In the tradition of Atul Gawande’s Being Mortal, this compassionate work helps individuals develop a more accepting view of dying while teaching them what to expect and how to navigate the healthcare system at the end of life.
In elderhood, the health care system has a narrow view of how to provide care. It focuses on extending a patient's life at all costs, with an over-reliance on machines and procedures, instead of caring holistically for the person. Accordingly, many of us will likely spend our final weeks in long-term care facilities or an ICU.
Dying at home, peacefully, and surrounded by family is almost impossible in our world--and our fear of death is a major contributor to this impossibility. Fittingly, the central idea of this book is that in old age, or when facing a terminal diagnosis, it is more important to understand your life rather than to extend it. While this may seem simple, its implications are profound.
A natural death means accepting that, at some point, we are old enough or sick enough to die. In our cynical and overly clinical age, it is difficult to reflect on the meaning of one's life, but that kind of honest introspection is exactly what we need. Accordingly, The Journey’s End seeks to help people manage their healthcare, their expectations, and their decisions in the final phase of life.
Michael D. Connelly served as the CEO of Mercy Health, one of the nation's largest health systems, from 1994 to 2017. Currently, he is the CEO Emeritus of Mercy Health (now Bon Secours Mercy Health System). He has global experience with health systems in Germany, the United Kingdom, Denmark, Sweden and Spain. He has also visited health facilities and orphanages around the world, including in Port a Prince, Haiti; Mathare Slums in Nairobi, Kenya; Kingston, Jamaica; Georgetown, Guyana, and Panguma, Sierra Leone. He has extensive governance experience and has chaired the following boards: Catholic Charities USA, the Urban League of SWO, the National Catholic Health Association, Catholic Medical Mission Board (CMMB) in NYC, and Premier, Inc. He also chaired the United Way for Greater Cincinnati (the 6th largest in the US) in 2013. He has published 17 articles in various healthcare journals, and currently lives on Johns Island, South Carolina.
Table of Contents
Forward By Professor David B. Nash, MD, MBA
Chapter 1: Preparing for the Last Phase of Life
Chapter 2: Agony: the Default Option
Chapter 3: The Fiction of Living Forever
Chapter 4: The Art and Science of Medicine
Chapter 5: The Economics and Ethics of Dying
Chapter 6: The Physicians’ Burden
Chapter 7: Patient Autonomy - A Double-Edged Sword
Chapter 8: Who’s Afraid of the Big GR?
Chapter 9: Disappearing
Chapter 10: Options for End-of-Life Care
Chapter 11: Preparing the Paperwork for Elderhood
Chapter 12: Understanding the FFS Payment System
Chapter 13: Fixing Primary Care Physicians Payments
Chapter 14: Making Comfort Care More Accessible
Chapter 15: Funding Options for End-of-Life Care
Chapter 16: Reinstituting the Role of Care Coordination
And Creating A Home for End-of-Life Conversations
Chapter 17: Accepting Life’s Limits
Chapter 18: The Importance of Trade-Offs.
Chapter 19: Concluding Observations
Appendix: Summary Recommendations
The literature on extending one’s life is, not surprisingly, popular and abundant. Here, Connelly argues that, in certain cases, the all-consuming goal of staying alive can actually lead to more pain and fewer well-lived days. Connelly, who worked as the CEO of one of the nation’s largest health systems, argues not for individuals to ignore their health concerns but instead to endeavor to make their end-of-life wishes known in advance. The Journey’s End outlines the ways the labyrinthine American medical system, from the focus on physician specialization to the complicated billing structures, encumbers the care patients receive, often leading to more invasive tests and procedures for negligible results. Connelly also provides ways patients can achieve better autonomy in how care is given as life ends. This is an incisive call to action that readers, no matter the stage of their current medical journey, will come away from more prepared and informed. A perfect complement to Atul Gawande’s Being Mortal.
Connelly, former CEO of a health care company, argues in his informative debut that death should be better handled in the medical system. Suggesting that current practices prize excessive interventions that can prolong suffering for end-of-life patients, Connelly details how features like fee-for-service insurance pay structures, which compensate doctors for the amount of procedures they complete, reinforce an overly aggressive form of elderly medical care. Instead of keeping patients alive at all costs, Connelly recommends helping them better come to grips with death, which can confer “closure, freedom, and a sense of purpose.” Connelly suggests patients create advance healthcare directives, explore palliative care options, and proactively discuss their philosophy on end-of-life care with loved ones. More broadly, his suggested policy reforms include eliminating prescription drug advertisements, which give patients false hope for cures, and taxing healthcare benefits to decrease demand for high-cost treatments. Connelly constructs a convincing case for reimagining cultural conceptions of death, through the discussions of policy recommendations and “death literacy.” Readers curious about end-of-life care practices will find this a helpful primer.
The end of life is a bit like an impenetrable wilderness: a dark and foreboding mystery. Michael Connelly is a reliable wilderness guide. He brings decades of experience in healthcare, a comprehensive command of current research, and steadfast humanism to The Journey’s End. Powerful and poignant stories energize this book, building trust and developing our capacities as we explore with him this inevitable part of the human journey. The practical advice and clear options offered by Connelly enlighten a path forward, empowering both individuals and society. A must read.
In his book The Journey's End, Michael Connelly brings a remarkable blend of insight, compassion, and expertise in health systems to examine the U.S. approach to end-of-life care. Connelly highlights how our current systems lead to an excessive focus on clinical intervention. He deftly blends personal experiences of patients and doctors with an in-depth discussion of the way we pay for health care. Conflicting economic incentives shape our country's costly approach to managing patient care and especially for those facing death. Connelly offers practical actionable advice for patients, families and policymakers.This is a unique book that I would highly recommend for my family, friends, students, and policymakers hoping to improve healthcare in the U.S.
When it comes to unpopular topics, death and dying rank right there with politics and religion. Yet, in The Journey's End, Michael Connelly shines a pragmatic light on this cultural taboo. He blends personal stories, a wealth of experience, and enlightened compassion to illuminate solutions to end of life issues. Michael mentored me for many years, and his passion on this topic is as authentic as it is compelling. This is a must read for anyone hoping to better understand end-of-life care.
5/22/23, Nashville Medical News: Author Michael Connelly wrote a piece featuring themes from the book.
6/6/23, MarketWatch: Michael Connelly is interviewed about the book.
6/19/23, Authority Magazine: Author Michael Connelly is interviewed about the five things we need to do to improve the US healthcare system.
7/28/23, Pharmacy Times: Michael Connelly was interviewed for a feature story highlighting key themes in the book.