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At Peace: Choosing a Good Death After a Long Life
The authoritative, informative, and reassuring guide on end-of-life care for our aging population.
Most people say they would like to die quietly at home. But overly aggressive medical advice, coupled with an unrealistic sense of invincibility or overconfidence in our health-care system, results in the majority of elderly patients misguidedly dying in institutions. Many undergo painful procedures instead of having the better and more peaceful death they deserve.
At Peace outlines specific active and passive steps that older patients and their health-care proxies can take to ensure loved ones live their last days comfortably at home and/or in hospice when further aggressive care is inappropriate.
Through Dr. Samuel Harrington's own experience with the aging and deaths of his parents and of working with patients, he describes the terminal patterns of the six most common chronic diseases; how to recognize a terminal diagnosis even when the doctor is not clear about it; how to have the hard conversation about end-of-life wishes; how to minimize painful treatments; when to seek hospice care; and how to deal with dementia and other special issues.
Informed by more than thirty years of clinical practice, Dr. Harrington came to understand that the American health-care system wasn't designed to treat the aging population with care and compassion. His work as a hospice trustee and later as a hospital trustee drove his passion for helping patients make appropriate end-of-life decisions.
Most people say they would like to die quietly at home. But overly aggressive medical advice, coupled with an unrealistic sense of invincibility or overconfidence in our health-care system, results in the majority of elderly patients misguidedly dying in institutions. Many undergo painful procedures instead of having the better and more peaceful death they deserve.
At Peace outlines specific active and passive steps that older patients and their health-care proxies can take to ensure loved ones live their last days comfortably at home and/or in hospice when further aggressive care is inappropriate.
Through Dr. Samuel Harrington's own experience with the aging and deaths of his parents and of working with patients, he describes the terminal patterns of the six most common chronic diseases; how to recognize a terminal diagnosis even when the doctor is not clear about it; how to have the hard conversation about end-of-life wishes; how to minimize painful treatments; when to seek hospice care; and how to deal with dementia and other special issues.
Informed by more than thirty years of clinical practice, Dr. Harrington came to understand that the American health-care system wasn't designed to treat the aging population with care and compassion. His work as a hospice trustee and later as a hospital trustee drove his passion for helping patients make appropriate end-of-life decisions.
304 pages, Hardcover
Published February 6, 2018
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Displaying 1 - 30 of 35 reviews
April 29, 2023
The update of hospice is to be at home as much as possible and to avoid intensive emergency care. To get off of the conveyor belt of treatment.
Listening to this book was like listening to your wisest and most caring family doctor. Such wonderful common sense approach to dignity and joy when facing the end of life.
Truly helpful.
Listening to this book was like listening to your wisest and most caring family doctor. Such wonderful common sense approach to dignity and joy when facing the end of life.
Truly helpful.
June 18, 2018
Well this is a hard subject, but very important I think. Its a very frank, informative and necessary end of life strategies.
"If we are lucky enough to get old, we should be prepared for some disability. If your strategy is to die late in life, then you should acknowledge that you will be old and need a strategy to die better".
The author is a doctor and writes of guiding his mother and father as well as patients through to the end of life. It is a lot of information and I began to feel overwhelmed. The process of dying of old age is complicated. Unfortunately we don't all have children that are doctors that can guide us through it. I can't imagine trying to absorb this information and make informed rational decisions if I were ill or incapacitated. I guess better to read it early and be prepared.
In his introduction he states , " It is about avoiding a painful dying process and futile medical care. It is simply a practical look at declining health, old age, progressive debility, and practical choices that people can make to minimise the likelihood of the unconsidered death and to maximise the liklihood of a 'better' death".
On the lighter side there were a lot of good quotes in the book. I particularly like one from Woody Allen, "I am not afraid to die. I just don't want to be there when it happens".
"If we are lucky enough to get old, we should be prepared for some disability. If your strategy is to die late in life, then you should acknowledge that you will be old and need a strategy to die better".
The author is a doctor and writes of guiding his mother and father as well as patients through to the end of life. It is a lot of information and I began to feel overwhelmed. The process of dying of old age is complicated. Unfortunately we don't all have children that are doctors that can guide us through it. I can't imagine trying to absorb this information and make informed rational decisions if I were ill or incapacitated. I guess better to read it early and be prepared.
