1. Roger S. Magnusson

Angels of Death: Exploring the Euthanasia Underground

(New Haven, CT: Yale University Press, 2002)       325 pages
(ISBN: 0-300-09436-6; hardcover)
(Library of Congress call number: R726.M276 2002)

    This book explores all the dynamics of helping victims of AIDS to die.
The research took place in Australia and San Francisco, California, USA.
But the experiences of these doctors, nurses, social workers, & other friends
can easily apply to the situations of any patients
who need aid and support in the process of dying.

    Once we understand that aid-in-dying is already taking place,
we should be willing to make the process more honest and open.
What is now an underground practice—with no public safeguards—
can in future decades become a reasonable and orderly process,
which can be endorsed by almost everyone
who thinks carefully and deeply about how best to die.

    Extreme opponents of the right-to-die want to prohibit
any action that might hasten death.
Extreme advocates of the right-to-die want no regulations at all:
Let the patient decide.  
Problems are created by both of these extremes.
Perhaps a rational middle ground can be created.
Exploring what is actually happening now
should empower us to create wise and compassionate ways
of helping patients who have good reasons to die.

    Doctors and nurses often conspire to help patients to die,
sometimes with the cooperation and help
of friends and relatives of the patients.
Because all of the cases discussed in this book
were people dying of AIDS, secrecy was not difficult to achieve.
The gay-and-lesbian communities where these deaths occurred
were close-knit and therefore easily able to cover their tracks.
The deaths were all recorded as having occurred from natural causes
—almost always from complications of AIDS.  

    However, the necessity for secrecy meant that
no public safeguards were applied to these deaths.
The doctors or nurses were acting alone,
without consulting anyone else.

    Giving excessive amounts of pain-killing drugs
is one of the most common methods of helping the patients to die.  
Another method is turning off life-supports (without authorization).

    Secrecy means that there is no paper-trail
that would show that anything out of the ordinary occurred.
Because their chosen forms of merciful death were still not legal,
these 'angels of death' needed to operate in secret.

    A system of public safeguards could have achieved the same end
with much less stress and danger for the helpers.
It would have taken a few days longer
to approve a voluntary death or a merciful death.
Under a system of careful public safeguards,
the process of planning for death
could have begun days or even weeks earlier.  
And everyone concerned could have been consulted.  

    This book proposes no safeguards for assisting others to die,
but here is a discussion of 15 proposed safeguards for life-ending decisions:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-10SG.html
In the opinion of this reviewer,
almost all of the cases discussed in this book
could have fulfilled these 15 safeguards.
And doubtful cases would have been clarified by using such safeguards.

    Doctors are divided concerning the right-to-die.
But the general public is more favorable.
And AIDS victims are overwhelmingly in favor
of the right-to-die for themselves
if their medical conditions become hopeless.

    Usually the AIDS patients are the first to mention voluntary death,
but sometimes, the option of choosing painless pathways
towards death is first mentioned by the care-givers.

    The fact that the patients are dying of AIDS
sometimes creates family chaos
because the other members of the family-of-origin
are learning for the first time that their son or brother is gay.  
It might be too difficult to ask the family to deal with
both homosexuality and death at the same time.

    Terminal sedation is one medical alternative to the more controversial
voluntary death with assistance or merciful death.
In terminal sedation the physician prescribes enough pain-killers
to keep the patient unconscious until death occurs by natural causes.
(The drugs might suppress breathing, shortening the process of dying.)
This method protects the doctor, hospital,
& anyone else involved in the life-ending decision
because no laws have been broken.
But terminal sedation takes away
the autonomy of the patient for the last few days,
since an unconscious patient can make no decisions.

    However—here back to this reviewer's opinion—
all the applicable safeguards for life-ending decisions
could be fulfilled before the terminal sedation begins.
Then it would be a voluntary death or a merciful death.

    Doctors and nurses sometimes refer to a "tacit understanding"
about the effects of increasing the sedation.  
The care-givers believe that the patient and the family understand
that the medication being given will shorten the process of dying.
But no one wants to say out loud:
"This is the final dose."
or "This medication will bring death."
When the right-to-die is openly affirmed by all,
then no such unspoken decisions need be taken.  

    Some palliative-care nurses interviewed for this book
admit to using 'left over' morphine to bring death.
Whenever morphine is used, the dose ordered by the doctor
might be less than the full amount in the ampoule.
Whenever some morphine is not needed for this patient,
the nurse is supposed to destroy the excess—witnessed by another nurse.
But they can easily agree not to destroy the excess
(and to create a false record of discarding the unneeded morphine)
so that they can use the excess morphine later for a merciful death.

