Abstract
For those looking for guidance on how to approach patients and families caring for patients at the end of life (EOL), Hester provides just that by interweaving a century-old philosophy with real-time decision making. He admits in the preface that the book's origins started in “bits and pieces, fits and starts”(pg. xii), referring to material originating from his doctoral dissertation, journal articles, and conference presentations. However, with clear prose and revealing footnotes Hester uses that fragmented beginning to craft a useful guide for those who find themselves on any side of the EOL narrative. He is unapologetic in the forward for focusing heavily on philosophic theory early on in the book. Such a focus, however, only adds to the richness of this work.
End-of-life Care and Pragmatic Decision Making is a well-written seven-chapter book, with the final chapter being a concise and provoking finale. The first chapter begins by reacquainting us with Socrates' choice to die in prison rather than in exile. This powerful story, bolstered by a modern day analogy, sets the foundation for an in-depth discussion of radical empiricism. Hester contends that Socrates chose to die in a manner that was consistent with the way he had lived life. He also reminds us that “Dying is a process within, the embodied living”(pg. 3), and “The dying process is part of the lived experience” (pg. 8). He further explains that “to engage in one's own dying process … may result in a morally appropriate choice to die even in the face of alternative ways to continue living” (pg. 8).
The second and third chapters provide the framework for subsequent chapters by reviewing William James's philosophy of radical empiricism in detail with a clear and concise summary for those who are not experts in philosophy, with applicable cases woven throughout. Hester argues that “to follow radical empiricism, all experience matters, experience is wherein value arises, and the whole of moral experience is not available to any one person”(pg. 19). He urges us not to think of experiences in a vacuum as they are undeniably intertwined with our community and environment. Hester then continues his argument to demonstrate the EOL implications of the radically empirical attitude. He argues that for some there is a duty to die, a moral obligation based on a radically empirical attitude. While this may be a contentious issue, Hester is able to clearly argue his case, concluding that “morality may require that tragic obligation be fulfilled by (or through, if you wish), patients” (pg. 58).
The final chapters of the book explore the use of this philosophical framework to understand attitudes toward meaningful acts of dying through suicide, assisted suicide, and euthanasia. Hester starts by asking two fundamental questions: “1) why and how some of us might wish to die differently, and 2) why and how those of us involved with dying persons might help their dying processes” (pg. 60). He then discusses issues surrounding the deaths of lucid dying patients, incapacitated dying patients, and severely impaired neonates. He provides evidence and examples from relevant cases in recent history, and develops practical and useful guidelines for approaching the care of patients and their families during EOL. At the heart of these chapters is the call to understand the patient as best we can and to use their narrative, and their place in their community, in making decisions. Hester touches on palliative and hospice care briefly, stating, “Palliative care, it must be acknowledged, is a form of aid in dying that should be available to every patient” (pg. 87). His final chapter, like radical empiricism itself, is in keeping with the previous six chapters. Hester proposes a model of good medical “care” and then eloquently concludes:
Taking seriously a radically empirical approach to patient care that encompasses patient experiences as integral to medical decision making … is a morally significant act that we must continually take seriously. … (pg. 161)
This well-written and thoughtful book offers a framework for thinking about EOL that may be useful for professional caregivers caring for patients at EOL as well as families and anyone else touched by the experiences of men, women, and children at EOL.