The Art of Dying Well

“The woods decay, the woods decay, and fall,

“The vapours weep their burthen to the ground,

“Man comes and tills the field and lies beneath,

“And after many a summer dies the swan.”

So begins Tennyson's haunting poem “Tithonus,” a meditation on death as part of the natural order of things. Natural, that is, for everyone except Tithonus, to whom the gods granted immortality but not eternal youth. Thus he grows older and older, ever more feeble with each passing day, yet can never die.

Today, “Tithonus” seems an uncanny prevision of much contemporary medicine. Drugs and radiation, chemotherapy, ventilators, feeding tubes, medical drips and monitors – all these may be worth enduring when a reasonable hope exists for a return to the world outside the intensive care unit. But, suggests Katy Butler in “The Art of Dying Well,” for more dire cases, when there is no cure for the cancer or one is already old and frail, alternative courses of action may be preferable. Some noninvasive treatments and gentler medications may allow a life with dignity, even if a shorter one, and avert the suffering and purgatory of a living death.

Butler isn't a doctor, but she is a professional science writer and author of the widely admired “Knocking on Heaven's Door,” a critique of our broken medical system told through case histories and an account of her father's traumatic last years. Not surprisingly, then, this “practical guide to a good end of life” delivers on its subtitle, offering detailed advice on dealing with – in poet Philip Larkin's phrase – “age, and then the only end of age.” Butler's factual, no-nonsense tone is surprisingly comforting, as are her stories of how ordinary folks confronted difficult medical decisions. In short, if you're coming up on three score and 10 or have already passed that biblical term limit for earthly existence, you will want to read “The Art of Dying Well” and keep it handy, if only for its lists of what to do as one's physical condition changes.