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Knocking on Heaven's Door

Knocking on Heaven's Door

The Path to a Better Way of Death

  • reading group guide
In this visionary memoir, based on a groundbreaking New York Times Magazine story, award-winning journalist Katy Butler ponders her parents’ desires for “Good Deaths” and the forces within medicine that stood in the way.

Katy Butler was living thousands of miles from her vigorous and self-reliant parents when the call came: a crippling stroke had left her proud seventy-nine-year-old father unable to fasten a belt or complete a sentence. Tragedy at first drew the family closer: her mother devoted herself to caregiving, and Butler joined the twenty-four million Americans helping shepherd parents through their final declines.

Then doctors outfitted her father with a pacemaker, keeping his heart going but doing nothing to prevent his six-year slide into dementia, near-blindness, and misery. When he told his exhausted wife, “I’m living too long,” mother and daughter were forced to confront a series of wrenching moral questions. When does death stop being a curse and become a blessing? Where is the line between saving a life and prolonging a dying? When do you say to a doctor, “Let my loved one go?”

When doctors refused to disable the pacemaker, condemning her father to a prolonged and agonizing death, Butler set out to understand why. Her quest had barely begun when her mother took another path. Faced with her own grave illness, she rebelled against her doctors, refused open-heart surgery, and met death head-on.

With a reporter’s skill and a daughter’s love, Butler explores what happens when our terror of death collides with the technological imperatives of medicine. Her provocative thesis is that modern medicine, in its pursuit of maximum longevity, often creates more suffering than it prevents.

This revolutionary blend of memoir and investigative reporting lays bare the tangled web of technology, medicine, and commerce that dying has become. And it chronicles the rise of Slow Medicine, a new movement trying to reclaim the “Good Deaths” our ancestors prized.

Knocking on Heaven’s Door is a map through the labyrinth of a broken medical system. It will inspire the difficult conversations we need to have with loved ones as it illuminates the path to a better way of death.
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  • Simon & Schuster Audio | 
  • ISBN 9781442366244 | 
  • September 2013
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Stages of Death

Katy Butler, author of Knocking on Heaven’s Door: The Path to a Better Way of Death, describes the 5 stages of death in the elderly, and how to be their best support.

Read an Excerpt

Knocking on Heaven’s Door PROLOGUE
On an autumn day in 2007, while I was visiting from California, my mother made a request I both dreaded and longed to fulfill. She’d just poured me a cup of tea from her Japanese teapot shaped like a little pumpkin; beyond the kitchen window, two cardinals splashed in her birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. She put a hand on my arm. “Please help me get your father’s pacemaker turned off,” she said. I... see more

Hear an Excerpt

Reading Group Guide

This reading group guide for Knocking on Heaven’s Door includes questions to enhance your discussion of the book as literature, as well as suggestions that may help you open difficult conversations with friends and relatives who are near the end of life.



Topics & Questions for Discussion

1. Where do you draw the line between saving a life and prolonging a dying? Has your family included a member who “lived too long”? Do you think it is okay to “let nature take its course”? How do you distinguish that from suicide?

2. How did you feel about Valerie Butler’s choice? Was it brave, or not? Do you think it caused her children more or less suffering than her husband’s death? What were the blessings and drawbacks of her unexpectedly rapid death? What were the advantages and disadvantages of her husband’s protracted death, from the point of view of his survivors?

3. Butler writes, “I don’t like describing what the thousand shocks of late old age were doing to my father—and indirectly to my mother—without telling you first that my parents loved each other and I loved them” (p. 2). In this passage she drops her journalistic point of view and turns directly to the reader, using the word “love.” Discuss Butler’s relationship to each of her parents and their relationship with each other. How does each change througho see more

About the Author

Katy Butler
Photograph by Cristina Taccone

Katy Butler

Katy Butler’s articles have appeared in The New York Times Magazine,The Best American Science Writing, and The Best American Essays. A finalist for a National Magazine Award, she lives in Northern California.

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