Books Supporting the Right-to-Die

Copyright © 2018 by James Leonard Park

    Selected and reviewed by James Park,
advocate of the right-to-die.
Organized in the order of quality, beginning with the best.
Comments in red are the opinions of this reviewer.

A note to authors of books supporting the right-to-die:
Please avoid the following four misleading words:
"euthanasia", "suicide", "hasten", & "medication".



1. James M. Hoefler 

Managing Death

(Boulder, CO: Westview Press, 1997)       206 pages
(ISBN: 0-8133-2816-0; hardcover)
(Library of Congress call number: R726.H564 1997)

     Hoefler documents a broad consensus among almost all groups
(doctors, nurses, hospitals, religious organizations)
that have taken official positions
concerning how to manage the process of dying:

1. Forgoing medical treatment and life-supports is not suicide.
2. Withholding and withdrawing life-supports are ethically the same.
3. Family members can decide for incapacitated patients.
4. Terminal illness is not required
    as a precondition for making life-ending decisions.
5. Food and water need not always be provided.

     We lack consensus about the following additional issues:

6. In persistent vegetative state (PVS) patients can be kept 'alive'
sometimes for years with the help of life-support systems.
More than 10,000 patients are in PVS at any given time in the United States.
If we had consensus, many more mechanical systems
supporting bodies in PVS would be disconnected.

7. Severe dementia is a condition in which the patient is no longer able
to make any meaningful decisions about life or death.
The number of such patients is measured in the millions.
But common sense and public opinion are moving toward consensus
that the severely demented need not be kept alive by artificial means.
In other advanced countries, they are not routinely put on life-supports
—as is quite common in the United States.
But America as a society does not yet have a consensus
about how to treat former persons who have permanently lost
such capacities as consciousness, memory, language, & autonomy.

     Hoefler discusses artificial nutrition and hydration at end of life.
Dying from lack of water is much quicker and easier than starvation.
Two months is a typical time to die from lack of food
—if there are no other physical diseases or problems.
A week or 10 days is all it takes to die
if all water and other fluids are given up.
According to all objective reports, this is a quick and easy death,
often without the need for pain medication.

    The following points about voluntary death by dehydration (VDD)
come from this reviewer rather than from James Hoefler:

     Giving up water and other fluids has some additional advantages
over other methods of bringing life to an end:

1. The patient can always change his or her mind.
Since it takes at least a week to die using this method,
the patient might see life quite differently
after a few days without food and water.
People tempted to commit irrational suicide
will probably recover from their suicidal urge before they die.
Then they will resume eating and drinking
—and continue to live indefinitely.
Other people will probably know about this decision to die
—which gives them ample opportunity to intervene
if they do not believe that death at this time is the best option.

2. Doctors need not be involved in the dying process at all.
Thus, there are no moral or legal questions
about doctors aiding in the process of dying.
Death by dehydration can be conducted completely at home,
without the need for any special equipment or drugs,
and without the involvement of any health-care institutions.

3. Giving up food and water is completely legal.
There are no laws against choosing this method of dying.
This eliminates the secrecy involved in underground means of death.

4. Families can be informed ahead of time about the planned death,
so they can gather for the last days of their loved one if they please.

     Death by dehydration might become
a preferred method for voluntary death
in the first few decades of the 21st century,
because it does not involve the state
or health-care institutions or personnel.
Patient autonomy is certainly preserved
because the decision to die must be affirmed over and over again
during the last week or 10 days of life.
And when the patient slips into unconsciousness,
the proxies and medical personnel can continue to withhold fluids.

     No new legislation is required to open this pathway towards death.
We already have the power to end our lives in this way.
The danger of irrational suicide is sharply diminished.
(Irrational suicide is a danger in all methods that bring death suddenly.)
The patient will go to sleep at night and wake up again in the morning
several times during the period of dying from dehydration
which will give new perspectives on problems
that might otherwise lead to an irrational suicide.
If this plan for achieving a voluntary death is announced to others,
they might decide to provide new support or better medical care,
which might postpone dying until some later time.

    (This reviewer has written two essays on this subject:

VDD:
Why Giving Up Water is Better than other Means of Voluntary Death

Voluntary Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice

And he has begun a website on the same subject:
Voluntary Death by Dehydration
Questions and Answers.)

     Hoefler hopes that death will be better managed in the future.
He suggests the following ways to improve the process of dying:

1. New standards of care will be developed for mortally-ill patients.
Then they will no longer suffer the default decision,
which is always to provide maximum aggressive medical care:
If it can be done, it will be done—until someone decides otherwise.

