METHODS OF MANAGING DYING
© 2018 by James Leonard Park
selected and reviewed by James Park.
following books are organized in order of quality, beginning with the
paragraphs in black are intended to present objective facts about
remarks in red
are the evaluations and opinions of this reviewer.
bibliography reviews books about the four most common
methods of managing the process of dying within modern medical care:
curative treatments and life-supports, &
up food and water.
Here is a brief explanation of
these recommended methods:
"Methods of Managing Dying in a
Lewis M. Cohen, MD
Story of Medicine, Murder Accusations,
and the Debate over How We
York: HarperCollins, 2010) 255
(ISBN: 978-0-06-172176-2; hardcover)
(Library of Congress
call number: R726.8.C635 2010)
(Medical call number: WB310C678n
The basic legal case underlying this volume
concerns the amount
of pain-killing medication given to a dying woman.
already clearly on a downward pathway towards death:
been discontinued by the doctor with the consent of the family.
morphine was being given to ease her distress as she died.
But one low-level health-care aid thought
was being used.
She reported this suspicion to the police,
the state police proceeded to investigate.
The lives of two
nurses were disrupted for several months
and their careers were
But no charges were ever brought
this terminal care was entirely within standard medical practice.
Some take-away conclusions from this
agree to talk to the police about any element of medical practice.
State and local police have no training in medical ethics.
are trained to investigate possible murders.
If police come
to your door asking about your behavior in the
refuse to speak with them without the hosptical lawyer present.
Do not go with the police to any
other location, especially late at night.
will not be arrested without probable cause that you
committed a crime.
Agree to answer medical questions
if they are asked by someone who has deep knowledge
about terminal medical care.
policemen and women and even detectives have no such expertise.)
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.
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
Nurses can recommend or request changes to these medical
but the doctor
has ultimate responsibility for medical decisions.
Laypersons and low-level health-care workers
do not understand modern medical ethics.
they should be educated to whatever level of understanding
are capable of attaining.
this educational process will require a few hours.
this is much better than the thousands
will be required if there is any investigation
by the office of the
a death has taken place in the hospital.
Each medical institution that takes care of the dying
in-service education about
options for life-ending decisions:
(1) increasing pain-medication,
(2) beginning terminal sedation,
curative treatments and withdrawing life-supports, &
(4) giving up food and water.
Such education should prevent all baseless
when good standards of terminal medical care are maintained.
Hospital lawyers should be prepared to inform the prosecutor
any controversial or questionable medical procedure.
most cases, this very willingness to ask the prosecutor
be strong evidence that no crime is likely.
ethics committees should put their recommendations into writing,
which should prevent misunderstandings by non-professional staff
and which should also head-off any investigation by
Sometimes very religious health-care workers and/or families
not agree with the methods of managing dying
are entirely legal in every state of the USA and many other
and when they object to any proposed course of action in the
views should be taken into account as much as possible.
when the medical decision goes against
what the conservatives would
more-complete documentation might be required
to protect the
professional medical opinions and recommendations
might help to prove that all
the proposed actions will be entirely
A review by the hospital lawyer might also be needed
establish that the methods of managing dying
were entirely legal
within that jurisdiction.
institutions that regularly take care of dying patients
to make clear to everyone involved
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.
"Four Legal Methods of Managing Dying":
L. W. Sumner
Study in Ethics and Law
York: Oxford University Press: www.oup.org,
(ISBN: 978-0-19-960798-3; hardcover)
Congress call number: K5178.S86 2011)
(Medical call number:
careful philosophical exploration of end-of-life medical choices,
which are intended or foreseen to shorten the process of
1. 'euthanasia' and 'physician-assisted suicide';
using pain-killers, knowing that vital functions will be
3. terminal sedationkeeping
the patient unconscious until death;
up all food and water by all method.
Specific chapters discuss these important themes:
patient consent and/or refusal of medical treatments.
pain-relieving drugs with the purpose of reducing suffering
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
various laws and regulations.
laws dealing with life-ending decisions
focus just on two
high-profile methods of choosing death:
doctor gives a lethal injection;
doctor prescribes a gentle poison.
But even in jurisdictions where
both of these life-ending options
have been available for many
less than 2% of all deaths are achieved by these methods.
more deaths are achieved by other methods,
which have the same resultdeathbut
have not been controversial:
(1) ending all curative treatment and
(2) increasing pain-killing drugs to relief
with the knowledge that the process of dying will also
(3) choosing terminal sedation
the patient continuously unconscious until natural death; &
giving up all food and water
will result in death by dehydration within a few days.
Because these four additional methods of choosing death
been thoroly discussed or studied,
we do not have precise data
Also, these additional methods of dying are often
In fact, it would be possible to use all four at
Even in locations where the
controversial methods are banned,
doctors are already
recommending the less controversial methods
patient faces the last few days in the hospital.
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
should be read by careful students of choices at the end of life.
Lois Snyder & Arthur L. Caplan, editors
IN: Indiana University Press: http://iupress.indiana.edu, 2002)
(ISBN: 0-253-33977-4; hardcover)
(Library of Congress
call number: R726.A855 2002)
book grew out of a consensus panel,
which attempted to identify
the common ground
among both proponents
of making life-ending decisions.
17 different authors contributed
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
Who should write and enforce any such guidelines or
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?
Six explicitly discusses several methods of choosing death:
increasing pain-medication with the knowledge that death will
(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 sedationkeeping
the patient asleep for the last days;
(5) physician prescribes
sufficient sleeping pills
to cause death if taken all at once by
Each of these methods of
is illustrated by the case-history
of an actual
patient who chose that pathway towards death.
Joanne Lynn, MD, editor
No Extraordinary Means:
Choice to Forgo Life-Sustaining Food and Water
IN: Indiana University Press, 1986)
(ISBN: 0-253-31287-6; hardcover)
Congress call number: R726.B9 1986)
(Medical call number: W50B993
See review in the first bibliography
January 8, 2013; Revised 1-9-2013; 5-10-2013; 5-16-2013; 6-12-2013;
Death by Dehydration
Books on Voluntary Death
Books on the Right-to-Die
on Advance Directives for Medical Care
Opposing the Right-to-Die
Books on Preparing for Death
on Terminal Care
on Helping Patients to Die