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Book Summary

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.

Accordingly, The Journey’s End seeks to help people manage their healthcare, their expectations, and their decisions in the final phase of life.


When Michael Connelly asked me to write the foreword to this book, I privately thought, “Wow, does the world need another book on death and dying?” However, since I have known Michael for nearly thirty years and am one of his biggest fans, I thought, “Well let me do a deep dive here and see what happens.” I am so glad that I followed my instincts.

In the United States, we believe that death is an option—and have foolishly poured untold resources, time, and energy into futile attempts at preventing death. Sadly, this has resulted in a terrible set of circumstances.

Fortunately, The Journey’s End is the best single treatise on under- standing this conundrum I have ever read. It offers a roadmap for our society to provide better and more humane care at the end of life. I am not surprised that Michael Connelly, a prominent national leader and past chair of numerous national and international boards in healthcare, was able to cut through the complexity and controversy surrounding this crucial topic.

I have always found the language of death objectionable. Our culture praises as heroes those who choose to fight death to their last breath while consuming expensive, futile treatments. What nonsense! Does this mean that others who accept their fate of dying without resorting to expensive care are not equally as brave? Michael confronts this contradiction.

This book expertly weaves heartfelt advice with serious scholarship. It references nearly every major book on death and dying and even in-corporates primary sources such as the famous stoic philosopher Seneca.

I was particularly enamored by the four phases of elderhood, going from awareness to the consequences of our health choices, to intentionality, to action. This reminds me of the young Elizabeth Kübler-Ross decades ago laying out the four stages of coming to grips with death. Importantly, The Journey’s End brings a much-needed, fresh perspective to this ancient problem.

Much like this book, I’ve long argued that fee-for-service medicine is the root of all evil in the health system. It needs to go, and this author has a sound plan for its demise.

Clinically it is my experience that many of my colleagues feel obligated to do everything to forestall death, often resulting in the un-intentional torture of the patient and the involved family. I have seen this so many times at the bedside in both the critical care unit and in the general patient wards of Jefferson Health, a place that has been my academic home for more than three decades.

Michael’s timing for this book is excellent. Our great country has suffered a million deaths from COVID-19, the largest per capita death rate of any developed nation in the world. The COVID-19 pandemic shined a brighter light on all of these challenges and demonstrated that no one is immune to the death trap. Indeed, many of these early deaths were in communities of color and among people with limited resources
and dwindling economic means.

We are facing skyrocketing inflation and the potential for a bankrupt Medicare trust fund as early as 2026. At the same time, we are figuratively teetering on the precipice as our system of delivering healthcare services begins to collapse under its own weight. In my view, COVID-19 should accelerate our embrace of the prescriptions for healthcare reform in The Journey’s End."


David B. Nash, MD, MBA


"[A] new healthcare book worth reading...The Journey’s End: An Investigation of Death and Dying in Modern America, by Michael Connelly with a forward by David B. Nash, MD, MBA. Thank you to Donald E. Casey, Jr., MD, MPH, MBA, MACP, FAHA for providing. This outstanding work. I give tremendous credit to...Michael Connelly for [his] remarkable leadership and efforts." - Scott Becker, Partner, McGuireWoods, Publisher, Becker's Healthcare

"'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...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." - Booklist

"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." - Publisher's Weekly

"This book expertly weaves heartfelt advice with serious scholarship. It references nearly every major book on death and dying and even incorporates primary sources...Importantly, 'The Journey’s End' brings a much-needed, fresh perspective..." - David B. Nash, MD, MBA

"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." - David C. Leach, MD, Former Executive Director, Accreditation Council for Graduate Medical Education

"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." - Justin Sydnor, PhD, Professor of Risk and Insurance, Wisconsin School of Business, University of Wisconsin, Madison

“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...This is a must read for anyone hoping to better understand end-of-life care.” - John M. Starcher, Jr., CEO, Bon Secours Mercy Health

"Michael Connelly's 'The Journey's End' is a highly engaging and insightful guide for both ourselves and our loved ones on how we ought to face death with dignity. Through his many years of experience and expertise as a successful health system CEO and national thought leader, Connelly shares his many insights on the current shortcomings of the American health care delivery system, which has fallen "woefully short' in providing effective palliative and hospice care to patients. We are offered alternative reflections on how we should, in the words of Roman Stoic Philosopher Seneca, 'live life fearlessly, then make peace with the fact that death is ever present.'


"In this regard, being fearless means being intentional about how to make use of our own extended life while preparing ourselves for death instead of fighting it. 'The Journey's End' provides detailed case studies that include stories of individuals dealing with difficult end-of-life decisions in the face of advanced illness to help illustrate these important challenges. In addition, many national experts in the field, such as Ezekiel Emmanuel, David Nash, Atul Gawande, David Leach, and Betsy McCaughey, are cited on topics such as the ethics and economics of end-of-life care.


"Connelly also presents well-crafted (and much needed) policy recommendations for improving palliative and end-of-life care, with special emphasis on the urgent need to fix the current health care payment systems that are destroying the fundamental physician-patient relationship. These recommendations are then summarized in an Appendix, which includes seven very practical personal preparation suggestions for end-of-life care. For those wishing to dig deeper into this important topic, there is an extensive list of excellent references as well as a comprehensive bibliography.


"Ultimately, 'The Journey's End' leaves us all with a much deeper understanding of a new path forward through an elegant model of patient and caregiver support and comfort that gives more meaning to life when facing death. This book is well worth the read and certainly deserves a special place on your bookshelf for future reference."


- Donald E. Casey Jr, MD, MPH, MBA, Thomas Jefferson University, College of Population Health, Review for American College of Medical Quality

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