2. We will make better use of hospice care.
Now it is often used just for the last week of life—or last few hours.
Taking advantage of hospice services for several weeks or months 
can greatly improve the process of dying.

3. We will develop a clearer concept of medical futility.
Research will show more clearly than ever before
which medical treatments are useful and which are useless
in the various situations in which such treatments might be applied.
Not only the medical profession but also the general public
will reach a more reasonable consensus
about when to omit or withdraw high-tech medical care at the end of life.

4. End-of-life decision-making will become more open and rational.
Both professionals and patients will understand death better,
empowering them to make wiser end-of-life decisions.
Death can be better managed rather than fought every step of the way.

5. We will reject the slippery-slope arguments
of those who oppose making any life-ending decisions.
By paying close attention to the particulars of each case
rather than trying to enforce rigid rules of morality,
wise decisions will emerge that can be embraced by everyone involved.

6. Advance Directives will be used more fully and wisely,
so that we can choose our own pathways towards death,
rather than being managed by the standard operating procedures
of the hospital or the medical profession.

     Managing Death is a basic and moderate book about dying.
Hoefler does not attempt to break new ground.
Rather he clarifies the consensus we already have
—and projects the elements of a new consensus
that is now beginning to emerge in our collective thinking.

    Everyone concerned about the process of dying
should read Managing Death.




2. John Griffiths, Heleen Weyers, & Maurice Adams

Euthanasia and Law in Europe

(Oxford, UK & Portland, OR: Hart Publishing: www.hartpub.co.uk, 2008)       595 pages
(ISBN: 978-1-84113-700-1; hardback)
(Library of Congress call number: KJC8357.E96G75x 2008)

    Updating and expanding Euthanasia and Law in the Netherlands, 1998.
The authors present a comprehensive review and commentary
on the laws and practices concerning life-ending decisions
in the following countries:
Netherlands, Belgium,  England and Wales,
France, Italy, Denmark, Norway, Sweden, Spain, & Switzerland.
All show increasingly acceptance of life-ending decisions,
but some countries have more advanced laws and controls.
Holland and Belgium have the most developed systems,
but the rates of making life-ending decisions in the other countries
are similar, even where 'euthanasia' is still not legally-recognized.

    The first half of the book is devoted to the Netherlands.
In Holland, doctor-assisted death
includes both 'euthanasia' and 'physician-assisted suicide'.
Both kinds of help in dying fall under the same regulations.
The only difference is taking pills (physician-assisted suicide)
or receiving a lethal injection from the doctor (euthanasia proper).

    The most surprising disclosures are the high frequency of
life-ending decisions as part of normal medical practice.
These include: (1) increasing pain-medication at the end of life;
(2) terminal sedation to keep the patient unconscious until natural death;
& (3) ending all medical treatments and life-supports
when it becomes clear that the patient will never recover.
Because all of these life-ending decisions take place in medical settings,
the doctors are the ones who recommend such changes in care,
which will result in the death of the patient.

    Exact numbers for these end-of-life medical decisions
are very difficult to determine
because there are no systematic ways of identifying the cases
and putting them into discrete categories.
Death-certificates can be studied.
These will show deaths openly declared to be 'euthanasia'
or 'physician-assisted suicide'.
But the termination of medical treatments is seldom mentioned.
Doctors can be polled about how often they help their patients to die.
But (especially where aid-in-dying is not yet legal),
doctors do not want to incriminate themselves
by admitting that they have used methods of helping
that are not yet approved by the laws of their countries.

    But doctors do routinely help their patients to die.
And these practices are within normal medical care
and the medical ethics of their respective medical associations.

    About half of all deaths in some European countries
take place with a meaningful element of choice.  
For contrast, the other deaths taking place within medical institutions
occur while doctors are still trying to save the patient from death.

The full range of medical treatments are still being applied
and all appropriate forms of life-support are still operating.
But the patient dies despite all such efforts to prevent death.
This reviewer calls such deaths being "treated-to-death".
Perhaps about 20-30% of all deaths fall into this category.   
The Netherlands has the most elaborate laws and controls.
Specially-trained doctors are available as euthanasia consultants
for all doctors who might be called upon to help patients to die.
Whenever a doctor agrees to 'euthanasia' or 'assisted suicide',
the doctor must report such deaths to a Regional Review Committee.
About 3% of total deaths in Holland are so reported.
Since the new euthanasia law went into effect in 2002,
no one has been charged with violating the law.
And technical violations of consulting and reporting requirements
have not led to any prosecutions of doctors.

