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Finish Strong: Putting YOUR Priorities First at Life’s End
From the President Emerita/Senior of Compassion & Choices, THE guide to achieving the positive end-of-life experience you want and deserve.It’s hard to talk about death in America. But even though the topic has been taboo, life’s end is an eventual reality. So why not shape it to our values? FINISH STRONG is for those of us who want an end-of-life experience to match the life we’ve enjoyed. We know we should prepare, but are unsure how to think and talk about it, how to live true to our values and priorities, and how to make our wishes stick.The usual advice about advance directives and conversations is important but woefully inadequate. This book describes concrete action in the here and now to help live our best lives to the end. FINISH STRONG will guide you • Finding a partner-doctor to honor your values and beliefs with humanity, deference and candor.• Identifying what matters most as vigor wanes and stating your priorities.• Having meaningful conversations with doctors and family about expectations and wishes.• Staying off the “overtreatment conveyor belt.”• Knowing when “slow medicine” is the best option to maintain quality of life.• Navigating home hospice, the ultimate healing experience. Written with candor and clarity by a nurse, physician assistant and attorney who became a leading advocate for end-of-life options, this book can help you FINISH InvitationTalking About Death Won't Kill You (But It Could Improve Your Life)Overtreatment and Diminishing ReturnsLet Me Die Like a DoctorHope & The Healing OptionThe Secret of Slow MedicineEscaping DementiaInside a Growing AdvocacyPeople Taking ControlSpace for the SacredIt's Harder Than You Think (But You Can Do It) Tools to Take Charge
- GenresNonfictionSelf HelpDeath
294 pages, Paperback
Published December 14, 2018
129 people are currently reading
197 people want to read
About the author
Barbara Coombs Lee
3 books4 followersAbout the new second edition
Finish Strong is for you, the healthcare consumer. It covers the tough issues around aging and dying other books shy away from.
This book was a long time in the making—a lifetime actually. It offers some of the fruits of my labors in medicine and healthcare advocacy. If you count the years I volunteered as a candy striper under the stern tutelage of the nursing nuns at St. Joseph Hospital in Joliet, Illinois, I’ve worked in healthcare almost fifty-five years. Dozens of clinical settings and assignments, countless patient encounters, years of advocacy in courtrooms and statehouses, decades of observation and experience—those are the seeds of the fruits borne by these pages.
In 2022, in creating the second edition of Finish Strong (https://www.amazon.com/dp/1732774463), I added a new chapter, “Race and Culture Matter.” It discusses the cultural differences, racial biases and institutional barriers that impact what the medical system offers people of diverse backgrounds, and the choices they make. My hope is that being aware of the cultural traditions and racial biases impacting healthcare can help people make choices that transcend those and reflect true, individual priorities at life’s end.
I dearly hope the stories, commentary and tips in Finish Strong will have a positive influence on your life and your healthcare choices.
Finish Strong is for you, the healthcare consumer. It covers the tough issues around aging and dying other books shy away from.
This book was a long time in the making—a lifetime actually. It offers some of the fruits of my labors in medicine and healthcare advocacy. If you count the years I volunteered as a candy striper under the stern tutelage of the nursing nuns at St. Joseph Hospital in Joliet, Illinois, I’ve worked in healthcare almost fifty-five years. Dozens of clinical settings and assignments, countless patient encounters, years of advocacy in courtrooms and statehouses, decades of observation and experience—those are the seeds of the fruits borne by these pages.
In 2022, in creating the second edition of Finish Strong (https://www.amazon.com/dp/1732774463), I added a new chapter, “Race and Culture Matter.” It discusses the cultural differences, racial biases and institutional barriers that impact what the medical system offers people of diverse backgrounds, and the choices they make. My hope is that being aware of the cultural traditions and racial biases impacting healthcare can help people make choices that transcend those and reflect true, individual priorities at life’s end.
I dearly hope the stories, commentary and tips in Finish Strong will have a positive influence on your life and your healthcare choices.
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Displaying 1 - 23 of 23 reviews
July 9, 2024
The author is the President of the organization Compassion & Choices which deal with end-of-life issues, promoting patient-driven values oriented choices about dying.
A number of us in my f2f bookclub has had to deal with elderly parents or siblings that have died over the past few years and did not necessarily have a good experience in the health care system during the dying process. In an effort to be more proactive in the future they chose this for a monthly read. I wasn't ready to read it at the time, my emotions too raw. Although I still cried reading many of the stories in the book. I was ready.
