MEDICAL METHODS OF MANAGING DYING


Copyright © 2018 by James Leonard Park

Books selected and reviewed by James Park.

The following books are organized in order of quality, beginning with the best.

The paragraphs in black are intended to present objective facts about each book.
The remarks in red are the evaluations and opinions of this reviewer.


    This bibliography reviews books about the four most common
methods of managing the process of dying within modern medical care:
(1) increasing pain-medication,
(2) beginning terminal sedation,
(3) withdrawing all curative treatments and life-supports, &
(4) giving up food and water.

    Here is a brief explanation of these recommended methods:
"Methods of Managing Dying in a Right-to-Die Hospice":
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/METHODS.html


1.  Lewis M. Cohen, MD

No Good Deed:
A Story of Medicine, Murder Accusations,
and the Debate over How We Die

(New York: HarperCollins, 2010)       255 pages
(ISBN: 978-0-06-172176-2; hardcover)
(Library of Congress call number: R726.8.C635 2010)
(Medical call number: WB310C678n 2010)

    The basic legal case underlying this volume
concerns the amount of pain-killing medication given to a dying woman.
She was already clearly on a downward pathway towards death:
Dialysis had been discontinued by the doctor with the consent of the family.
And morphine was being given to ease her distress as she died.

    But one low-level health-care aid thought that
too much medication was being used.
She reported this suspicion to the police,
and the state police proceeded to investigate.
The lives of two nurses were disrupted for several months
and their careers were changed forever.
But no charges were ever brought
because this terminal care was entirely within standard medical practice.

    Some take-away conclusions from this book:
Never agree to talk to the police about any element of medical practice.
State and local police have no training in medical ethics.
They are trained to investigate possible murders.
If police come to your door asking about your behavior in the hospital,
refuse to speak with them without the hosptical lawyer present.
Do not go with the police to any other location, especially late at night.
You will not be arrested without probable cause that you committed a crime.

    Agree to answer medical questions
only if they are asked by someone who has deep knowledge
about terminal medical care.
(Beat policemen and women and even detectives have no such expertise.)
The office that might eventually bring charges
will have to develop some expertise in the care of the dying
if that office is ever going to charge anyone with committing a crime
as a part of terminal care in a hospital.

    Criminal law must still cover any activities in the hospital.
There are rare cases in which doctors and/or nurses
did in fact commit serious crimes under the color of medical care.
But only a prosecutor familiar with modern medical care
should attempt to examine questionable medical care given in a hospital.

    There can be differences of medical opinion
about how much medication to give to a dying patient,
but all such decisions should be clearly recorded in the medical orders.
Nurses can recommend or request changes to these medical orders,
but the doctor in charge has ultimate responsibility for medical decisions.

    Laypersons and low-level health-care workers
often do not understand modern medical ethics.
So they should be educated to whatever level of understanding
they are capable of attaining. 
Sometimes this educational process will require a few hours.
But this is much better than the thousands of hours
that will be required if there is any investigation
by the office of the prosecutor
after a death has taken place in the hospital.

    Each medical institution that takes care of the dying
should have in-service education about
the legal options for life-ending decisions:
(1) increasing pain-medication,
(2) beginning terminal sedation,
(3) ending curative treatments and withdrawing life-supports, &
(4) giving up food and water.
Such education should prevent all baseless complaints
when good standards of terminal medical care are maintained.

    Hospital lawyers should be prepared to inform the prosecutor
before any controversial or questionable medical procedure.
In most cases, this very willingness to ask the prosecutor
should be strong evidence that no crime is likely.

    Hospital ethics committees should put their recommendations into writing,
which should prevent misunderstandings by non-professional staff members
and which should also head-off any investigation by ill-informed police.

    Sometimes very religious health-care workers and/or families
will not agree with the methods of managing dying
that are entirely legal in every state of the USA and many other countries.
If and when they object to any proposed course of action in the hospital,
their views should be taken into account as much as possible.
And when the medical decision goes against
what the conservatives would have chosen,
then more-complete documentation might be required
to protect the health-care workers.
Additional professional medical opinions and recommendations
might help to prove that all the proposed actions will be entirely proper.
A review by the hospital lawyer might also be needed
to establish that the methods of managing dying
were entirely legal within that jurisdiction.

    Medical institutions that regularly take care of dying patients
should have written policies to make clear to everyone involved
just what end-of-life choices are authorized.