    Some doctors interviewed always refuse requests for death.
They do not want to violate the laws as written.  
But they call for changes in the laws
that would permit more rational decisions about end-of-life care,
including the possibility of choosing an earlier death
when the only other alternatives is lingering suffering.  
Doctors do need to protect themselves,
so they can continue to care for other patients
instead of languishing in jail because they helped a patient to die.  

    At the other end of the spectrum, there are doctors and nurses
who readily cooperate with requests for death.
They admitted to the author
that they had assisted in dozens of voluntary deaths.
But these care-givers would also like to see changes in the laws
so that the process of making such life-ending decisions
could be more transparent.  
Fulfilling public safeguards would prevent
some abuses and mistakes that probably now occur.
But until the laws are changed,
these compassionate care-givers will continue
their secret and informal assistance in the process of dying.

    There are a few doctors in the 'euthanasia underground'
who resist the creation of public safeguards for life-ending decisions.
These doctors believe they have enough experience of attending deaths
so that they can decide the most appropriate pathway towards death
without any input from others.
They make life-and-death decisions every day.
Why bring in other doctors to second-guess their choices?
The doctor already knows everything
about the physical condition of the patient
and has already chosen the wisest course.
Why call for a psychiatrist?
The doctor already knows that the patient is perfectly sane.
Why involve the family in a very-traumatic decision for death?
The doctor knows best and can take the burden of choice upon himself.

    These free-lance 'angels of death' do not want more regulation.
They do not want to see the creation of a bureau of death-decisions.
Legalizing what they now do in secret
would only create more paperwork and use up valuable time
that could be devoted to caring for more patients.  
These agents of death want to rely on
common sense and their professional judgments.

    Legalizing voluntary death and merciful death
could either make life-ending decisions too easy or too difficult.

    The process could become too easy if a panel of experts
routinely approved all requests for voluntary death or merciful death.
Then some doctors would be tempted to dispose of difficult cases
by applying for approval for death rather than working against long odds.  

    The process could become too difficult
if a new system created a large bureaucracy of professionals
who had to become familiar with all the facts of each case
before approving a voluntary death or a merciful death.
If the process became too difficult and time-consuming,
some doctors and nurses would continue
to help their patients to die without consulting the bureaucrats.

    Almost all of the 'angels of death' interviewed for this book
had second thoughts about the process of helping others to die.
They wondered whether some other treatment might have been tried.
They worry about being caught in illegal or unethical behavior.
They wonder whether their religious beliefs support their actions.

    This reviewer points out once again,
that if there were open public safeguards for life-ending decisions,
then many more people would have been involved
in making or supporting these end-of-life choices,
which are now taken in secret by only a few people
acting alone and acting outside the law.

    The author did uncover some poor medical practices:
(1) Prescribing death-pills without ever seeing the patient.
(2) People willing to help with death
who were completely unknown to the patient before the request for death.
This made it a kind of dial-a-death service,
like ordering a pizza on the telephone.
(3) Doctors and nurses who were tired
and just wanted to "get it over with" so they could go home.
(4) Some care-givers were too casual about helping people to die.
They were willing to agree with any request,
without checking to see how wise it was for this patient.
(5) In one case, the doctor sent the family away
and ordered termination sedation—without consulting anyone.
The nurse told the author about it
because she did not think this death was wisely decided.
The patient wanted to live.
And the family would not have agreed if they had been consulted.

    Angels of Death ends without recommendations for change.
It mostly describes what was happening then.  
Many care-givers were helping their patients to die.  
This was done in secret because such actions were illegal.
No public safeguards were applied.
And such underground aid-in-dying is likely to continue
in more or less the same patterns for the foreseeable future.  

    One major change might be legal recognition of the right-to-die,
which would create some guidelines and safeguards
to prevent abuses and mistakes that do occur
when dying is aided by self-appointed 'angels of death'.

    Even more specifically, this reviewer has written
about controlling free-lance 'angels of death'.
Thirteen specific safeguards are suggested,
which would prevent almost all the present-day abuses
by self-appointed agents of death.
At the same time, fulfilling these safeguards
would permit wise and compassionate chosen death.