    Here is an analysis of 13 safeguards for 'euthanasia' now in Dutch law:
Guidelines for Euthanasia in the Netherlands:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-NETH.html

    Euthanasia and Law in Europe is required reading
for anyone who wishes to comment on the end-of-life practices in Europe.
All previous information is out-of-date and no longer applicable.
Critics of the right-to-die will have to revise their critiques of Holland
in light of much new information in this book.

     And all who favor the right-to-die will find much useful information here.
Which of the laws, practices, & regulations should be copied elsewhere?
Has the right-to-die already been realized
in normal medical practice that allows reasonable life-ending decisions?
If we are not required to suffer until we die,
perhaps better cooperation with our doctors is all we need
so that we will have a peaceful and gentle death when the best time comes.




3. Stuart J. Youngner & Gerrit K. Kimsma, editors

Physician-Assisted Death in Perspective:
Assessing the Dutch Experience

(New York: Cambridge University Press: www.cambridge.org, 2012)       403 pages
(ISBN: 978-1-107-00756-7; hardcover)
(Library of Congress call number: R726.P484 2011)
(Medical call number: WB65P578 2012)

    23 academics and physicians with first-hand experience
with 'euthanasia' and 'physician-assisted suicide' in the Netherlands
offer their perspectives and analyses of how these life-ending decisions
are achieved and reported in Holland.

    Several chapters at the beginning trace the unusual pathways
by which Holland has finally arrived at its present practices.
Usually court decisions have led to regulations that make exceptions
to the laws against helping patients to die.

    The decision to bring life to an end must be chosen by the patient
and only physicians are permitted to help their patients die
in these prescribed ways defined in Dutch law.
Usually the life-ending decision is carried forward by the family doctor,
after careful consultation with a euthanasia consultant,
who is trained in the process for making the decision to end life
and knows the proper methods for reporting such deaths.

    Because "unbearable suffering" is required by Dutch law of 2002,
there has been considerable discussion about exactly what qualifies
as conscious suffering that cannot be relieved by any medical methods.
Some advocates of the right-to-die argue that the normal losses of old age
are sufficient losses of dignity to qualify as "unbearable suffering".
And because patients must be suffering,
if they become comatose,
they no longer qualify for aid-in-dying.
Also, Alzheimer's patients do not qualify
for 'euthanasia' or 'physician-assisted suicide'
because it is uncertain whether they are suffering unbearably.
And they can no longer give informed consent for a life-ending decision.

    This is a peculiarity of Dutch law that might be avoided by other countries.
Instead of requiring "unbearable suffering",
would it be sufficient to determine that meaningful life is over?

    Reporting-rates of 'euthanasia' and 'physician-assisted suicide'
continues to improve each year.
And as of 2011, about 2% of all deaths in Holland
were being achieved by these defined and reported methods.

    Another 2% are achieved by patients who decide to forgo food and water.
This method of choosing death does not fall under the Dutch law
and therefore does not require consultation and reporting.

    Also, an even larger number of deaths
are achieved as a normal part of medical practice,
which would be found in any countries with advanced medical care.
These include providing pain-medications at the end of life,
with the knowledge that the pain-killers might shorten the process of dying.
Terminal sedation is becoming more popular:
The doctor decides to keep the patient continuously unconscious
until death comes as a part of the natural process of dying.
And, of course, whenever life-supports are in use,
it is completely within normal medical practice
to discontinue all forms of medical treatment and life-supports.
Such life-ending medical decisions often include
discontinuing artificial nutrition and hydration,
but these doctor-initiated decisions are not counted
in the 2% of Dutch deaths (mentioned above)
caused when patients themselves decide to give up food and water.

    In Dutch medical practice at the end of life,
it seems important to distinguish between
drugs that cause immediate death

and drugs that shorten the process of dying.
Certain drugs are recommended for achieving 'euthanasia'.
These do not have any other medical uses.
And the doctor's report of 'euthanasia'
will specify exactly what gentle poison was used.

Other drugsmost notably morphine
are widely used in order to relieve pain and suffering
in all sorts of medical patients, not just those expected to die.
However, morphine also suppresses vital functions,
which will sometimes lead to the death of the patient.
When the death results from the use of morphine,
this is not considered a case of 'euthanasia' or 'physician-assisted suicide'.
This death will be reported on the death-certificate as "from natural causes".
And no report to the Regional Review Committee will be required.
 

