BOOK REVIEW

Death Interrupted: How Modern Medicine Is Complicating the Way We Die

Blair Bigham, MD

House of Anansi Press, 2022

Reviewed by Johny Van Aerde, MD, PhD

In Death Interrupted, Dr. Blair Bigham tries to define what death is and when it occurs. The closer the place of death to intensive care settings, the more difficult it becomes. 

In his journey from EMS to ER physician to practising intensive care, Bigham discovered that death is no longer black or white; it has become a grey zone as a result of fundamental changes in societal thinking and the never-ending increase in technology. Death is not an on/off switch, it is a process. 

Bigham’s skills as a journalist shine throughout the entire book as he explains difficult concepts in simple, clear language. This book is about the twilight zone between life and death, the agonizing space for ICU staff, families, and, most of all, patients, even though they are often kept unconscious. By interviewing experts in intensive care, palliative medicine, the law, philosophy, and ethics, by reading extensively, and by adding his own personal experiences and reflections, Bigham explores our society’s understanding and perception of death. 

It is Western society and our understanding of ourselves as humans and as individuals that have made the process of dying so opaque and controversial. Brigham concludes that ego, hope, and entrenched beliefs cloud the judgement of physicians and families, leading to well-intentioned actions with disastrous consequences for the dying patient, who, supported by machines and technology, becomes an innocent bystander, left in limbo by those empowered to end their suffering. Perhaps, it is not the meaning of life that needs to be understood, but our fear of death and how to turn the process into a potentially good thing. 

The boundaries between life and death are socially and culturally determined, and they are always shifting. The rise of technology and the loss of death as a common human experience with people dying at home in their own bed are only partly responsible for the “death dilemma,” as Bigham calls it. The current culture also encourages people more than ever to feel special, so that death seems unacceptable and every individual feels deserving of continued life. It is part of general unrest in which society is facing a crisis of authority, an assault on knowledge and expertise, and an erosion of trust in government, medicine, and technology. Add to that unfamiliarity with death, the extreme denial that the self can and will be discontinued, the burgeoning individualism of our modern-day egos, combined with increasing secularization and lost belief in the afterlife. 

Education about death is needed and has been shown to help in making better decisions and accepting death. As for the medical profession, we too need to change our perception of death as failure. That includes disconnecting our self-worth and self-esteem from always having to push the envelope by looking at numbers and organs, rather than the person and their future. 

According to Bigham, there are three players in the death dilemma and none of them is technology or equipment. First, there is the patient who has the responsibility to arrive in the ICU with clear, written wishes to guide care in line with their values and beliefs. Second, the family must be ready to make difficult decisions. Families often don’t know the wishes of their loved ones and, because of that gap, they put their own beliefs and interests before those of the patient. Thinking about the best interests of the patient should start before the event that brought them to the ICU. Third, the physicians and ICU team have to step back and distinguish the forest from the trees. ICU workers and physicians become focused on numbers and equipment without seeing the big picture, the entire patient.

To make dying a better process, Bigham suggests, “When ICU docs care for their patients and understand their families, and when families understand the limits of medicine at the end of life, an alliance can be formed to honor the patient’s life with a loving end.” Everyone in Canada who is alive and plans to die at some point needs to read this book. 

Author

Johny Van Aerde, MD, PhD, FRCPC, is former executive medical director of the Canadian Society of Physician Leaders and founding editor of the Canadian Journal of Physician Leadership.

Correspondence to: johny.vanaerde@gmail.com