"Final Choices: To Live or to Die in an Age of Medical Technology," by George M. Burnell, MD

Final Choices presents an excellent discussion of the options and difficulties which face patients who choose to exercise their right to die with dignity and peace of mind in an age when medical technology is advancing rapidly, state laws are confused, and multiple dilemmas face physicians caring for terminally ill patients. Death, and the planning for it, are issues people generally avoid. In this book the author effectively uses nontechnical language to discuss this subject and related matters. He discusses the problems caused by the tension between technology and human desire, individual freedom of choice, and the control of one's own death.

The ultimate goal of the book is to allow an individual patient to make informed decisions pertaining to his or her own death. I read and have reviewed the book in this context, having metastatic cancer of the prostate but being completely symptom-free under treatment and feeling well. The book is well documented with extensive references, a glossary, case studies, sample forms, and tables of states' policies on right-to-die issues. The author discusses living wills, proxies, and power of attorney. He reviews the hospice movement and the concept of dying in one's own home, as was once the norm. He also discusses in detail the dilemma facing medical professionals who are faced with balancing patient welfare, ethics, state laws, and liability.

This book will be useful to three groups of people: professionals, concerned readers, and individuals facing death. Doctors, nurses, psychologists, or members of the clergy will find this book an excellent resource. Thoughtful citizens will find it a thought provoking instrument and may therefore be encouraged to plan for their own future. I personally found the book useful and interesting; the case report dealing with metastatic cancer of the prostate was especially helpful.

Not surprisingly, the average person or involved family member is likely to have difficulty thinking about or even recognizing the issues relevant to fatal illness. Because of that, the chapters titled "Key Questions You Need to Ask Yourself," "What Your Doctor May Not Tell You about Dying," and "How to Talk to Your Family or Friends about Dying or Prolonging Life" are especially helpful in getting one's thinking and planning organized.

On the other hand, for the individual imminently facing death, particularly if in a grieving state of mind, the book will likely be too voluminous. That individual or family may not then have the patience or desire to read through a book of this magnitude. Therefore, it is important to recommend this book at the proper time. Understanding that both doctors and patients often are uncomfortable discussing death, this book can beneficially be recommended to patients as "a wise precaution" as soon as a mortal illness is diagnosed.

Plenum Insight Press, 1993. 374 pg. ISBN 0-306-44462-3. Dr. Burnell is a psychiatrist who retired from the Hawaii Permanente Medical Group.

Other books received, by Permanente authors:

Cardiac Surgery: Safeguards and Pitfalls in Operative Technique, Siavosh Khonsari, MD. Lippincott Raven, Philadelphia 1997 (2nd edition). $195. ISBN 0-397-51626-6. Dr. Khonsari is Chief of Cardiac Surgery for SCPMG.

Optics, Refraction, and Contact Lenses, EH Thall, MD; KM Miller, MD; Perry Rosenthal, MD; Robert J. Schecter, MD; RF Steinert, MD; TL Beardsley, MD. American Academy of Ophthalmology, San Francisco, 1997. ISBN 1-56055-077-5. Dr Schecter is an ophthalmologist with SCPMG.

Finance: Profit, Planning, and Control for Managers, Tim Becker, Larry Gonzales. Donna Lupinacci, Claud Pitts III, George K. Sharghi. Simon & Schuster, 1998. ISBN 0-536-00036-0. Mrs. Lupinacci is a medical department manager with SCPMG.

If you are a Permanente author with a recently published book, please have your publisher send a reviewer's copy of your book to The Permanente Journal.

Roger E. Rinaldi
Mr. Rinaldi is a civil engineer who, as a result of routine PSA testing while feeling perfectly well in October 1996, unexpectedly was diagnosed at age 64 with metastatic anaplastic cancer of the prostate. He has responded dramatically to hormone therapy: his PSA has dropped from 121 to 0.1 and he remains well. While visiting San Diego, his thoughtful approach to dealing with family responsibilities and his own mortality was captured in the 24-minute videotape "I Never Died Before." This videotape will be of practical use to physicians who may wish to give copies to patients with fatal illnesses or who are drawing up advance directives. Sample copies may be obtained by making out a check for $5 made payable to SCPMG, and mailing it to Vincent J. Felitti, MD; SCPMG Department of Preventive Medicine; 7060 Clairemont Mesa Boulevard; San Diego, CA 92111. Bulk purchases can be arranged. Also helpful is the Internet site, located at www.agingwithdignity.org.


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