While for most of us, this will be a difficult conversation to have with our loved ones, it is imperative that we all make those who might have to make decisions for us to know exactly what we want and what we will not tolerate if such an occasion arises. It is wonderful to see health care moving in this direction. This book provides a lot of reasons why these conversations are necessary for us all, as this doctor has seen too many “bad deaths” in his career. ( )

First U.S. Edition

This book is part of what really is a revolutionary approach to health care as the end of life approaches -- treat the patient, not the disease. Doctor Volandes wants patients and their doctors to think about the health care they want when an illness reaches the point where a cure is unlikely. The way he wants patients to think about it is by learning what various alternative kinds of care entail, and by talking about what they want -- openly and honestly, with their loved ones and their doctors. Do they want medical professionals to "do anything"? Do that want some support of functions that are failing, but not the most drastic? Or do they want comfort care, in which everything possible is done to eliminate pain and discomfort, but in which drastic measures are not taken.

If no decision is made, Dr. Volandes points out, the medical default is to do anything to keep the patient alive; that's what medical ethics call for unless the patient orders otherwise, and that's how the system works. Allowing this to happen, or in fact deciding to "do anything" often has nothing to do with treating the illness itself, but consists of treating the conditions that arise from it -- CPR when the heart stops, a ventilator when breathing fails, a feeding tube when the patient cannot eat. These may prolong life, but the quality of life that results can be miserable. For those who are already at that point, or who have loved ones at that point, these are decisions that need to be made, or the default will apply. Some may in fact choose the "do anything" option: that's their choice. But many others will choose not to accept drastic treatment, and will focus instead on care that keeps the comfortable. These are choices that need to be considered, and communicated clearly before a crisis arises.

For those of us who are not ill, but who are getting on, these are also choices that should be considered and communicated. If nothing else, it can spare our loved ones a great deal of anguish when our time comes. Dr. Volandes way of doing this is what he calls "The conversation". He provides ways of approaching this, and he also talks about ways of communicating one's wishes once choices have been made -- living wills, health care proxies, and so on and so forth.

This is a compassionate "how to" guide to making -- and communicating! -- choices that older people should make. ( )

Prepared to go

The Conversation: A Revolutionary Plan for End-of-Life Care by Angelo Volandes (Bloomsbury USA, $26).

Angelo Volandes, a Harvard University medical researcher and the founder of Advance Care Planning Decisions, offers a rational and compassionate antidote to fear mongering about “death panels” and the almost-universal reluctance to discuss end-of-life issues. In The Conversation: A Revolutionary Plan for End-of-Life Care, Volandes busts myths and offers sound advice about how to decide—for ourselves, thank you very much—what sorts of end-of-life measures we’d prefer to have taken.

This is a sensible and empathetic book, written in clear language and with facts close at hand—including the reality that patients who opt for palliative care only often outlive those who choose more aggressive measures.

The bottom line is that we will all die; that cannot be controlled. What we do have some measure of control over—provided we make our decisions in advance and convey them clearly—is how painful or invasive that death will be.

Reviewed on Lit/Rant: www.litrant.tumblr.com ( )