    Let us hope that baseless charges like those discussed in this book
have now passed into medical history in advanced countries.
Modern terminal care does embrace
a number of legal and moral life-ending choices.
See "Four Legal Methods of Managing Dying":
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-L-END.html



2.  L. W. Sumner

Assisted Death:
A Study in Ethics and Law

(New York: Oxford University Press: www.oup.org, 2011)       236 pages
(ISBN: 978-0-19-960798-3; hardcover)
(Library of Congress call number: K5178.S86 2011)
(Medical call number: WB33.1S955a 2011)

    A careful philosophical exploration of end-of-life medical choices,
which are intended or foreseen to shorten the process of dying:
1. 'euthanasia' and 'physician-assisted suicide';
2. using pain-killers, knowing that vital functions will be suppressed;
3. terminal sedation—keeping the patient unconscious until death;
4. terminal dehydration—giving up all food and water by all method.

    Specific chapters discuss these important themes: 
(2) patient consent and/or refusal of medical treatments.
(3) using pain-relieving drugs with the purpose of reducing suffering
and/or the intention of bringing death;
(4) evaluating and responding to patient requests for death;
(5) deciding death for others.

    Part II deals with the attempts to control end-of-life choices
using various laws and regulations.

    Almost all laws dealing with life-ending decisions
focus just on two high-profile methods of choosing death:
(1) 'euthanasia'—the doctor gives a lethal injection;
(2) 'physician-assisted suicide'—the doctor prescribes a gentle poison.
But even in jurisdictions where both of these life-ending options
have been available for many years,
less than 2% of all deaths are achieved by these methods.

    Many more deaths are achieved by other methods,
which have the same result—death—but have not been controversial:
(1) ending all curative treatment and life-support systems;
(2) increasing pain-killing drugs to relief suffering
with the knowledge that the process of dying will also be shortened;
(3) choosing terminal sedation
—keeping the patient continuously unconscious until natural death; &
(4) giving up all food and water
—which will result in death by dehydration within a few days.

    Because these four additional methods of choosing death
have not been thoroly discussed or studied,
we do not have precise data about how often they occur.
Also, these additional methods of dying are often combined.
In fact, it would be possible to use all four at once.

    Even in locations where the controversial methods are banned,
doctors are already recommending the less controversial methods
when the patient faces the last few days in the hospital.
When we ourselves are on our death-beds,
we already do have these possible methods of dying. 

    This book supports the right-to-die
and offers common-sense methods to avoid abuses and mistakes.
It should be read by careful students of choices at the end of life. 



3. Lois Snyder & Arthur L. Caplan, editors

Assisting Suicide:
Finding Common Ground

(Bloomington, IN: Indiana University Press: http://iupress.indiana.edu, 2002)       232 pages
(ISBN: 0-253-33977-4; hardcover)
(Library of Congress call number: R726.A855 2002)

    This book grew out of a consensus panel,
which attempted to identify the common ground
among both proponents and opponents of making life-ending decisions.
17 different authors contributed their thoughts.

    How does taking gentle poison provided by a doctor
differ ethically and legally from ending medical treatments and life-supports?

    Can guidelines be applied consistently to all end-of-life situations?
Who should write and enforce any such guidelines or safeguards?

    Why should physicians be expected to be the main agents of death?
Should others (both professional and lay persons)
also participate in planning and carrying forward plans for death?

    Chapter Six explicitly discusses several methods of choosing death:
(1) increasing pain-medication with the knowledge that death will come;
(2) withdrawing life-supports with approval of the patient and/or the family;
(3) giving up eating and drinking as a method of bringing death;
(4) terminal sedation—keeping the patient asleep for the last days;
(5) physician prescribes sufficient sleeping pills
to cause death if taken all at once by the patient.

    Each of these methods of choosing death
is illustrated by the case-history
of an actual patient who chose that pathway towards death.



4.  Joanne Lynn, MD, editor

By No Extraordinary Means:
The Choice to Forgo Life-Sustaining Food and Water

(Bloomington, IN: Indiana University Press, 1986)       272 pages 
(ISBN: 0-253-31287-6; hardcover)
(Library of Congress call number: R726.B9 1986)
(Medical call number: W50B993 1986)

    See review in the first bibliography below.


Created January 8, 2013; Revised 1-9-2013; 5-10-2013; 5-16-2013; 6-12-2013; 7-6-2013;
4-30-2014; 11-3-2016; 2-28-2018;

See related bibliographies:

Voluntary Death by Dehydration

Best Books on Voluntary Death

Best Books on the Right-to-Die

Books Opposing the Right-to-Die

Best Books on Preparing for Death

Books on Advance Directives for Medical Care

Books on Terminal Care

Books on Helping Patients to Die



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