Kathryn Mannix, With the End in Mind – Dying, Death and Wisdom in an Age of Denial, London: William Collins, 2017.
With the End in Mind – Dying, Death and Wisdom in an Age of Denial is written by Dr Kathryn Mannix, a palliative care specialist in Britain. This is not a Christian book, but is written to challenge the modern approach to death which pretends that it’s not really going to happen. She agrees that the availability of immunisation, better nutrition, more effective drugs, improved treatments such as dialysis have extended the lives of many, but the experience of keeping loved ones at home and being familiar with dying patterns and death has disappeared in first world countries. The dying are rushed to hospital for treatment rather than staying at home, so that they die in unfamiliar surroundings. She says “technology is deployed in a new deathbed ritual that is a triumph of denial over experience. The death rate remains 100%, and the pattern of the final days, and the way we actually die, are unchanged.”
Dr Mannix has written beautifully and touchingly the stories of over thirty people who have been under her care in her forty years of experience, and demonstrates how good palliative care at home, where possible, can make a loving difference to the end of a life. She also shows how we can care well for those who are dying. However, one of the most powerful stories, and certainly the most chilling, concerns a young British man who went to work in The Netherlands where he married and had a child. When he was in his early thirties, he was diagnosed with a large tumour in his rectum. Over a period of months he had many surgeries, but to no avail – the complications were such that there was not really any hope of cure. One of the doctors explained this to him quietly and asked if he understood. He did understand – he understood that he couldn’t be cured, so that he needed to go home to spend as much time as possible with his wife and daughter. The doctor told him that in The Netherlands he had an extra choice of euthanasia, but he said he wanted to go home.
This happened a few times over the next few days and as he could hear other patients being told they could go, or have other treatments, he was only told that he had “a choice’. He began to view the ward as a prison and decided that he had to go back to England where he would be out of reach of further offers of help to die. He did that and was admitted to a hospice where his wife and daughter could stay also. While he had appreciated the excellent healthcare he had received, he was critical of the subtle nuance in every consultation that became very depressing, and prevented him from admitting to new symptoms, for fear of further offers of ‘help’. He lived two more months in the hospice with his wife and daughter, and died peacefully there.
Dr Mannix finishes this story by saying “The possibility of unintended pressure is a dilemma currently confronting healthcare systems across the world. Once the euthanasia genie is out of the bottle, you must be careful what you wish for.”
While Dr Mannix doesn’t offer comments about life after death, she makes suggestions about ‘dying well’ – allowing opportunities to talk, write letters, advance care planning etc. She emphasises the importance of accepting each day as a gift from God, but goes no further. Yet this is still a book with a most worthwhile message.
Mrs Patricia Christian is vice-president
of Evangelicals for Life