    And some attempts to discover the frequency
of each kind of life-ending decision

have focused on exactly what drugs were used
at the end of life
and in what quantities.

Dutch doctors strongly defend their right to practice terminal care
within the standards of normal medical practice,
as defined by their medical societies.
Thus, the practice of increasing everyday drugs to relieve suffering
is reported as death from palliative care
rather than death from 'euthanasia'.

This even extends to the use of drugs
to keep the patient completely and continuously unconscious
until natural death occurs.
Such 'terminal sedation' is much more common than 'euthanasia'. 
But the lack of required reporting means that the exact frequency
of such life-ending decisions is not known.
Death by terminal sedation might be 10 times as common
as death by 'physician-assisted suicide' and 'euthanasia' combined.

    The Dutch system for making life-ending decisions
involves just the patient and his or her doctors.
Others might be involved in rather informal ways,
such as family members and nurses,
but the official decision is made by the patient
and his/her primary-care physician.
When 'euthanasia' or 'physician-assisted suicide' is being chosen,
at least one other physician must be consulted and approve.

    This book provides an excellent over-view of how
'euthanasia' and 'physician-assisted suicide' are achieved in Holland.
Other life-ending decisions are much more common,
but they do not require any special consultation and/or reporting.

    In the future, the Netherlands might continue to lead the way
toward more liberal and transparent life-ending decisions.
Other methods of choosing death
besides 'euthanasia' and 'physician-assisted suicide'
will become more widely acknowledged and discussed.
Some of these methods of dying are already
well-accepted practices within normal terminal care.
But other methods of dying
(such as taking sleeping pills or giving up food and water)
are chosen primarily by the patients when they are ready to die.

    Will Dutch law be the first to recognize officially
the difference between 'voluntary death' and 'irrational suicide'?



4. Richard N. Côté

In Search of Gentle Death:
The Fight for Your Right to Die with Dignity

(Mt. Pleasant, South Carolina: Corinthian Books: www.corinthianbooks.com, 2012)       405 pages 
(ISBN: 978-1-929175-36-9; hardcover)
(Library of Congress call number: R726.C68 2012)

(not to be confused with a small book of 42 pages published in 2008
which had the same ISBN as the hardcover edition of this book
and the same main title.  Its subtitle was "A Brief History of the NuTech Group".)

    A Social History of the Right-to-Die: The End of the Beginning?

    Historian and journalist, Richard Côté, here profiles
the major movers in the right-to-die up to 2012.
Readers will recognize these names: Derek Humphry, Jack Kevorkian,
Sue Rodriguez, Philip Nitschke, Rodney Syme, Faye Girsh,
Richard MacDonald, Pieter Admiraal, Boudewijn Chabot,
Stanley Terman, Ludwig Minelli, Michael Irwin, & Russel Ogden.
Dozens of lesser-known characters also grace these pages.
Almost 100 pictures are included.

    Writing this book took 5 years.
It is based on published materials
and personal interviews with many of the major figures.
Forty-two formal interviews were video-recorded.
Some short segments of these are available on YouTube.
(Search term: "In Search of Gentle Death".)

These allow us to see the faces and hear the voices
of some of the people we can read about in this book.
30 pages of source-notes and 10 pages of bibliography appear at the end.

    Some chapters profile a single leader of the right-to-die movement.
Other chapters deal with major themes such as new methods of dying.

    Because the author wanted to write a narrative of his experiences
rather than a book of straight exposition,
he named his chapters obscurely.
(As a service to potential readers, in parentheses
this reviewer adds a brief account of each chapter.)

Ch. 1  The Parallel Universe
(George Exoo helps Rosemary Toole to die)

Ch. 2  Good-bye, My Love
(Derek Humphry starts a revolution)

Ch. 3  Euthanasia's Lightening Rod
(Jack Kevorkian is the Lone Ranger of doctor-assisted dying)

Ch. 4  The Twilight Zone
(famous cases of the right-to-die)

Ch. 5  Who Owns My Life?
(Sue Rodriguez and the Canadian scene)

Ch. 6  Robbing Death of Its Sting
(new technology for voluntary death)

Ch. 7  Grandma Martens Makes Her Rounds
(voluntary death in Canada)

Ch. 8  The Search for the Peaceful Pill
(Philip Nitschke and Australia)

Ch. 9  Death Down Under
(more about Australia and New Zealand)

Ch. 10  Caring Friends and Hemlock's End
(strife and evolution in right-to-die organizations)