In his introduction he states , " It is about avoiding a painful dying process and futile medical care. It is simply a practical look at declining health, old age, progressive debility, and practical choices that people can make to minimise the likelihood of the unconsidered death and to maximise the liklihood of a 'better' death".
On the lighter side there were a lot of good quotes in the book. I particularly like one from Woody Allen, "I am not afraid to die. I just don't want to be there when it happens".
January 22, 2023
Dr. Harrington expressed very clearly what I have long suspected: the aged receive far too much medical treatment in the United States. The good doctor shows us that most of the interventions received by the dying only serve to increase their suffering rather than relieve it. He explains the alternatives for comforting the dying.
This book is hard to read at times with its graphic descriptions of death but has clear explanations of how the body shuts down and the presence or absence of pain. He explains how dementia kills, which was a puzzle to me. The book is helpful for anyone who won't be making a quick exit, and as more and more of us die simply of old age.
This book is hard to read at times with its graphic descriptions of death but has clear explanations of how the body shuts down and the presence or absence of pain. He explains how dementia kills, which was a puzzle to me. The book is helpful for anyone who won't be making a quick exit, and as more and more of us die simply of old age.
December 13, 2018
Written by a physician, this book encourages one to think about end of life. In his sensitive yet practical manner, the author wants all of us to consider and then specify exactly how we want to die. He sprinkles the novel with personal anecdotes from his own life and medical practice.
March 12, 2023
Very helpful. Worth reading for anyone.
June 2, 2023
Update: Mom died 5 weeks after I finished this review, after reading the book twice in the last couple of years. I have to say that it is, without a doubt, the best book I read to prepare us. It was a peaceful passing, with all of our ducks in a row. I'm so grateful.
Dayum. Harsh, yet needed. Probably the most useful book I've come across for dealing with my 93 year old mother as I age myself. Must buy a print copy for the forms. I listened to several parts more than once. Lots of meart to chew here.
Dayum. Harsh, yet needed. Probably the most useful book I've come across for dealing with my 93 year old mother as I age myself. Must buy a print copy for the forms. I listened to several parts more than once. Lots of meart to chew here.
April 5, 2024
3,5 stars; sensible book on the limits of medicine and and ardent appeal for a humane approach to the end of life; bit tedious at times but worth your time; for more on the subject be sure to check out: The Five Invitations: Discovering What Death Can Teach Us About Living Fully, How We Die: Reflections of Life's Final Chapter, The Art of Dying Well: A Practical Guide to a Good End of Life, With the End in Mind: Dying, Death, and Wisdom in an Age of Denial.
January 27, 2019
I am grateful for this book that many of my friends are currently reading. It is also a help as I am a patient advocate for a friend who is going to begin Palliative Care. Personally, the book is a great help when I, along with my husband, know that we need and want to have a comfortable understanding of the dying process. The authors chapters and end of chapters "Things to remember/Things to consider" summarize so beautifully the chapter and the hi lights. I do want to live my last days comfortably at home and/or in hospice when father aggressive care is inappropriate.
I appreciated his writing about the challenges of end-of-life decisions that must be made with our families and myself/ourselves.
It was also helpful to me that the author shared in depth his experience of the death of his parents. His honesty and treatment and the decisions of his parents brought fresh insight into his research and writing.
I appreciated his writing about the challenges of end-of-life decisions that must be made with our families and myself/ourselves.
It was also helpful to me that the author shared in depth his experience of the death of his parents. His honesty and treatment and the decisions of his parents brought fresh insight into his research and writing.
April 28, 2021
Harrington outlines disease processes or trajectories to emphasize choices that minimize the chances of a medicalized death and maximize the chances of a better death. The goal of this book is to use the knowledge of disease trajectories to choose a point in the disease process at which one considers stopping aggressive treatment and recognizes that palliative treatment is likely to offer a better outcome. There is a lot of discussion of the '"medicalization” of an institutionalized death that has dominated medical treatment and patient expectations for the last fifty years and has come to define the new normal of prolonging life at all cost.' Harrington identifies six conditions that actually cause death (the CAUSES of these conditions are myriad): Heart Failure, Cancer, Chronic Obstructive Pulmonary Disease, CVA (stroke), Dementia, and Diabetes. His premise is by recognizing which of these is actually going to be the cause of your death, you can use the predictable trajectory of each condition to make your plans, not get caught in the "treat because we must" spiral.
