbook, perhaps in tandem with an ill relative.I found it incredibly helpful in understanding how my own wee Mum might die in coming days, weeks, months; Parkinson’s, dementia, frailty are all diminishing her quality and quantity of life. They receive their care via England's national health program, so everyone qualifies for the same care. The book is structured around a series of fictionalised case studies drawn from Mannix's own experiences, many of which are deeply affecting. In addition to being an engaging and, dare I say, heartwarming read, it is also richly filled with lessons and advice for current or future use. There is a Pause for Thought moment at the end of each chapter where there are suggestions and practical details are discussed.

The author's purpose in this book is to demystify dying and let people know that it doesn't have to be all that unpleasant. This was compounded by her discussion of euthanasia, a subject that is obviously very relevant in this context. As the hospice leader she's working with on Holly's case describes it to Holly's daughters: 'Have you noticed that she stops breathing from time to time? Kathryn Mannix's With the End in Mind: Dying, Death and Wisdom in an Age of Denial is written from her own experiences as a specialist in palliative care, and this proved, for me, both its strength and its downfall.She has written this because, as a palliative care specialist of 30 years, she has seen a lot of people dying. Even then, death is often held at bay and life prolonged at all costs: the fragile and disintegrating body is plugged into machines, pumped full of oxygen and blood and drugs, its gallant heart restarted and kept going, no matter the pain, no matter the hopelessness of the endeavour, no matter that at a certain point this isn’t living, just a slowed-down, drawn-out, painful and undignified dying.