Via The New York Times: Sherwin B. Nuland, ‘How We Die’ Author, Dies at 83. Excerpt:
Dr. Sherwin B. Nuland, a surgeon and author who drew on more than 35 years in medicine and a childhood buffeted by illness in writing “How We Die,” an award-winning book that sought to dispel the notion of death with dignity and fueled a national conversation about end-of-life decisions, died on Monday at his home in Hamden, Conn. He was 83.
The cause was prostate cancer, his daughter Amelia Nuland said.
To Dr. Nuland, death was messy and frequently humiliating, and he believed that seeking the good death was pointless and an exercise in self-deception. He maintained that only an uncommon few, through a lucky confluence of circumstances, reached life’s end before the destructiveness of dying eroded their humanity.
“I have not seen much dignity in the process by which we die,” he wrote. “The quest to achieve true dignity fails when our bodies fail.”
In “How We Die, ” published in 1994, Dr. Nuland described in frank detail the processes by which life succumbs to violence, disease or old age. Arriving amid an intense moral and legal debate over physician-assisted suicide — perhaps the ultimate manifestation of the concept of a dignified death — the book tapped into a deep national desire to understand the nature of dying, which, as Dr. Nuland observed, increasingly took place behind the walls of the modern hospital. It won a National Book Award.
Dr. Nuland wrote that his intention was to demythologize death, making it more familiar and therefore less frightening, so that the dying might approach decisions regarding their care with greater knowledge and more reasonable expectations. The issue has only intensified since the book was published, and has been discussed and debated in the medical world, on campuses, in the news media and among politicians and government officials engaged in health care policy.
“The final disease that nature inflicts on us will determine the atmosphere in which we take our leave of life,” he wrote, “but our own choices should be allowed, insofar as possible, to be the decisive factor in the manner of our going.”
Beyond its descriptions of ruptured embolisms, spreading metastases and bodily functions run amok, “How We Die” was a criticism of a medical profession that saw death as an enemy to be engaged, frequently beyond the point of futility.
In chiding physicians, Dr. Nuland pointed the finger at himself, confessing that on more than one occasion he persuaded dying patients to accept aggressive treatments that intensified their suffering and robbed them of an easier death. One of those patients was his brother, Harvey, an accountant who died of colon cancer in 1990 after receiving an experimental treatment with no reasonable chance of success.
Looking back on that episode, Dr. Nuland wrote that he had mistakenly tried to give his brother hope, failing to acknowledge that disease, not death, was the true nemesis.
My father died at 64 in his own bed 33 years ago, also of prostate cancer, and he was one of the lucky ones: It killed him, but it did not destroy him. I hope it went as well for Dr. Nuland, whose book is brilliant, and may it go as well for all of us.