Ms. Lee gives a brief synopsis of how she got here & what experiences formed her beliefs about end-of-life care and then subsequent chapters are chock full of tools, specific verbiage, resources & anecdotes to address the various issues. The most mainstream now are advanced directives & hospice, the most controversial is medical aid in dying.
I found chap two particularly interesting: how to go about finding a doctor that has the same values as you regarding end-of-life, so that you can be assured of their support with your advanced directives. Someone who believes the patient is in charge of their care & that there is shared decision making. I think this is easier said than done, but she does give specifics on how to start the conversation, and follow-through with developing one's specific advanced directive.
Chap 8: Escaping Dementia - valuable advice about supplementing a traditional advanced directive with specifics on this issue, including making a video supplement.
Chap 11: A Place for the Sacred - aligning one's religious beliefs & traditions with end-of-life desires, using to one's religious traditions, rites etc to elevate the dying process to a spiritual experience.
Other chapters are entitled: Overtreatment & Diminishing Returns, Let me die like a Doctor, Hope & Heroism, Hospice, The Secret of Slow Medicine, and People Taking Control.
Overall a terrific resource for a difficult subject & that gives one an actionable item list.
A number of us in my f2f bookclub has had to deal with elderly parents or siblings that have died over the past few years and did not necessarily have a good experience in the health care system during the dying process. In an effort to be more proactive in the future they chose this for a monthly read. I wasn't ready to read it at the time, my emotions too raw. Although I still cried reading many of the stories in the book. I was ready.
Ms. Lee gives a brief synopsis of how she got here & what experiences formed her beliefs about end-of-life care and then subsequent chapters are chock full of tools, specific verbiage, resources & anecdotes to address the various issues. The most mainstream now are advanced directives & hospice, the most controversial is medical aid in dying.
I found chap two particularly interesting: how to go about finding a doctor that has the same values as you regarding end-of-life, so that you can be assured of their support with your advanced directives. Someone who believes the patient is in charge of their care & that there is shared decision making. I think this is easier said than done, but she does give specifics on how to start the conversation, and follow-through with developing one's specific advanced directive.
Chap 8: Escaping Dementia - valuable advice about supplementing a traditional advanced directive with specifics on this issue, including making a video supplement.
Chap 11: A Place for the Sacred - aligning one's religious beliefs & traditions with end-of-life desires, using to one's religious traditions, rites etc to elevate the dying process to a spiritual experience.
Other chapters are entitled: Overtreatment & Diminishing Returns, Let me die like a Doctor, Hope & Heroism, Hospice, The Secret of Slow Medicine, and People Taking Control.
Overall a terrific resource for a difficult subject & that gives one an actionable item list.
March 7, 2022
Talking about death won’t kill you, but it could improve your life (end-of-life in particular). The preceding provides a succinct explanation of why reading this book may be good for you. This book’s purpose is to provide the knowledge and perhaps needed motivation for making informed end of life decisions.
Modern medicine has been a blessing for many and has successfully prolonged average life spans. But everyone eventually faces death, and it is at those times when the treatments, tests, and procedures available from modern medicine yields diminishing returns. Yet in spite of these diminishing returns many doctors will simply urge additional treatment. Some American States have laws that require doctors to inform their patients about the option of palliative care when the prognosis of death is within six months, but even in these States many patients are not so informed.
The primary focus of this book is on informed decision making. In most cases this will involve withholding additional treatment that has no realistic chance of offering a cure or remission but does bring with it a high probability of causing pain and discomfort. Fortunately there has been advances and increased acceptance in recent years of hospice and palliative care for end of life situations.
This book also includes information about physician-assisted suicide. There is a whole chapter about the history of efforts to legalize assisted suicide. This history unfortunately includes stories of persistent opposition to these laws. But those motivated to promote theses legal changes were also persistent, and there are now ten States that have made provisions for it.
This book also discusses availability of palliative sedation as part of comfort care in protecting a dying patient from pain which sometimes can speed up the process of dying. This book does not try to say what the right decisions are, but rather makes the case for patient centered care. The patient deserves to be informed of the choices available, and their decisions should be honored and followed.
This book is filled this many stories of both good and bad experiences of patients facing end of life decisions. These stories are a reminder that it’s not easy to assure that one’s wishes will be followed.
Modern medicine has been a blessing for many and has successfully prolonged average life spans. But everyone eventually faces death, and it is at those times when the treatments, tests, and procedures available from modern medicine yields diminishing returns. Yet in spite of these diminishing returns many doctors will simply urge additional treatment. Some American States have laws that require doctors to inform their patients about the option of palliative care when the prognosis of death is within six months, but even in these States many patients are not so informed.
