/ Book Reviews

Dudley, William (Ed.) (1992). Death and Dying: Opposing Viewpoints. San Diego: Greenhaven. 236 pp. ISBN 0-89908-167-3.

One of a series of eleven volumes considering opposing viewpoints on a number of subjects, this text is an effort to bring together under one umbrella the most controversial issues surrounding death and dying. Noting that "a person's family and friends, cultural values, and medical and social institutions all comprise part of the context in which individuals die," the editor has culled a wide variety of viewpoints about a topic much on the minds of Americans today as advances in medicine, health, and technological know-how bump up against families' abilities to deal with increasingly tough decisions about the end of life.

The book is divided into five chapters, each containing a preface, four to eight position papers debating the focused issue, a critical thinking exercise and a periodical bibliography containing both popular and scholarly sources. Each of the papers is preceded by a brief description of the author's purpose and several questions to guide the reader. In addition, the editor has included a preliminary discussion about the importance of considering opposing viewpoints, followed by a short introduction to the volume. Following the last chapter is a listing of organizations concerned with the issues discussed, a bibliography of books, and a general index. The editor's target audience appears to be study groups interested in these issues, and the kind of structure and content provided would be helpful as a stimulus for group discussion and further study.

One notable shortcoming of the book is the often thinly-landscaped essays. Many are simply not long enough to provide much depth; nor is there much direct reference to existing studies about the topic. In some cases, the editor's choice of contributors may be part of the problem. While some are noted scholars of the subject and have written thoughtful abstracts or extensions of previously-published work, others are clearly writing from personal experience and opinion, making their arguments interesting but less convincing. Despite the unevenness and brevity of the papers, some are provocative and satisfying, particularly those in the final chapter where contributors William A. Reinsmith and Paul Edwards square off about the survival of human consciousness following death. All in all, the volume does provide an interesting overview of death-related issues for the reader and an opportunity to be reflective about both personal perspectives and the viewpoints of others surrounding death and dying.

Anne K. Soderman
Family and Child Ecology
Michigan State University

Irish, Donald P., Lundquist, Kathleen F., & Nelsen, Vivian Jenkins, (Eds.). (1993). Ethnic Variations in Dying, Death, and Grief. Washington, D.C.: Taylor & Francis. 226 pp. ISBN 1-56032-277-2.

Ethnic Variations in Dying, Death, and Grief examines cultural differences in death-related practices and beliefs and is directed especially to practitioners. The authors address the need for the health-care system and its personnel to recognize, understand, and adapt to the needs of patients and clients from diverse cultures in the United States and Canada. Part One presents crosscultural and personal perspectives, providing tools designed to assist the reader togain insight into his or her own attitudes of issues related to death, grief, and multi-cultural diversity. Part Two provides a basic description of eight selected and perhaps less well-known ethnic and religious communities: African-American, Mexican-American, Hmong, Native-American, Judaic, Buddhist, Islamic, Quaker, and Unitarian. In Part Three, professionals in the health care field (physicians, nurses, social workers, morticians, and a health care administrator) were invited to reflect on the descriptions of the various ethnic and religious communities, and to consider their relevance for practice.

This book could serve as a good supplemental text for courses on death and dying or other applied courses in the helping professions. It is aimed at health care professionals; however, it should also be of interest to other professionals who work with families or who are preparing to work with families. Many minority families who are otherwise assimilated into the majority culture return to traditional practices when dealing with crises. The principal value of this book is to raise the awareness of practitioners to look beyond their own beliefs and to consider life events as others experience them. However, a word of caution is needed: While the descriptions of the ethnic and religious communities are helpful, instructors need to point out that there may be great variation within different cultures and religions. Incorrect presumptions about cultural differences can be just as insensitive as failure to recognize variation. Overall, the text amply demonstrates the connection between effective health care and cultural awareness.

Elizabeth A. Olsen
Institute of Gerontology
Wayne State University

Nuland, Sherwin W. (1993). How We Die: Reflections on Life's Final Chapter. New York: Alfred A. Knopf. 278 pp. ISBN 0-679-41461-4.

