Sooner or Later: Restoring Sanity to Your End-of-Life Care.
Article Type: Book review
Subject: Books (Book reviews)
Author: Anastas, Jeane W.
Pub Date: 04/01/2011
Publication: Name: Social Work Publisher: National Association of Social Workers Audience: Academic Format: Magazine/Journal Subject: Sociology and social work Copyright: COPYRIGHT 2011 National Association of Social Workers ISSN: 0037-8046
Issue: Date: April, 2011 Source Volume: 56 Source Issue: 2
Topic: NamedWork: Sooner or Later: Restoring Sanity to Your End-of-Life Care (Nonfiction work)
Persons: Reviewee: Iocovozzi, Damiano de Sano
Accession Number: 254311536
Full Text: Sooner or Later: Restoring Sanity to Your End-of-Life Care. Damiano de Sano Iocovozzi. Bloomington, IN: Transformation Media Books, 2009, 124pages. ISBN: 978-0-984-22586-6. $12.95 paperback.

In this slender volume, Damiano de Sano Iocovozzi, a nurse practitioner, draws on his years of experience to provide a self-help resource for individuals facing a terminal diagnosis or stage of illness and their caregivers. He provides useful lists of questions for patients and caregivers to consider and suggestions about what they should ask medical professionals regarding their prognosis and available options for treatment and care. Iocovozzi writes with compassion and conviction, integrating many case examples from his practice to illustrate his points.

Perhaps the most helpful aspect of the book is Iocovozzi's use of a typology of diseases to determine which end-of-life care options are most suitable. These are ACURE (acute, critical, unexpected, responsive, easily diagnosed and treated), for which heroic medical measures are very appropriate; COPE (chronic, outpatient, palliative, efficacious/treatable); and CARE (critical, active, recalcitrant, and "eventual" [by which he apparently means ultimately terminal]). Iocovozzi argues that, ethically, types of medical care offered should correspond to the stage or type of medical problem being addressed. This makes the provision of heroic methods of life support inappropriate for those individuals who have the CARE form of illness. In fact, it is to people with this form of illness that Iocovozzi's book is primarily addressed, although for many people it may actually be more difficult than it might seem to determine when an illness has progressed from the COPE to the CARE stage.

Iocovozzi's viewpoint is clear: He favors the use of advance directives that include "do not resuscitate" clauses. In support of this position, he realistically depicts what the treatment that follows resuscitation actually involves for patients in intensive care units and correctly notes how rarely such treatment results in significant improvement for people who are not expected to live much longer under any circumstances. Iocovozzi prefers the use of hospice care--either in home or institutional--to make the last days of life as comfortable and meaningful as possible for both patients and their families.

However, as Lewis Cohen (2010) has pointed out in his excellent new book No Good Deed: A Story of Medicine, Murder Accusations, and the Debate over How We Die, which describes the ethical and legal controversies in a recent case about palliative care, health care professionals can differ as sharply in their assessments of what constitutes the correct course of action as does the general public. Sooner or Later, therefore, will best be used when patients and their families have already decided not to take extraordinary measures to prolong life and are seeking, instead, the kind of encouragement and practical suggestions for arranging end-of-life care the way they want it to be that this book provides.


Cohen, L.W. (2010). No good deed: A story OF medicine, murder accusations, and the debate over how we die. New York: HarperCollins.

Jeane W.Anastas

New York University
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