The primary focus of this book is on informed decision making. In most cases this will involve withholding additional treatment that has no realistic chance of offering a cure or remission but does bring with it a high probability of causing pain and discomfort. Fortunately there has been advances and increased acceptance in recent years of hospice and palliative care for end of life situations.
This book also includes information about physician-assisted suicide. There is a whole chapter about the history of efforts to legalize assisted suicide. This history unfortunately includes stories of persistent opposition to these laws. But those motivated to promote theses legal changes were also persistent, and there are now ten States that have made provisions for it.
This book also discusses availability of palliative sedation as part of comfort care in protecting a dying patient from pain which sometimes can speed up the process of dying. This book does not try to say what the right decisions are, but rather makes the case for patient centered care. The patient deserves to be informed of the choices available, and their decisions should be honored and followed.
This book is filled this many stories of both good and bad experiences of patients facing end of life decisions. These stories are a reminder that it’s not easy to assure that one’s wishes will be followed.
Once scenarios like these are in full swing, little can be done to avert needless suffering and mitigate the damage. The key to avoiding such situations in our own lives is to be aware of the looming threat they pose and strengthen the decision-making muscles that will deflect them. Science is on your side. The Institute of Medicine, the American Society of Clinical Oncology, and numerous other researchers and authorities agree that relentless medical aggression hurts patients. It imposes needless suffering on the dying. It is unlikely to extend life and may even shorten it.
Unbelievably, twenty years and hundreds of millions of dollars in medical education and palliative care initiatives have had little impact on such heedless intensive intervention. One in four patients who enter the ICU with documented DNR orders get last-ditch treatments even the professional oncology society recognizes as harmful. And three in four younger cancer patients with a documented preference for comfort care get at least one aggressive intervention during their last month of life. (p.253)
January 29, 2019
I am recommending this to friends and family. Finish Strong is well written, full of anecdotes and germane information, and pulls no punches about what we may face toward the end of life and why it's in our interests to plan for it. Also, unlike other modern-medicine books written from the first-person POV of an ill person or the child of an ill person, or the lofty views of a physician diagnosing a sick American medical system, Barbara Coombs Lee focuses on writing directly to and for us, whom she calls the “healthcare consumer.”
The info Coombs Lee shares is useful for anyone facing tests or treatments—and that seems to be all of us, eventually. She talks candidly about the “overtreatment conveyor belt” that doctors and family members may mistakenly push us towards, and how to avoid it. She writes about the limitations of all those advance directives forms we dutifully fill out, and how to make our wishes stick when a crisis does happen. She discusses how to interview your often-intimidating doctors before agreeing to their tests and treatments to make sure they will be a partner in honoring your values and beliefs (not theirs), with humanity, deference, and candor. She explains complex topics like “slow medicine,” the distinction between palliative care and hospice, and how to escape dementia (now there’s a tough but vital topic). Best of all, for me, Coombs Lee brings up topics I was leery of asking about or didn’t even know about.
Finish Strong doesn’t presume to know or influence an individual’s story. It doesn’t recommend particular values and priorities, but it does reveal how to discover these for yourself and put them to work in talking with doctors and choosing a course of medical treatment. Coombs Lee shares the questions to ask, the things to consider and the alternatives to weigh. Very helpful.
The info Coombs Lee shares is useful for anyone facing tests or treatments—and that seems to be all of us, eventually. She talks candidly about the “overtreatment conveyor belt” that doctors and family members may mistakenly push us towards, and how to avoid it. She writes about the limitations of all those advance directives forms we dutifully fill out, and how to make our wishes stick when a crisis does happen. She discusses how to interview your often-intimidating doctors before agreeing to their tests and treatments to make sure they will be a partner in honoring your values and beliefs (not theirs), with humanity, deference, and candor. She explains complex topics like “slow medicine,” the distinction between palliative care and hospice, and how to escape dementia (now there’s a tough but vital topic). Best of all, for me, Coombs Lee brings up topics I was leery of asking about or didn’t even know about.
Finish Strong doesn’t presume to know or influence an individual’s story. It doesn’t recommend particular values and priorities, but it does reveal how to discover these for yourself and put them to work in talking with doctors and choosing a course of medical treatment. Coombs Lee shares the questions to ask, the things to consider and the alternatives to weigh. Very helpful.
May 21, 2025
Recommended by Maggie in 2nd session of the "Leaning into Hard Decisions" series at Friendsview Retirement Community.