How We Die: Reflections on Life's Final Chapter presents a graphic and intimate discussion of death. Written in very precise medical terminology, Nuland, a medical doctor, describes the process a body goes through as it approaches death. He believes that a realistic sense of what is to be expected when dying serves as a defense against the fear and terror of death which is pervasive in American culture. By knowing the distinctive process and specific destructive patterns of each disease, we are free from unnecessary terrors and may be better prepared to recognize when it is appropriate to ask for relief, or perhaps to begin contemplating whether to end the journey altogether.

This book is not easily dismissed or forgotten, as it forces us to confront our own mortality. The powerful images the book produces are not usually pleasant, but they are thought-provoking and cause the reader to question previous ideas, or lack of them, about the process of death. While the book may not be enjoyable for everyone to read, it is fascinating and makes an important contribution to the understanding of the true nature of the dying process. Nuland was awarded the 1994 National Book Award for Nonfiction for this work.

Mary Kay DeGenova
Human Environmental Science
Central Michigan University

Quill, Timothy E. (1993). Death and Dignity: Making Choices and Taking Charge. New York: W.W. Norton. 1993. 255pp. ISBN 0-3903-448-8.

Written by a physician, Death and Dignity focuses on insights gained from Quills's personal and professional experiences with death. Case studies are used to support the author's belief that care of the dying should be based on "values of informed personal choice, minimizing suffering, and nonabandonment" (p. 20). Quill suggests that medical interventions resulting in protracted and painful death violate th intent of the Hippocratic Oath, which has two paradoxical directives: To prolong life and minimize suffering. He suggests that medical education and the physician reimbursement system overemphasize prolongation of life and use of invasive treatments while de-emphasizing development of skill in the humane care of the dying. Quill also elaborates on seven clinical criteria which he believes should be met before physicians assist with suicide and chastises Kevorkian for not meeting those criteria. Acknowledging the fact that some people lose their cognitive or communications ability prior to dying, Quill uses case studies to emphasize the importance of establishing a living will and health care proxy. The appendix contains samples of forms designed for those purposes.

Quill based this book on his belief that we need to explore stories of dying in hope of learning how to use medical power for "prolonging a meaningful life and humanizing the process of dying" (p. 23). His focus is on physicians, the terminally ill, and their families. Although he was the medical director of a hospice program, Quill rarely speaks of the, role of nurses in the care of the dying, and never considers how non-physician providers are affected by our laws or their educational preparation for end-of-life care. He presupposes that changes in the law, physician education, and reimbursement policies would result in physicians choosing to be present when their patients are dying naturally or by their own hand. In spite of this limitation, and minimal reference to ethical theory, this book is a valuable addition to the literature on death and dying. Through case studies, readers experience the difficult choices made jointly by physicians and dying persons or their families as they try to minimize suffering and provide humanistic end-of-life care. A wide variety of readers may benefit from reading this book: Family and professional caregivers, educators of health care professionals, policy makers, and anyone interested in preserving the right to some form of control over one's own care decisions and death experience.

Margaret M. Flatt
Nursing and Allied Health
Saginaw Valley State University

Spiegel, David (1993). Living Beyond Limits. New York: Fawcett. 336 pp. ISBN 0-449-90-40-9.

The purpose of this book is to help persons experiencing cancer or other serious illness to take control and enhance the quality of their lives. The author suggests that patients should make the most of personal and social resources to live well while fighting the disease. Insights gained through extensive experience and research while a psychiatrist at Stanford University School of Medicine and the shared experiences of numerous women who were members of support groups form the basis of this book. Spiegel repeatedly expresses his concern that some of the current approaches to cancer treatment can result in self-blame for not being able to "think away the disease." He clearly does not add to this misconception. One concern about the book is the implication that the research and clinical findings apply to other chronic diseases. While cancer often is considered a chronic illness, it differs from many other chronic illnesses which frequently have insidious onset and, at the time of diagnosis, are often not viewed by the individual as life threatening.

I highly recommend this book to individuals experiencing a life-threatening illness, their families, and friends. For those patients who do not wish to participate in support groups, the book itself, with the shared experiences of others in similar circumstances, could act as a support. While Spiegel's sensitivity and concern is obvious, he deals with issues in a direct and straight-forward manner. Health care professionals and students can also benefit significantly from this rare glimpse of the patient's perspective which can only serve to increase practitioners' empathy and understanding as they collaborate with families to promote the well-being of those experiencing life-threatening illness.