---

2. Stephen Jamison, PhD.

Final Acts of Love: Families, Friends, and Assisted Dying

(New York: Putnam, 1995)       279 pages

    This book should be read by everyone who plans a voluntary death
or who plans to help someone else in a voluntary death—doctors included.
It is a very careful guide for exploring all the dynamics associated
with choosing to die and helping others to end their lives.
Final Acts of Love is based on interviews with 140 different people,
who assisted in 160 voluntary deaths.
Only 10% of these were reported as suicides.
The rest were attributed to natural causes.
The helpers were usually not doctors, but family members and friends.

    Here are several of the cautions raised in this comprehensive discussion:
1. Is the medical diagnosis and prognosis clear to all?
2. Have all the medical options been explored, tried, and then rejected?
3. Has a specialist in the disease given a second opinion?
4. Is the patient asking for better treatment
      or for loving attention rather than death?
5. Is the patient's judgment impaired by the disease or the treatment?
6. Is the patient irrationally depressed or suicidal?
7. Is the decision to die caused by a medical crisis?
8. Is the patient being pressured or manipulated by others
      for personal or financial reasons?
9. Is the patient manipulating others into helping
      when the patient could achieve a voluntary death without help?
10. Does the patient have an irrational fear of nursing homes?
11. How many people have been involved in discussing the proposed death?
12. How many independent people agree that death is the best option?
13. What impacts will this death have on other people?
14. Has the patient's wish to die persisted over time?
15. How long a waiting period would ensure that death is a wise decision?
16. What special measures will be needed to make the death
      appear to be "from natural causes" or a "private suicide"?
17. How will this death be reported and registered?
18. What people will be present for this voluntary death?
19. What roles will each take in the process?
20. Is one helper too enthusiastic about causing death?
21. What will the helpers do if the first method of dying fails?
22. Has concern for secrecy and the details of dying
      obscured the possible meanings that might be realized from this death?
23. If I plan to help another to die, what are my own personal, ethical,
      philosophical, or religious views about assisting a voluntary death?
24. What safeguards and limits would I put on my participation?
25. What will be the impacts on those who help with a voluntary death:
      psychological, moral, professional, political, & legal?

---

3. Stephen Jamison, PhD.

Assisted Suicide:
A Decision-Making Guide for Health Professionals

(San Francisco, CA: Jossey-Bass Publishers: www.josseybass.com, 1997)
(ISBN: 0-7879-0873-8; hardcover)
(Library of Congress call number: R726.J357 1997)

    Almost all doctors and nurses who work with dying patients
get asked from time to time to assist their patients to die.
This book directly addresses this dilemma:
What should the doctor or nurse do when asked to assist a dying patient
to achieve a peaceful and painless death?  

    'Assisting suicide' is still officially a crime almost everywhere.
But this book reports that such laws have never been used
against a health-care worker who has helped someone to die.  

    This book does not explore the reasons for death
as seen by the patient who is dying.  
Those issues are in the background.
And it is assumed that the nurse or doctor
would not assist a patient to die
unless it was in the best interests of the patient.  

    Rather, this book focuses on the decision-making process
within the health-care professional—the doctor or nurse—
who must decide how to respond to a request for help in dying.  

    The doctor is first supposed to do no harm.
And sometimes assisting a patient to die is a help rather than a harm.
But the doctor does not want to get a reputation
as someone who helps patients to die.  

    Will the doctor be present when the patient takes the gentle poison?
The doctor should not recommend death as a treatment option.
But when the patient brings it up,
the doctor needs to think deeply about what is best for the patient
and how best to protect all the people who might become involved
—including, of course, the doctor himself or herself.  

    Good communication between the doctor and the patient
should make explicit all the reasons the patient wants to die
—both valid reasons and invalid 'reasons'.
Here are some of the invalid reasons for choosing death: 
Some patients want to die because they fear they will lose the power
to choose death at a later phase of their disease.  
Some patients are emotionally exhausted by the whole process.
Some patients suspect they have additional medical problems
they have not been told about.  
Some patients do not want to be an emotional
or financial burden on their loved one.  
Some worry about isolation as they die.
Others feel in despair.

    There are two extreme ways of responding:
(1) Absolutely refuse to assist the patient to die.
(2) Grant the wish to die immediately.  
Every health-care worker has a right to refuse to help the patient die.
But when they refuse to help, they should refer the patient
to someone else who feels more open to choosing death.

    In some complex cases, where various doubts might arise,
it could be wise to call in a psychological consultant,
who will assess the patient's state of mind
and abilities to make wise life-ending decisions.  

    Families of the dying often complicate the process.  
Some family members might be opposed to any chosen death.
Some relatives feel guilty for having neglected the patient.
Sometimes parents did not know their sons were gay
—much less dying of AIDS and now asking for assistance in dying.  

