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With the End in Mind – How to Live and Die Well

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’Dr Maddix’s creativity and compassion in supporting all the people she cares for to have a more comfortable death is striking’

Title: With the End in Mind – How to Live and Die Well

Author: Kathryn Mannix

Publisher: Williams Collins

Reviewer: Nida Rahman, trainee mental health worker

What was it like?

With the End in Mind’ is a book about death, but why slog through 350 pages evoking the fears lying beneath the surface of our decaying bodies? Because Dr Kathryn Maddix, an expert in palliative medicine, replaces our underlying dread with a welcome sense of understanding.

This book presents us with an array of characters. We meet a high-powered retired head teacher with a diagnosis of motor neurone disease, who is frustrated at the illegality of euthanasia. We become acquainted with a popular figure in the local Nigerian community with a diagnosis of breast cancer, gladdening the hospice with the scent of deep-fried plantain. Each pattern of life is unique thus there is no uniformity in the way death is greeted. Reactions exist on a continuum from avoidance to tender acceptance.

What were the highlights?

Dr Mannix’s creativity and compassion in supporting all the people she cares for to have a more comfortable death is striking. It illustrates that there is no ‘one size fits all’ to a comfortable death. Everyone’s needs’ vary in regards to areas such as personal preference, cultural expectations and generational differences. ‘With the End in Mind’ reinforces the necessity of exploring how strength is found in diverse places, from cognitive behavioural therapy, religion, the support of loved ones, and at times, the power of dark humour.

Strengths & weaknesses:

The characters we meet, enable us to reflect on how our behaviour and feelings may play out as the end approaches. This is important, as delving into discussions of ’kicking the bucket’ isn’t something we are prone to doing. British Social Attitudes (2013) indicates that while 70% of British people state that they feel comfortable discussing death, a mere 5% of us have a living will or advance care plan. Only 11% have written funeral plans prepared and less than half have spoken about their wishes if they were not to have long left. With the End in Mind provides an explanatory approach towards our discomfort towards human impermanence, highlighting advancements in medicine and technology changing perceptions of death to medical failures as opposed to natural parts of life.

Although Dr Mannix enables us to develop a sense of comfort through the knowledge her patients receive optimal care, there is a chance readers may be left with a sense of concern for the loved ones who are left behind, especially after untimely or unexpected deaths, which may well result in disbelief or severe shock. This area is not adequately explored and in a large part, accounts for the deep sense of sadness felt upon putting the book down.

Who should read it?

I would recommend this book not only to health workers but to anyone who is willing to embark on the challenging, but vital, journey of developing an understanding of how to manage and process an integral part of life: death.

with the end in mind

with the end in mind



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