Dispatches From the End of Life

Medical advances have shifted the boundary between life and death, raising controversial questions for doctors and patients. Physician Haider Warraich zooms in on these issues in Modern Death: How Medicine Changed the End of Life, supplementing medical history with tales from the life-death border that are disturbing, bewildering, and inspiring.

Some of your cases involve deep uncertainty—in one, it's unclear whether the patient is even alive.

I think for many patients, the only thing worse than a bad diagnosis is not knowing what's going on. At times I feel the need to simplify a complex situation. But when I know that there is no right answer, I tell patients, "Hey, we actually don't know." Sometimes that helps to ease some of their frustrations.

More people are spending their final days in hospitals and nursing homes. Why is the question of where we die so urgent?

The vast majority of people, when surveyed, say that they want to die at home. People are used to being able to control things—not big things, but small things. At the hospital they lose all control over their schedule. They can't get out of bed without an alarm going off. They can't have a meal without their blood sugar being checked. And there is nothing more disempowering than dying.

How does communication within families about end-of-life issues need to change?

So many times these conversations happen when patients are ill and afraid and have no time to process information. I think these talks are best had sooner, when people can appreciate what is truly important to them.

Rethinking Death

1950s-60s: CPR, ventilators, and other innovations expand the doctor's death-defying toolkit, enabling patients with limited brain activity or other critical problems to persist.

1976: The parents of Karen Ann Quinlan, a comatose young woman, win a court battle to discontinue her life support. The decision helps empower patients and families to terminate care.

1981: A presidential commission proposes a law, adopted by most states, that recognizes the permanent absence of brain function—even when heart function remains—as legal death.

2013: Jahi McMath, a girl in California, is declared brain dead—a judgment disputed by her parents. The hospital is authorized by the court to release her body; her parents resume her care in New Jersey.