    Before agreeing to assist a patient in dying,
the doctor should make certain that pain and other forms of suffering
have been addressed in the best possible ways.  

    What methods of assistance in death are available to the doctor?

    1. The doctor can order increased pain medication,
but when the dose is out of line with general medical practice,
the nurse will notice that a secondary purpose is to bring death.

    2. The doctor can discontinue the life-support systems.  
Jamison does not call this a method of assisting death.

    3. The doctor can cooperate with the patient
who decides to give up food and fluids.
This method of achieving a voluntary death is completely legal.  

    4. The doctor can order terminal sedation
—enough pain-killers to keep the patient unconscious until death occurs. 
And the drugs will probably shorten the process of dying.

    Because other means of assisting a patient to die were still illegal,
90% of the assisted deaths Jamison studied were reported as natural death.  
The other 10% were reported as (unassisted) suicides.  

    Even tho many assisted deaths have been reported in the media,
almost no one has been prosecuted or sued.  
But there is a small risk,
which suggests that knowledge of the real method of dying
should be confined to a small circle of people who can be trusted.  

    Assisted Suicide should be read by all health-care workers
who might ever be asked to help a patient to die.  
In general, it does favor the right-to-die.
But most of the book is taken up with cautions
that doctors and nurses should heed
when responding to requests for aid in dying. 

---

4. Charles F. McKhann, MD 

A Time to Die:
The Place for Physician Assistance

(New Haven, CT: Yale University Press, 1999)
(ISBN: 0-300-07631-2; hardcover)
(Library of Congress call number: R726.R355 1999)
(Medical call number: W50M47847t 1999)

    A physician and professor at a medical school
discusses all perspectives on physician-assisted voluntary death.

    First, some common situations in which the patient
wishes to reduce his or her suffering
by choosing the most appropriate time to die:
cancer, AIDS, Alzheimer's disease, pain.  
The person who is inevitably dying
might not want to dissipate his or her estate in futile medical care.  
Being able to pass some wealth to the next generation
sometimes means more to the dying individual
than a few more days or weeks of low-quality 'life'.

    Sometimes patients wish to die for irrational 'reasons'.  
The full situation should be assessed before
discussing the best timing of death.  

    Alternatives to voluntary death should be explored first:
comfort care, pain relief, hospice care.  
If such methods do not handle the situation satisfactorily,
then the doctor has some other methods  
which will assist the patient to the desired goal
—a peaceful, painless, & dignified death.
Some of these methods of assistance are now legal:

    (1) The doctor can provide sleeping and/or pain medication,
which have as a known side-effect shortening the dying process.
This could even take the form of 'terminal sedation',
in which the patient is kept unconscious until natural death.  

    (2) In some states of the USA,
the doctor can even write a prescription for gentle poison
once several safeguards have been fulfilled.

    (3) If the patient is being sustained by some form of life-support,
all concerned can agree to discontinue such supports.  
Natural death will quickly follow.  

    (4) If all concerned approve death by dehydration,
then food and water can be withheld
and the doctor can order additional medications
which can eliminate the unpleasant aspects of this method of dying.

    When considering legal methods of assisting a voluntary death,
completely open discussions can involve
all who care about the life and well-being of the dying patient.  

    Dr. McKhann discusses the Dutch experience
of voluntary death with doctor assistance.  
The experience of the Netherlands has uncovered several problems,
which can be corrected in any new legislation in the United States.

    What about people who have requested death
in an Advance Directive or other careful document
but who slip into a semi-conscious state
before they can request death one last time?  
How realistic is it to require the patient
to be awake and capable up to the last moment before death?

    Why should the law authorizing physician aid-in-dying
require reporting to the coroner and/or the public prosecutor?  
A physician-assisted voluntary death is not a suspicious death.
And no crime has been committed.  
Law-enforcement officials have no training in the right-to-die.
Whatever reporting to public authorities is required
should take place before the death, not after,
in case this death might be premature.  
Reporting after the death could have no positive outcome.
Thus, many Dutch physicians did not correctly report
their physician-assisted voluntary deaths.  
These deaths are just reported as deaths from natural causes,
which do not involve the police,
the public prosecutor, or the courts in any way.  

    Physicians are rightly concerned about
the legal aspects of helping their patients to die.
Not only is assisted dying against the law in most states,
but doctors might also be sued by a relative
who did not approve of the voluntary death.
Also, doctors avoid public association with assisted dying.
They have been trained to cure—not kill.  
And most of the professional medical groups
are opposed to any physicians assisting in dying.