Favorite quotes:
"...I also came to see that the field of medicine had a role to play in removing death's sting. It would have to alleviate people's fear of suffering during the dying process. It would have to renounce its habit of aggressive and futile interventions that so often add torture to the experience of dying. After twenty-five years in the medical field, I was spurred by the profound injustices dying patients were forced to endure. I wondered how society might make a transition to less fearsome dying and more compassionate living." p 5
All of Chapter 2: "Talking about Death Won't Kill You (but it Could Improve Your Life) pp 21-50
"Today's appointments tend to be brisk, business-like and bent on efficiency. Several oft-cited studies issued since the 1980s bring the stunning news that American patients usually have between 12 and 18 seconds to tell their doctor what brought them to the appointment before the doctor interrupts them." p 53
"Twenty years ago, Dr. David Pisetsky wrote about what he often felt when families asked that he and his team 'do everything' to prevent the impending death of their loved one. Fully aware of the futility of medical interventions at such a time, he wrote, 'I would like to say, "Family, only you can do everything. Only you can talk of your love and give kisses before the skin is cold. Only you can talk of the future and of dreams to be fulfilled. Only you can talk of the past when life was resplendent because time seemed infinite.
""Family, only you can oppose the flow of time and enjoy one last day together. Only you can give peace and sustenance for the next journey. Family, only you can do everything. I am only a physician. I can do nothing at all."" p 58
"My own empiric evidence confirms that there is truth to the suspicion that in order to navigate our health system successfully, without ending up in the cycle of overtreatment, it helps to be either a doctor or nurse, be lucky enough to have married one or to have a healthcare proxy who is one." p 71
Favorite quotes:
"...I also came to see that the field of medicine had a role to play in removing death's sting. It would have to alleviate people's fear of suffering during the dying process. It would have to renounce its habit of aggressive and futile interventions that so often add torture to the experience of dying. After twenty-five years in the medical field, I was spurred by the profound injustices dying patients were forced to endure. I wondered how society might make a transition to less fearsome dying and more compassionate living." p 5
All of Chapter 2: "Talking about Death Won't Kill You (but it Could Improve Your Life) pp 21-50
"Today's appointments tend to be brisk, business-like and bent on efficiency. Several oft-cited studies issued since the 1980s bring the stunning news that American patients usually have between 12 and 18 seconds to tell their doctor what brought them to the appointment before the doctor interrupts them." p 53
"Twenty years ago, Dr. David Pisetsky wrote about what he often felt when families asked that he and his team 'do everything' to prevent the impending death of their loved one. Fully aware of the futility of medical interventions at such a time, he wrote, 'I would like to say, "Family, only you can do everything. Only you can talk of your love and give kisses before the skin is cold. Only you can talk of the future and of dreams to be fulfilled. Only you can talk of the past when life was resplendent because time seemed infinite.
""Family, only you can oppose the flow of time and enjoy one last day together. Only you can give peace and sustenance for the next journey. Family, only you can do everything. I am only a physician. I can do nothing at all."" p 58
"My own empiric evidence confirms that there is truth to the suspicion that in order to navigate our health system successfully, without ending up in the cycle of overtreatment, it helps to be either a doctor or nurse, be lucky enough to have married one or to have a healthcare proxy who is one." p 71
December 29, 2020
A thought-provoking presentation about identifying, and communicating, what medical assistance you want under various scenanrios. The author emphasizes that even in the states that (unlike Colorado, Washington, Vermont, California, Oregon, a few others) that have not enacted legislation permitting individuals to choose quality of life over quantity, there are still choices and decisions to be made; and that simply filling out the Living Will and Medical POA forms will (may) not give effect to your wishes.
And eye-opening discussion, with questions to ask and checklists in boxes in each chapter, this book is a conversation-starter and an eye-opener - and maybe should be read by everyone......!!
Because how many of us avoid discussing death....
And eye-opening discussion, with questions to ask and checklists in boxes in each chapter, this book is a conversation-starter and an eye-opener - and maybe should be read by everyone......!!
Because how many of us avoid discussing death....
October 12, 2022
This non-fiction is so special to me that I'm buying my own copy.
It is about one's priorities at life's end. Some 50+ years ago my Mom and I discussed how she wanted to die: at her own time and in her own way. I agreed wholeheartedly. It didn't happen that way. But that's another story.
Now, with this book, I have a good chance to die on my own terms. Though the main focus of the medical aid-in-dying movement is for terminal illness with a six-months to die diagnosis, Alzheimer's and its related illnesses are fatal but cannot be given the six-month end, it is a definite part of how you want to die.
