Peaceful Dying is a work of considerable effort and organization. Dr. Tobin has painstakingly analyzed his experience as a physician caring for patients with terminal illness and compiled a step-by-step guide to help both patients and their families achieve a “peaceful dying.” The audience for this work is the community—any individuals who are attempting to grapple with the issues faced when either they or a loved one is diagnosed with a terminal condition.
The book begins with an analysis of the dying process and the typical personal response one has to confronting an end-of-life situation. From this point, Dr. Tobin describes a 26-step process that he has structured into the “FairCare System” for patients to follow in order to facilitate a “peaceful dying” for themselves.
The FairCare System emphasizes that patients diagnosed with a terminal condition must confront their fear of dying and come to terms with that fear. The only way to do that is to learn as much as possible about their disease and its treatment from their doctors in order to assume control over the decision-making that determines the course of their disease. In effect, Dr. Tobin is emphasizing the importance of the patient side of the informed consent equation.
Once patients “take control of their life,” Dr. Tobin asserts that they are better able to come to terms with death and examine the questions of ultimate concern in the dying process: What is my own spiritual destiny? How can I prepare myself and my family for my death? How can I be sure to be comfortable and not alone?
Dr. Tobin asserts that first one has to begin to address the existential meaning of life and one’s place in the world. The steps outlined in the FairCare System provide a guide that is intended to facilitate the patient’s ability to address these issues and thereby achieve a peaceful dying.
Dr. Tobin provides a useful framework to facilitate conversations between patient and family and health care providers. This framework is a welcome addition to the current literature on end-of-life care. Although there are medical textbooks to inform professionals providing care to terminally ill patients, such as the Oxford Textbook of Palliative Medicine, and journals, such as the Hospice Journal and the Journal of Palliative Medicine, there are few sources to help the patient and family confront terminal illness in a practical way. It will be interesting to see how well the steps outlined succinctly in Peaceful Dying provide practical assistance for patients with advanced disease and their loved ones.
A 52-year-old man presented with an erythematous lesion in the axilla of unknown duration. Surgical excision was performed. What is your diagnosis?
