Emil Cardan and Voichita Cardan, Death and Medicine
University Medical Publishing House, Cluj Napoca, Romania, 2016, ISBN 978-973-693-693-7
This book consists of 21 chapters dealing with the entire series of important peri-mortem issues; it is neither a handbook nor a simple lecture, but a compendium of general medical knowledge on death.
Beyond a couple of short introductory chapters examining the various ways of dying and their semiotics, much of the text considers a range of pathologies in terms of their causal relationship to death. The first of these takes a detailed look at medical conditions of interest to intensive care units, including cardiac arrest and resuscitation, chemical pneumonia, malignant hyperthermia, drowning, and electrocution. They are not considered clinically, but to emphasize the way they lead the case concerned to death; in other words, the reasons for the inexorable development of the pathological course and, in particular, the mechanism of dying.
Smoking, alcoholism, and irradiation disease come next; the remaining pathologic entities are ‘allocated’ a place according to how and when they fatally interfere with the course of life. The time necessary for a condition to cause death derives from the speed with which it compromises the metabolic essentials of the most important organs, i.e., oxygen supply and vital parameters of the milieu intérieur.
As medicine today is no longer rigidly opposed to death, the book addresses the role modern medical practice can play in generating organs for transplantation, on one hand, and on the other hand, in facilitating society’s approach to euthanasia and, when useful, developing strategies to ease the process of dying. It is here that Dr J. Kevorkian’s contribution and the Dignitas Clinic in Zürich are considered.
In addition to medical issues proper, the text also approaches several historical aspects of death, such as mummification, pandemics, the Crusades, the use of cadaveric blood, and the death penalty in its many notorious versions, including crucifixion and the guillotine.
A few short chapters are devoted to a number of post-mortem matters, including autopsy, forensics, classic preservation and cryonics, cremation, and spontaneous decomposition, as well as the use of cadavers for teaching purposes, with Prof. von Hagens’ plastination. Since embalming is not currently addressed in medical materials, it is discussed here in detail. In the interest of thoroughness, contemporary taxidermy is also presented.
Particular features of the book include a comprehensive coverage of peri-mortem issues, a consistent medical approach, human death considered within a larger biological context, an extensive use of bulleted lists, relevant foreign expressions in order to facilitate understanding, and supporting references directly related to the academic significance of given chapters.
It is for the contemporary medical workers a professional duty to effectively involve themselves in death management: to necessarily prevent it any time such a task seems possible and useful and, contrarily, to help the human creature to pass away when this is in their favour. There is no other medical subspeciality, apart from intensive care, in the position to better address both alternatives. While the anti-death strategy does represent a laudable mantra of the entire medical practice, nowadays the rationale for intensivists to also approach the way of dying in a professional manner in the interest of both the dying patient and society is developing.
Finally, ethical concerns and a possible correlation between near-death experiences and paranormal phenomena are also given their due attention.
The 397-page text, supported by a list of 317 references and a thematic index, is firmly grounded in scientific and academic rigour. Its essayistic narration, some personal reflections in response to a selection of aphorisms, as well as several art reproductions, combine to strike a tone that is both accessible and memorable.
Efforts have been made by the publisher to offer a book that is easily readable. With a friendly graphic and a robust physical structure, the volume remains open throughout, both figuratively and in the proper sense of the word.
For those who prefer digital book versions, the text is available on the Internet as open access.
The book is recommended to all medical workers who deal, in their routine activity, with death and its consequences. It could be also used in medical schools for those subjects related to the end of life.