    When Dr. McKhann asked other physicians for their opinions,
most said that they would be more willing
to help their patients die in the last weeks of life
if it were legal, moral, & professional to do so.  

    The public resists physician-assisted voluntary death
because of fears of abuse and mistakes.  
Like all other human beings, doctors do sometimes make mistakes.
But the public does not call for an end to air transportation
because pilots sometimes make mistakes
that result in the deaths of everyone on board those planes.  

    However, most cases of physician-assisted voluntary death
are nowhere near the error zone.  
There is no rush to achieve death this instant.  
And if there are doubts about the wisdom of this chosen death,
then other opinions can be obtained
—from other doctors and relatives not yet consulted.

    Some people worry about greedy relatives,
who hope to get their hands on their inheritance a bit sooner.
But most can wait a few weeks for their money.
And if there is any such doubt,
the full situation should be brought into the open.  

    Even more unlikely is the rare case of the mad doctor,
who gets some kind of enjoyment out of killing people.  
Occasionally doctors have been exposed as serial killers.
But outlawing the right-to-die is probably not much help
in dealing with doctors who relish the power to kill their patients.  
Physicians who wish to kill their patients
can already kill them in a thousand ways
without claiming that their murderous behavior
has anything to do with the right-to-die.                                                            
Careful detective work is the best way to catch these doctors.  
We already have good laws against murder.  
The criminal-justice system should deal with this problem.  

    The public also worries that the 'right-to-die'
will be applied first to vulnerable people.
But the facts point in the opposite direction:
The vulnerable people get little or no health care at all.
Neglected patients will not get any special attention from doctors
who want to help them to die.  
With respect to less-favored groups of people,
doctors are already wary of providing sub-standard care.  

    Dr. McKhann reviews the standard safeguards for deciding death:
1. requests from the patient while still capable of making decisions.
2. doctors' opinions about prognosis and treatment options.
3. psychiatric evaluation of the candidate if there is any doubt.
4. waiting period to avoid impulsive death.
5. full reporting of all material facts.  

    Such safeguards can probably be improved,
perhaps even to the degree needed
to win over some opponents of the right-to-die
who raise the specter of people being put to death
for the benefit of the state.  
The discussion of the right-to-die
should be kept completely separate
from the discussion about health-care costs.

    Finally, Dr. McKhann explores the legal basis for the right-to-die.  
The U.S. Constitution grants us privacy
and the equal protection of the laws.  
This includes reproductive freedom
and the right to refuse unwanted medical treatments.
But the U.S. Supreme Court has resisted
finding a right-to-die in the Constitution.
This is a proper area for legislative change by the states.
Most of the laws against assisting suicide
are more than 100 years old,
written long before modern medical technology.
Such laws were intended to keep everyone
from assisting an irrational suicide.
We need new laws to allow physicians to assist in chosen deaths
—deaths that are wise, compassionate, well-planned, & rational.  

    The present system of secret assistance in dying
is open to mistakes and abuses.
Can we make choosing the best time for death
an open and rational discussion,
in which all concerned persons will have a voice?

    As long as assisting a patient to die remains illegal,
the doctor is not inclined to ask for a second professional opinion
about the advisability of choosing death now
rather than following the pattern for standard terminal care.  
Most of the family members must be kept in the dark
about the life-ending decision because of the fear of prosecution. 
Only informal, personal safeguards are applied.  
Any new laws regarding the right-to-die
would bring the decision-making process into the open,
where public safeguards would be applied to every case.

   A Time to Die: The Place for Physician Assistance
is a wise and compassionate book
about the prospect of physicians helping their patients to die.  
It does not break any new ground in the discussion,
but the fact that it was published
shows that we are more open to the possibility
of making reasoned choices at the end of life.  
Dr. McKhann believes that it is only a matter of time
before physician assistance in voluntary deaths will be approved.  
How soon will we have this right to choose?

---

5. John West

The Last Goodnights:
Assisting My Parents with their Suicides:
A Memoir

(Berkeley, CA: Counterpoint: www.counterpointpress.com, 2009)     254 pages
(ISBN: 978-1-58243-488-3; hardcover)
(Library of Congress call number: R726.W47 2009)

    Lawyer John West provided pills to help his parents die in 1999.
Both were in their 70s and had been health-care professionals.
His father was dying of fast-advancing bone cancer.
His mother suffered from the early stages of Alzheimer's disease.
They did not die at the same time, which might have been suspicious.

