Realistic Challenges, and Important Considerations, of a Good Death

Achieving a Good Death: A Practical Guide to the End of Life

Chris Palmer
Rowan & Littlefield, 2024
338 pp., hardcover
ISBN: 978-147585-0512
Also available: Kindle

Reviewed by Frank Brennan, MD

This book has both an historic context and a contemporary resonance. In the aftermath of the bubonic plague in the 14th century, a tradition grew of ars moriendi (the “art of dying”), essentially a collective wisdom to help people anticipate and prepare for death. In the modern era, a genre of literature has emerged exploring serious illness and death. This literature attempts to re-acquaint the public with the fact that, despite the extraordinary advances in public health and medical interventions, humans remain a mortal species.

To the modern ear, the phrase “good death” is an oxymoron. A prevailing view is that death, always to be fought against, is never good: that little occurs between diagnosis and death except suffering. Palmer opens up these preconceptions, isolating one after the other. He emphasizes the importance of equal attention to both the comfort of the patient and the scope of the treatment. He warns patients, families, and clinicians against being caught up in a cycle of interventions that may have little benefit, but exact much suffering. He reinforces the benefits of preparation. Preparation, however, can only occur if the subject of deterioration and dying is raised. Never raised, it may never be considered. Patients and families may be left floundering in the wake of change.

Throughout the book, Palmer turns to families and carers. He is realistic in describing the challenges of caring and the exquisite balance between the “sacred and even transcendent" aspect of caring for a loved one and the “exhausting and vexing” nature of such care. He points out the importance of carer self-care: “Being a capable and reliable carer means giving high priority to taking care of yourself.”

The author describes the phenomenon of the “seagull relative” who, living distantly, arrives at the bedside of a dying patient, insisting on active treatment. He states that “many feel that they have neglected the patient and their remorse transforms into an overzealous desire to ‘save’ the patient.”

The author poses the problem of the patient who is suffering unnecessarily, enduring interventions, inadequate symptom management, and not being afforded dignity. He discusses the broad scope of palliative care to such patients thoroughly. The response in the next chapter to such suffering is medical assisted dying. Chris Palmer is a member of organizations promoting assisted dying and Final Exit Network, a US organization that accompanies people who suicide (Palmer terms it “self-deliverance”), including those deemed ineligible under assisted dying laws. Clinicians in palliative care, having endorsed the role of their discipline in the first of these consecutive chapters, may struggle—as I do—with the tone and content of the chapter on assisted dying.

(December 2024)

Dr. Frank Brennan is a palliative care physician, past president of the Australian and New Zealand Society of Palliative Medicine, a senior lecturer in the Faculty of Medicine at the University of New South Wales, and a lawyer. 

On the Kindness of Strangers and other Essays: Musings on Medicine as a Human Science

Achieving a Good Death: A Practical Guide to the End of Life

Norelle Lickiss
Forty South Publishing (Tasmania), 2024
640 pp, softcover
ISBN: 9780-97564-0647

Reviewed by Frank Brennan, MD

Norelle Lickiss has thought long and deeply about the human condition. Certainly, her chosen profession brought her there. As a doctor, she attended the bedsides of countless patients and observed carefully what she saw. But it was her intellect and spirit that elevated these observations into the deepest discourse: What does it mean to be human? What is suffering, dignity, compassion, and hope? What does it mean to be a doctor to patients, their families, and the wider society?

That enquiry led her on a lifetime of reflection. Reading widely in literature, philosophy, history, medicine, and theology, Lickiss grappled with these issues. Aiding the grappling was writing. Over many years she wrote essays and delivered speeches. Some were published; many were not. Here now is a collection of those essays and addresses.

A principal theme of her enquiry is the role and practice of medicine. Lickiss shares rich insights. The one area for which she brings a unique perspective is the discipline of palliative medicine. One of the founders of palliative medicine in Australia, Lickiss taught and mentored numerous physicians and other health professionals in the practice and philosophy of the discipline.

She emphasized the importance of a rigorous approach to medical practice, including meticulous history-taking and physical examination. For the philosophy of the discipline, she taught the importance of curiosity in understanding the breadth and depth—the human complexity—of the patient as a person. Lickiss quotes Walt Whitman's Song of Myself: "I…am not contain’d between my hat and my boots."

On the topic of educating students, Lickiss posed these questions at the book launch: 

"How do we as educators of medical students and doctors-in-training help them not just to learn loads [of facts]…but also learn how to grow into a person of radical integrity who can be a highly competent, compassionate, healing presence to fellow persons? And has some understanding of the human condition, even in darkness as well as light? And is profoundly conscious of our common humanity, and recognizes the equal intrinsic dignity of each person? And judges and acts accordingly?"

To this end, and throughout her career, Lickiss encouraged her colleagues, senior and junior, to be open to the humanities—including art, philosophy, and poetry—to gain a better understanding of the human person, including themselves. 

This is all echoed in the collection of essays and addresses. They date from 1973, when she wrote a thesis on the health of aboriginal people in Sydney, and include advice to a young doctor; reflections on palliative medicine and the nature of human suffering, hope, and dignity; and final ruminations from the perspective of being a patient herself, vulnerable, troubled, and uncertain.

Drawing on the wisdom of the ages, Norelle Lickiss has added her own to that legacy. 

NOTE: Australian readers can buy the book direct at fortysouth.com.au.

(December, 2024)

Professor Lickiss is a former director of palliative care at Royal Prince Alfred Hospital, Sydney, Australia and founder of the Sydney Institute of Palliative Medicine.

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