July 20, 2019
Many of us are dealing with aging parents, a seriously-ill loved one, or even our own health issues. Dr. Harrington speaks about the point at which someone realizes that further treatment for a physical condition (whether it be a specific disease or general aging) will probably lead to overly-invasive tests, overaggressive treatment, possibly unexpected complications, and potential suffering. It's at that point that the patient (and/or family) can decide whether to pursue any treatment at all, or concentrate on palliative care, attempting to remain as comfortable as possible. He discusses the six most common terminal diseases, and provides guidelines to help make these decisions.
This is an excellent book, though even just the first few chapters make his point. For anyone who might not have time to read even that much, check out Dr. Harrington’s website (samharrington.com) and read his articles or watch the 5-minute video.
This is an excellent book, though even just the first few chapters make his point. For anyone who might not have time to read even that much, check out Dr. Harrington’s website (samharrington.com) and read his articles or watch the 5-minute video.
May 2, 2018
Dr. Samuel Harrington’s book, “At Peace: Choosing a Good Death After a Long Life," explores the six most common chronic diseases that lead to death in America (congestive heart failure, cancer, chronic obstructive pulmonary disease, stroke, dementia, and diabetes), how to recognize when one of these illnesses is nearing its natural conclusion, and what options a patient might have other than the aggressive care measures medicine offers. He talks about both his professional experience managing death as a gastrointerologist as well as the personal growth he experienced helping his parents face end-of-life choices. I thought this was well-written, personal, and thought-provoking and have put it out for my patients to read. I would encourage other providers to do the same.
February 15, 2018
The author's purpose is to explain the folly of aggressive medical treatment of terminal diseases for the elderly and the need for "The Conversation" about a person's desires and expectations as they approach death. He explains the usual progression of diseases or conditions that are most likely to lead to death of the elderly. This goes beyond discussions of advanced directives and explains that we need to accept that death is in our future and the opportunities we have to exert our limited control over that process. This is an important book for the elderly, families of the elderly and those who will be elderly soon!
August 3, 2018
Realistic and practical guide to end of life situations aimed at the elderly or caregivers of the elderly.
"This is a book about exit strategies. ... It is about making the end of life less bad. It is not about extending life...It is about avoiding a painful dying process and futile medical care...It is simple a practical look at declining health, old age, progressive debility, and practical choices that people can make to minimize the likelihood of the unconsidered death and to maximize the likelihood of an 'better' death."
"This is a book about exit strategies. ... It is about making the end of life less bad. It is not about extending life...It is about avoiding a painful dying process and futile medical care...It is simple a practical look at declining health, old age, progressive debility, and practical choices that people can make to minimize the likelihood of the unconsidered death and to maximize the likelihood of an 'better' death."
February 26, 2020
Harrington isn't the best writer, but he brings up a lot of end-of-life issues that I believe warrant advance planning and discussion regardless of what age you are. I commend him for discussing such a hard topic and for bringing to light a topic from which most people shy away. Medicalized deaths are tragic and leave a bitter taste in the mouths of all involved family members, and this book gave me insight with regards to avoiding that for myself and for advising any dear older friends I have. I definitely will recommend this book to others so that they also can be informed about their options whenever that time approaches for them (or their family members).
What I don't like about this book is in the last chapter, Harrington alludes to an acceptance of medically-assisted deaths (also know as physician-assisted suicides). Medically-assisted death is, in my opinion, the opposite of a dignified death, and while I can understand his arguments leading up to it, I think this option creates a lot of confusion and hurt for the family. I would never advocate for legalization of medically-assisted deaths because of countries that refuse to give people care since insurance companies in those countries believe "it's cheaper just to kill them". This option to me does not seem ethical on so many levels.
What I don't like about this book is in the last chapter, Harrington alludes to an acceptance of medically-assisted deaths (also know as physician-assisted suicides). Medically-assisted death is, in my opinion, the opposite of a dignified death, and while I can understand his arguments leading up to it, I think this option creates a lot of confusion and hurt for the family. I would never advocate for legalization of medically-assisted deaths because of countries that refuse to give people care since insurance companies in those countries believe "it's cheaper just to kill them". This option to me does not seem ethical on so many levels.