I have been a supporter of Compassion & Choices for several decades.
If anyone who reads this wants to talk, please conact me.
It is about one's priorities at life's end. Some 50+ years ago my Mom and I discussed how she wanted to die: at her own time and in her own way. I agreed wholeheartedly. It didn't happen that way. But that's another story.
Now, with this book, I have a good chance to die on my own terms. Though the main focus of the medical aid-in-dying movement is for terminal illness with a six-months to die diagnosis, Alzheimer's and its related illnesses are fatal but cannot be given the six-month end, it is a definite part of how you want to die.
I have been a supporter of Compassion & Choices for several decades.
If anyone who reads this wants to talk, please conact me.
January 8, 2020
Very important read for anyone who wants to be sure THEY are in charge of their final days - no matter what age you are! Written by the past director of Compassion and Choices, she has nursing, medical (PA), and legal degrees, and years of experience working with people who suffered needlessly, and many who managed to avoid that. Just because you have some paper work and/or have talked your wishes over with some family - it's not enough. You have to plan and document and communicate with everyone, and make sure everyone on your team, including doctors and care facilities, are board with your choices.
The book is a bit repetitive, but the information contained here is invaluable!
The book is a bit repetitive, but the information contained here is invaluable!
August 6, 2023
The book, authored by one of the people who helped author the Death With Dignity legislation here in Oregon, motivated me to review and update my AdvanceDirectives, think about when I would like to have the medical system stop trying to help me survive, should I have dementia, and attend to other end of life concerns "in Advance". It pointed me to the website Compassion and Choices, which is a wealth of information about Advance Directives and Medical Aid in Dying, for people in all of the states in the USA.
October 23, 2019
Insightful, practical, thought-provoking
Appreciate the clear, non-medical language about the topics of navigating through healthcare, patient-agency, and the Western culture shifts occurring now in the States as well.
I have more to do in order to learn to ask better questions and to also consider my own boundaries and vision for what might constitute my own best quality of life.
Appreciate the clear, non-medical language about the topics of navigating through healthcare, patient-agency, and the Western culture shifts occurring now in the States as well.
I have more to do in order to learn to ask better questions and to also consider my own boundaries and vision for what might constitute my own best quality of life.
March 5, 2021
This book has excellent info for anyone who is facing death or is close to someone in that situation.
Even if death may be many years away, I still recommend this book. It has quite a lot of practical advice and the author also has a website affiliated with the book for more info on how to avoid overtreatment.
Even if death may be many years away, I still recommend this book. It has quite a lot of practical advice and the author also has a website affiliated with the book for more info on how to avoid overtreatment.
April 6, 2022
Comprehensive and compassionate review of the current choices we have in departing our life here. I found the stories surrounding this issue most helpful as I think about reality of my end of life days in the future. The book describes concrete action in the here and now to help live our best life's to the end.
August 26, 2020
Death is most often a difficult topic particularly with the emphasis on youth. This book addresses and encourages us to have the hard conversations so that we have more power and control regarding how we die.
February 4, 2022
Many compelling stories around bringing the issue of death with dignity to the table. Delves into the reasons it's been opposed politically and for religious reasons. Certainly another testimony to not leaving things to chance and having a plan.
July 22, 2020
Repetitious
This book size should be cut in half. Too many stories and not enough direction as to specific ways to get the medical professions attention.
This book size should be cut in half. Too many stories and not enough direction as to specific ways to get the medical professions attention.
November 15, 2020
Great information and instructions about how to make sure that the end of your life progresses as you want it to.
January 3, 2021
Barbara Coombs Lee has produced a solid guide to planning for a good death, whatever a good death looks like to you. I plan to add the dementia rider to my existing paperwork
March 31, 2021
Barbara Coombs Lee’s book is one I will need to purchase and keep for reference. So many good points to consider and keep in mind.
April 27, 2021
good guide to determine and put in place your wishes for end of life
August 23, 2021
This one completes the trifecta of needed books in this area. Being Mortal, Elderhood and Finish Strong are all important reads for this topic and only slightly overlap.
February 1, 2022
What we need most from our family and friends is the promise to help us finish strong and go gently.
May 10, 2022
I'm 75. This book is very important reading. I want to have some control over my dying. This book is a guide. I recommend it highly
August 22, 2025
Repetitive, but better than other books I’ve read on this topic. Helps that the author is both a one-time nurse and law school graduate.
February 22, 2022
Barbara's book is a wonderful asset for planning as we age.
Displaying 1 - 23 of 23 reviews