The Journey's End

An Investigation of Death and Dying In Modern America

Michael D Connelly

• Publisher: Rowman & Littlefield
• Year: 2023
• Edition: 1
• eBook ISBN:
  9781538175491
• Topic: Social Sciences
• Subtopic: Health Care Delivery
• Index: Social Sciences

In the tradition of Atul Gawande's Being Mortal, this compassionate work helps individuals develop a more accepting view of dying while teaching them what to expect and how to navigate the healthcare system at the end of life.
In elderhood, the health care system has a narrow view of how to provide care. It focuses on extending a patient's life at all costs, with an over-reliance on machines and procedures, instead of caring holistically for the person. Accordingly, many of us will likely spend our final weeks in long-term care facilities or an ICU.
Dying at home, peacefully, and surrounded by family is almost impossible in our world--and our fear of death is a major contributor to this impossibility. Fittingly, the central idea of this book is that in old age, or when facing a terminal diagnosis, it is more important to understand your life rather than to extend it. While this may seem simple, its implications are profound.
A natural death means accepting that, at some point, we are old enough or sick enough to die. In our cynical and overly clinical age, it is difficult to reflect on the meaning of one's life, but that kind of honest introspection is exactly what we need. Accordingly, The Journey's End seeks to help people manage their healthcare, their expectations, and their decisions in the final phase of life.

Table of contents

• Foreword
• Acknowledgments
• Introduction
• 1 Preparing for the Last Phase of Life
• 2 Agony as the Default Option
• 3 The Fiction of Living Forever
• 4 The Art and Science of Medicine
• 5 The Ethics and Economics of End-of-Life Care
• 6 The Physician’s Burden
• 7 Patient Autonomy: A Double-Edged Sword
• 8 Who’s Afraid of the Big, Bad GR?
• 9 Disappearing
• 10 Options for End-of-Life Care
• 11 Preparing Paperwork for Elderhood
• 12 Understanding the FFS Physician Payment System
• 13 Changing the Primary Care Payment Model
• 14 Making Comfort Care More Accessible
• 15 New Funding Options for End-of-Life Care
• 16 Reinstituting the Role of Care Coordination and Creating a Home
• 17 Accepting Life’s Limits
• 18 The Importance of Accepting Trade-Offs
• 19 Concluding Observations
• Appendix: Recommendations for Improving End-of Life Care
• Notes
• Bibliography
• About the Author