    Even tho this book was published 10 years after the events,
it must have been based on careful diary notes,
since it gives specific dates for most of the events
and quotes conversations with all the family members involved.

    In part because these events took place in the last century,
complete secrecy had to surround the planning for these deaths.
The father had two hips replaced just before his (secretly) planned death.
The mother was trying to carry on as normal,
so that no one would question her death either.

    The plans were completely successful in both cases.
The family doctor had no suspicions about either death
and he signed the death-certificates without even seeing the bodies.
These deaths were reported as due to natural causes.
But the actual method of dying was massive amounts of pills
voluntarily taken by the two parents
with the planning and help of the son who wrote the book.

    The father's death was more clearly a voluntary death
because he was not expected to survive
the rapidly-spreading cancer for many more weeks.
And he was clearly in charge of his own death;
his mental capacities were not compromised in any ways.
It might be said he was a member of the One-Month-Less Club,
since he knew that his life held nothing further than more days in bed.
Because of the clear medical facts,
there was probably no need for any further safeguards.
He had been head of the department of psychiatry at UCLA.

    The mother's death might be more difficult to categorize
since she lacked a definite downward pathway.
She might have lived a few more months,
even tho she did not want to tolerate the mental decline
she knew she was experiencing.
She had been a clinical psychologist.
If voluntary death had been a viable option in California at the time,
she might have decided to continue living a bit longer.
But she feared that she might lose the power to take the pills herself.
And her son was not willing to cause her death by himself.

    Even tho the expression "assisted suicide" appears in the title
and a few times in the text, it is not essential to the concept of this book.
(The author does refer once to his father "committing suicide".)
This reviewer would have preferred another term—"voluntary death".
Such a non-offensive term could easily replace "suicide"
wherever it appears in this book.
The right-to-die movement has moved away from the word "suicide".
But the author shows little sign of being in contact with this movement.
And perhaps this misleading term appears
because the writing began a decade earlier.

    It is also possible that the publisher thought that "assisted suicide"
should appear in the title because that would sell more books.
And the Library of Congress
classifies this book as "Assisted suicide--biography".
"Assisted suicide" is a traditional term.
And it is the one preferred by opponents of the right-to-die.
But this reviewer recommends that it be replaced by "voluntary death",
which separates it from the thousands
of irrational suicides that take place each year.

    Another option for choosing a timely death,
which was legal at the time, was voluntary death by dehydration.
John West hopes that lethal injections by doctors will be permitted,
as was then possible in Holland and a few other European countries.
Other members of the family (and even close friends)
could have been included in the last days of John West's parents
if they had chosen an open way of ending their lives.
And the author would not have traumatized himself
by the months of secret planning
if they had decided to use legal methods of choosing death.

    The Last Goodnights is well described as a memoir,
since it is the detailed account of everything that happened
from the point of view of the author.
The writing is so good that my partner and I decided to read it aloud,
over a period of several days.
Only a few books deserve to be read aloud.
We both found it a compelling personal story.
And it was an occasion for discussing the issues raised
by the inevitability of death for all of us.

    The author did worry about being questioned by the police.
He did not want either parent to be subjected to autopsy,
which would have disclosed the drugs used to ease their passing.
And, since he is a lawyer, he probably knows that there is little chance
of any legal sanctions coming down on him now
because of his role in the voluntary deaths of his two parents in 1999.
Perhaps there is a statue of limitations
with respect to helping other people to die.

    This book will provide lots of food for thought
for anyone thinking of choosing a voluntary death
or considering helping others to choose voluntary deaths.

---

6. Timothy E. Quill, MD 

Midwife Through the Dying Process:
Stories of Healing and Hard Choices at the End of Life

(Baltimore, MD: Johns Hopkins University Press, 1996)       239 pages

     Dr. Timothy Quill became famous for disclosing
that he helped one of his patients to die by providing the necessary drugs.
This happens in only one of the nine deaths discussed in this book.
Midwife Through the Dying Process
traces the diseases and terminal illnesses of nine people
personally known by Dr. Quill in Rochester, New York.
The patients' families were almost always involved in the dying process.
Terminal sedation is the closest Dr. Quill is now willing to go
toward helping patients to die.
But the book contains many useful insights into the dying process
as seen thru the eyes of the doctor.

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Created December 28, 2003; revised several times, including 5-29-2010; 8-30-2010; 2-8-2012: 2-29-2012;
1-9-2013; 4-12-2013; 6-29-2013; 4-30-2015; 3-5-2017; 7-12-2017; 3-8-2018;

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