Mary Periard
Department of Nursing
University of Michigan-Flint

Schneider, John M. (1994). Finding My Way: A New Perspective on Loss and Grief. Colfax, WI: Seasons. 397 pp ISBN 0-96-38984-1-8.

Finding My Way is a book rich with personal reflections and anecdotes from the author's many experiences as a transpersonal grief psychotherapist. The intimacy revealed by the author's process of coping with his own personal losses tapped the long-forgotten memories of this reviewer. Its emotional impact penetrates and validates one of the most complex processes through which individuals proceed after the encounter of a significant loss or separation, such as death or divorce. The book offers a new and dynamic holistic model covering all aspects of the grieving process and is designed to be of practical use to both socially-oriented and clinically-oriented professional helpers charged with treating the loss and grief of others as well as of self. Although the author emphasizes that "human beings in helping roles cannot be trained to be more humane in their response to dying or to other existential issues" (p.29), there is agreement that validation by another or self is one of the most powerful tools for empowering and enriching the grieving person. Validation of personal worth comes from knowing that one has done the best one can within life experiences.

The author offers insightful and creative suggestions on how best to facilitate the life-empowering spirits of individuals. The book is both practical and theoretical, containing many case studies, focusing on the reforming and transforming process a person encounters through understanding, love, and forgiveness. For the professional, the model and information provide an intellectual basis for a professional care forum for further exploration of the relationship between separation and loss theory and family therapy practice or transpersonal psychotherapy.

Lillian A. Phenice
Family and Child Ecology
Michigan State University

Shapiro, Ester R. Grief as a Family Process: A Developmental Approach to Clinical Practice. New York: Guilford. 307 pp. ISBN 0-89862-196-8.

What helps people grieve? What can clinicians and grief counselors offer in terms of support for bereaved families? Why do families find it so hard to share their grief? Ester Shapiro answers these and many other questions in the succinctly written and long overdue book that views the process of grieving as a natural and necessary response to death, versus a morbid or pathological outcome. The goal of the book is to introduce readers from a variety of theoretical and clinical practice perspectives to an integrative, systematic developmental model of grief. Part 1 of the book contains a description of the systemic developmental approach to family bereavement that ends with a concise, eight point summary of the framework. In Part II the author closely examines individual grief in a systemic context with inclusion of four chapters describing the experiences and developmental implications of grief for adults and children. Of particular value is the inclusion of case examples and a summary table of children at different stages of development from infancy to adolescence. The section concludes with a discussion about children's grief as it is affected by parental grief. Part III examines grieving families and their shared development. Clinical case studies illustrate how shared strategies for stability are a necessary part of family adjustment after the death of a family member. The section concludes with a discussion about the death of a child and subsequent family development. Part IV provides an overview of social and cultural factors in family bereavement since cultural beliefs may help or hinder grief support for families. This section is also replete with theoretical reviews and culturally diverse case studies, including discussion about grief reactions as they occur in relationship to specific circumstances of a death (murder, suicide, traumatic events, illness). In Part V, the conclusion of the book, the author wisely reminds the clinician to acknowledge one's own vulnerabilities when encountering death and grief; to consider the position in one's own process of family life cycle development and to be aware of one's own cultural assumptions, personal biases, and hypotheses generated by the mental health profession.

The limitations of the book, although minor, include: omission of a discussion about the special needs of bereaved young adults (ages 25-35); and the book's focus on general bereavement, with less direction for clinicians working with clients whose family members died from AIDS, suicide, or who are missing. The book contains comprehensive, well integrated chapters that balance bereavement literature with in-depth, clinical case examples. Overall, this book is an invaluable tool for those wanting to learn more about bereavement and families and is indispensable to any person who works with grieving families, including psychologists, family therapists, hospice staff, clergy, and many others. It is a brilliant theoretical contribution, one of the best I have encountered to date.

Kelly Rhoades
Grief Educator and Consultant
Southeastern Michigan