Dealing with Doctors, Denial, and Death: A Guide to Living Well with Serious Illness

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Often when death is the inevitable and impending outcome of a health diagnosis, doctors are reluctant to discuss alternatives to treatment, feeding into a culture of denial that can result in expensive, ineffective, and unnecessary over treatment that may or may not extend life but almost always damages the quality of life. Here, a seasoned doctor and researcher looks at the ways in which we are accustomed to treating illness at all costs, even at the expense of the quality of a patients life. He considers our culture of denial, the medical professions role in over treating patients and end of life care, and the patients options and role in these decisions. The goal is to help patients and families make informed decisions that may help the seriously ill live better with their illnesses. This profoundly empowering book will help people make informed decisions about their lives and medical care, especially those who have a life-threatening or life-changing illness themselves or have a family member living with one. Incorporating specific questions for patients to ask their doctors and discuss with their families, the book provides an analysis of various forces that influence our decision-making. The book also examines the professional, psychological, economic, and social pressures that influence physicians treating seriously ill patients, including those that lead doctors to recommend treatments that may be futile. The book concludes with resources that seriously ill patients and their families can call upon to give them support and assist with the logistical, emotional, and spiritual challenges of end-of-life care.

Reviews

'Accepting death and making the time before death peaceful and comforting is one of the best gifts we can give to ourselves, our family, and our loved ones,' says oncologist and medical ethicist Mangalik as he takes on a big and often avoided topic in his debut book. His goal is to empower patients to avoid unnecessary medical treatments and to 'prepare you and your family for you to have a comfortable, peaceful death.' He educates readers on all aspects of the end of life, including accepting the inevitability of death, understanding why doctors over-treatone reason is their 'refusal to accept failure'; another is 'competitiveness and ambition'and resisting the urge to demand unrealistic treatments. There is a great deal of helpful information in these pages, on topics such as interpreting statistics and end-of-life directives. Among many good points the author makes is that patients may 'go for a treatment based on the best possible scenario' without understanding that 'improvement of heart function by x percent' might not actually make the patient feel better.... Readers will find much of value. * Publishers Weekly *
Mangalik, who spent 50 years as an oncologist, radiates compassion in this common-sense guide to planning a 'good death.' People can take charge of how they want to die, ideally free of pain and surrounded by family and friends. 'Why do we not prepare for our own death' Mangalik asks. Doctors tend to overdo treatment for many reasons, including financial incentives and fear of lawsuits, but patients dont need to just say yes. He notes that patients can legally refuse feeding tubes and intravenous fluids. This thought-provoking book is meant for the healthy as well as those who are ill. 'The best time to ask yourself what you do, and dont, want is when you are in good health,' Mangalik advises. He discloses that one big reason for his advocacy for honesty and openness is memories of how his own family stayed mum when his mother died in her thirties of an acute gallbladder infection. Mangalik provides invaluable information everyone can use to be prepared to face the inevitability of death and celebrate each life. * Booklist *
Dealing with Doctors, Denial, and Death is a life-affirming, holistic look at approaches to pain, quality of life, treatment, and death. Mangalik examines these topics from multiple perspectivesthe patients (and their family), the physicians, differing world views, and the medical-industrial complexs influence on the marketing and incentivization of advanced medical technology and pharmacology. Central to this discussion is the patient-physician dyad, which is informed by sharing information and values, but which is often fraught by opposing understandings of what is considered reasonable treatment. Complicating these interactions are beliefs that reasonable means to treat at all costs, or that the judgment that deciding less treatment is equated with failure. Mangaliks exploration of hidden influences ranges across world views of life and death, incentives fostering overtreatment, the downside of medical specialization, and most notably, personal denial. The reader is invited to consider what could be expressed as the long view, wherein death is part of life (exemplified by psychiatrist Elisabeth Kbler-Ross) and that death is the final act of living (a belief of Buddha). Mangaliks humane and humble treatment of people, doctors, and death is strongly recommended.... Summing Up: Highly recommended. All readers. * CHOICE *
Dying in America has become, unfortunately, much more complicated and fraught with hazards than it needs to be. Dr. Mangalik has given us a much needed, and very practical, guide to navigating the process for ourselves and our loved ones. His insights and advice provide concrete strategies for ensuring that end-of-life care is compassionate, appropriate, and dignified. -- Robert Truog, MD, Frances Glessner Lee Professor of Medical Ethics, Anaesthesia, & Pediatrics; Director, Center for Bioethics, Harvard Medical School; Executive Director, Institute for Professionalism & Ethical Practice; Senior Associate in Critical Care Medicine, Boston Children's Hospital
Dr. Aroop Mangaliks book is a masterful, sensitive, and eminently readable discussion of one of lifes great, and always changing, problems: how to think about suffering, dangerous illness, and death. Like it or not, almost all of us will face that situation. His book brings considerable experience and insight to an ancient problem that is forever inescapable. -- Daniel Callahan, cofounder and President Emeritus, The Hastings Center
Drawing on five decades of experience, oncologist Aroop Mangalik succinctly describes the steps patients and families can take to ease the end-of-life passage. With great clarity he shows readers why doctors are prone to over-treat and why the goal of comfort has become so elusive for so many. Dealing with Doctors, Denial and Death is a necessary, welcome guide through the maze of our problematic health care system. Readers will find useful information about CPR, hospice and palliative care, how to reduce non-beneficial treatments and most importantly, what to ask doctors when facing difficult medical choices. -- Sharon R. Kaufman, author of Ordinary Medicine: Extraordinary Treatments, Longers Lives, and Where to Draw the Line

Author Bio

Aroop Mangalik, MD is a retired oncologist and an ethicist. He has been an active clinician for many years and continues to teach ethics at the University of New Mexico School of Medicine and at the University of New Mexico School of Law. He has worked for many years to reduce unnecessary and unwanted treatments, especially for patients in advanced stages of their diseases. He has several publications in peer-reviewed medical journals pertaining to his work in the laboratory and in clinical trials.