Death rules: how death shapes life on earth and what it means for us. Will Cairns. Fremantle, WA: Vivid Publishing, 2014 (235 pp, US$9.99). ISBN 9781925171921 (e-book edition).
A FAR NORTH QUEENSLAND palliative care physician provides an interesting, wide-ranging and personal review of the biology of dying and death from the point of view of one whose medical career has been largely devoted to the care of patients at the end of their lives.
The author’s approach is heavily influenced by his observations of the natural history of the Great Barrier Reef and evolutionary theory.
Cairns discusses obstacles to an open appraisal of death, the biology of death and dying, coping with dying and death, and the implications of prolonging life without considering the costs.
He points out that our cultural heritage entrenches beliefs about death and dying that largely ignore the science of death, but he acknowledges the importance of culture in normalising death.
Cairns reminds us that although life expectancy is increasing in many countries, the quality of this extended existence is often suboptimal. In the past, death came early but quickly; now it comes later and may be distressingly slow, and at a high emotional, physical and financial cost. The shift in strategy from a search for the prolongation of life (at almost any cost) to an acceptance of the inevitability of death and the need for improving the quality of the time remaining is one that many health care practitioners (and patients and their families and friends) find difficult.
This book is a reminder of the importance of expert end-of-life care, “a good death” and the need for better education of health care providers and the general public about death and dying.