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Book and Media Reviews
March 1, 2006


Author Affiliations

Book and Media Reviews Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA.

JAMA. 2006;295(9):1067-1072. doi:10.1001/jama.295.9.1070

This very well-researched and elegantly written, if somewhat unevenly argued, volume succeeds less as a history than a historically based meditation on the meaning of death and the physician's relationship to the dying patient.

Shai Lavi, who teaches law and sociology at Tel Aviv University, begins by presenting the approach to death developed by John Wesley in the late 18th century as a transitional form of “the art of dying”: the early Methodists practiced a ritual of public prayer and testimony to aid the dying person to achieve mastery over both the physical and spiritual pain of leaving earthly life. While retaining the spiritual emphasis of earlier practices, Lavi argues, the Methodists made death part of “this-world” rather than the passage to the next. By the end of the 19th century, however, pain and death had lost much of their spiritual meaning: “The hour of dying, once a climatic [sic] moment . . . became an undignified departure, in which dying patients gradually lose their humanity” (p 68). Physicians such as William Munk, author of Euthanasia, or Medical Treatment in Aid of an Easy Death (1887), had redefined pain as a warning sign of illness or injury, but such a warning had little meaning in terminal illness, when the patient suffered from both physical pain and despair (psychic pain). The physician's duty, therefore, was to maintain hope and to relieve pain, allowing the patient insofar as possible to fall into a painless sleep when all hope was gone.