November 17, 2017
I rate At Peace a 4 because it contains vital conversations about a seemingly taboo or at the very least unapproachable subject, the death of elderly patients. Dr. Harrington discusses the ins and out of choice in a variety of scenarios told with his own mother and father's deaths at the crux. I wish this book was available before my own father's death and will begin to recommend to friends who are in the throws of concern for their own parents. Thank you, Dr. Harrington.
March 5, 2018
This is the best book written by a doctor who cares for patients.
Every senior citizen over 60 years must read this book for very
Good information about major illnesses including ‘the process of
Getting old’. No need to fear. Non one will get all the illnesses.
When to refuse aggressive treatment is dealt by the author
Very informatively and interestingly. Lucky that i got the occasion
To read this important book at the age of 73. Must read by seniors.
Every senior citizen over 60 years must read this book for very
Good information about major illnesses including ‘the process of
Getting old’. No need to fear. Non one will get all the illnesses.
When to refuse aggressive treatment is dealt by the author
Very informatively and interestingly. Lucky that i got the occasion
To read this important book at the age of 73. Must read by seniors.
June 22, 2018
Can't say enough good things about this book. It's clear, concise, to the point and, understandable. It elaborates on when pursuing options are realistic and when they are not and most of all, says it kindly with examples of better and worse deaths. There are enough examples in the book without making it simply about case studies. He discusses how people die in simple and easy to understand terms. I would recommend this book to anyone that is at age 65 or older.
September 10, 2018
Recommended by a friend and really worth a read.
I feel dense. It had never occurred to me that someone would be medically frail without looking frail. I had thought about DNRs and not getting hooked up to machines. I hadn't thought about the possibilities of not treating pneumonia or sepsis or stopping "normal" prescriptions.
I think that the title sounds like the author is advocating assisted suicide, but he's not.
I feel dense. It had never occurred to me that someone would be medically frail without looking frail. I had thought about DNRs and not getting hooked up to machines. I hadn't thought about the possibilities of not treating pneumonia or sepsis or stopping "normal" prescriptions.
I think that the title sounds like the author is advocating assisted suicide, but he's not.
September 23, 2018
Great book for end of life planning. A must read for anyone with aging parents and facing our own mortality. At Peace provides options to those of us that do not want to end this life in the hospital hooked up to tubes and monitors. It gives us the power to make our own decisions on how we go out.
April 4, 2019
Written by a physician this book makes strong arguments for securing a more gentle and happier death. The author gives practical advice on how you can navigate through the medical establishment towards this goal avoiding unproductive procedures. In addition he tells personal stories of his family and patients and how this has approach has made their death more peaceful .
June 24, 2018
Every hospice /palliative professional should consider this required reading
Every hospice /palliative professional should consider this required reading. Practical, no-nonsense info to make having conversations with families so much better
Every hospice /palliative professional should consider this required reading. Practical, no-nonsense info to make having conversations with families so much better
August 5, 2018
I recommend this to anyone wanting to plan for the future. Where I come from, death is a subject to be avoided or relentlessly optimistic about. This book treats the process of dying respectfully and realistically, I appreciate the author's perspective.
October 29, 2018
I agree with this author, a medicalized death seems cruel and prolongs suffering. I learned many things, especially in the first half of the book.
I had to force myself to finish , as it began to be repetitive.
I had to force myself to finish , as it began to be repetitive.
September 21, 2023
Emphasizes the need to plan ahead for end of life choices. Hard to face the fact that US health care is a money making enterprise. This is especially true for those advancing in years. Important read.
March 12, 2018
Good death
I am approaching 70. In good health but realize I won't always be. I have been exposed to several ideas that were new. I hope to make better good choices.
I am approaching 70. In good health but realize I won't always be. I have been exposed to several ideas that were new. I hope to make better good choices.
April 15, 2018
Most people don't want to think about end of life discussions much less have them, but the author argues for having them with your loved ones and your doctors.
September 7, 2018
Required reading!!
October 5, 2020
I highly recommend this book to anyone over the age of 60 or who is caring for a person over that age.
If you read the description of the book, it more than adequately covers the book. Informative.
If you read the description of the book, it more than adequately covers the book. Informative.
March 6, 2021
Excellent book. I would love to get it into the hands of all my friends.
June 8, 2021
Great book to provide some perspective on carrying for aging parents.
Displaying 1 - 30 of 35 reviews