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BOOK REVIEW

MODERN DEATH:

HOW MEDICINE CHANGED

THE END OF LIFE

By Haider Warraich, M.D.
Review by Fred Olin, MD

T his book is hard for me to describe: It is a history book, a the brain.” So, just because the heart has stopped and the person isn’t
book about ethics, a philosophical tome, and, to a small ex-
breathing no longer means they are “dead.”
tent, a professional autobiography. I’ll give you a hint of
Nowadays, the criterion in this situation is “brain death.” So, let’s
what’s in it by listing a few of the 13 chapter titles; “When Cells Die,” look at these two court cases: New Jersey resident Karen Quinlan
“How We Learned Not to Resuscitate,” “When Guardians are Bur- overdosed on alcohol and tranquilizers in 1975. She was rendered
dened,” “When Death is Desired” and “When the Plug is Pulled.” unresponsive and anoxic. Although she was “revived”, she was brain
Dr. Warraich is currently a cardiology fellow at Duke University dead. Her parents wanted life support removed, but the physicians
Medical Center, and how he managed to write this book with its and hospital refused. The parents sued. The case made headlines and
600+ references during his various levels of training is a mystery to intrigued the nation. When she was finally removed from life support
me. I bought his book because one day I happened to hear an inter- she lingered on, comatose, for ten years and died of pneumonia in
view with him on NPR’s “Fresh Air with Terry Gross” and was fas- 1985. Another case was that of Nancy Cruzan, who crashed her car
cinated with his presentation. Highlights of that interview are in 1983, and whose fate was argued in Missouri’s courts and in the
available at NPR.org. press. Ultimately, despite the objections of medical, legal and reli-
The history mentioned is integrated into the narrative. It starts in gious factions, the courts allowed the family to have the feeding tube
biblical times, moves to ancient Greece, then forward to the present. removed and, about two weeks later “…Nancy completed the long
As I read the book I learned all about some of the famous court cases and agonizing death that had taken almost eight years to unfold.”
that have defined physicians’ and families’ duties and options when a Each of these situations resulted in strange bedfellows on each side,
person appears to be “dead” but is still being kept “alive” by artificial and decisions that echo down to the present in both medical and
means. But wait! Before we look at that, we have to know what “alive” legal circles.
and “dead” are. In the chapter entitled “How Death was Redefined” The plight of families and caregivers when a loved one is declared
is this line: “…quite shockingly, there is no a single agreed upon def- to be “dead” by current criteria despite being kept “alive” is discussed
inition of life.” This is followed by a long and intellectually stimulating at length by Dr. Warraich. Several scenarios are illustrated, including
discussion on just that subject. After that comes an equally fascinating that of a woman whose daughters were at odds over what to do until
tale about how “Progress during the first half of the twentieth century they were asked to tell the physician about their Mom: What sort of
had definitely moved the chalice of life from the heart and lungs to person was she, how did she live, etc.? As they answer that she was

34 San Antonio Medicine • February 2018