Illegal to die of old age - a book review

In his book "How We Die" Sherwin B. Nuland describes how the U.S. Government in its annual "Advance Report of Final Mortality Statistics" neatly tabulates all the deaths by cause. And nowhere in the report is "old age" listed as a cause. In fact, this attitude is echoed by the World Health Organization - it is illegal to die of old age. There are many other wonderful facts and descriptions in this book. Now that it is 12 years old, I'm not sure if the statistics need to be updated but I would guess that how we die changes very little over the years.

Nuland, a practicing surgeon, has detailed the major causes of death - from sudden heart attacks to more lingering strokes to the very lengthy dying process of Alzheimer's. He describes the physiology, the pathology of disease in its relentless attack on the human body and how, despite all the advances of medical science, the disease always wins.

The descriptions aren't pretty. Nuland pops our bubble that dying can be done with dignity. But somehow, knowing the possibilities takes away some of the fear and dread. The stories are told sensitively as one would expect from a medical practitioner who has had some years of experience but also as one would expect from a brother or son or friend. Some of the more poignant descriptions are very personal.

Now that 80% of our deaths in America occur in the hospital, we need a book like this to remind us of the reality of death and to help us cope with that reality.