Ch. 11  Going Dutch
(the right-to-die in the Netherlands)

Ch. 12  The Battleground States
(some American states change their laws)

Ch. 13  Esta Es Mi Volundad
(the right-to-die in Latin America)

Ch. 14  One-Way Tickets to Zurich
(voluntary dying at Dignitas)

Ch. 15  The Disunited Kingdom
(struggling for the right-to-die in Great Britain)

Ch. 16  Those Feisty Scots
(leaders of the right-to-die in Scotland)

Ch. 17  A Rising Tide Lifts All Ships
(the right-to-die in other lands)

Ch. 18  Seeker of the Grail Secrets
(Russel Odgen in British Columbia)

Ch. 19  The Big Sting
(the Final Exit Network and law enforcement)

Ch. 20  Seamless Care for a Gentle Death
(reasonable choices at the end-of-life)

    Who will read In Search of Gentle Death?
First, the approximately 425 living people listed in the Index.
Perhaps only Derek Humphry knew more people
in the right-to-die movement than Dick
Côté.
(And, yes, this reviewer is also mentioned.)

    Everyone concerned about the right-to-die should read this book.
It is an interesting and pleasant review
of the first bumpy years of the right-to-die movement.

    Because this book summarizes what has happened
in the last several years leading up to publication,
it looks backward more than it looks forward.

    It uses such terms as the following: "euthanasia",
"physician-assisted suicide", "hasten death", & "medication".

These are the terms and thought-forms of the leaders profiled.
And the author was correct to use their very words
especially in quotations.
But more forward-looking authors
should use more appropriate words

when writing in their own voices.
Others who write about the future of right-to-die
can be more careful to use expressions
that cannot be distorted by the opposition.

    "Gentle Death" is certainly a good replacement for "euthanasia".
Who could be opposed to having a gentle death?

"Assisted dying" would be better than "physician-assisted suicide".

"Timely death" would be better than "hastened death".

And "gentle poison" would be better than "medication".
See my recommendations for new expressions on the Internet:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/RTD-BKS.html

    These traditional expressions appear dozens of times.
Readers familiar with the history of the right-to-die
will read right over these code words,
but people who are exploring the right-to-die for the very first time
will be pulled into the past when they come across
"euthanasia" and "assisted suicide".

    Even the expression "death with dignity"
does not correctly describe choosing gentle death.
Do deaths with little or no element of choice lack dignity?

    The basic reason I have entitled this review:
"The End of the Beginning"
is because everything in this history fails to notice
that thousands of life-ending decisions
are already taking place in modern hospitals
as a part of normal medical practice.
When we readers of this book come to the end of our own lives,
very likely we will make significant life-ending decisions.
Or reasonable life-ending decisions will be made for us by our proxies.
To what degree do we already have the right-to-die?

    Doctors, patients, & their proxies
are already making the following four kinds of choices,
which bring human life to a peaceful and timely end:
(1) increasing pain-medication, (2) terminal sedation,
(3) ending curative treatments and disconnecting life-supports,
& (4) medical dehydration.
Perhaps the organized right-to-die movement
has helped this quiet revolution in medical care to advance.
Maybe all we need now is better communication
with the doctors who will be taking care of us at the end.

    More discussion of this quiet, behind-the-scenes revolution
will be found in my on-line essay with the following title:
"Four Medical Methods of Managing Dying".
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-L-END.html

    If In Search of Gentle Death marks the end of the beginning,
then the next phase will be better cooperation between
the advocates of the right-to-die and the medical profession.
We might see a shift from the 'suicide-model right-to-die'
to the 'medical-model right-to-die'.
Hospital deaths will usually include a meaningful element of choice.
And hospice
care will include all the legal methods of choosing death.

    Nevertheless, Richard Côté has done us a great service
by putting all of this interesting and useful information into one book.
Sadly, his own life came to a sudden end in 2015.




5. Guenter Lewy

Assisted Death in Europe and America:
Four Regimes and Their Lessons

(New York: Oxford University Press: www.oup.com, 2011)       250 pages
(ISBN: 978-0-19-974641-5; hardback)
(Library of Congress call number: R726.L49 2010)

    This book is a careful presentation of all the facts about
acknowledged assistance by doctors in the deaths of their patients.
The longest chapter deals with the Netherlands.
But other chapters discuss doctor-assisted death in
Belgium, Switzerland, & Oregon.
Using the original terminology, these are legal deaths
by means of "euthanasia" and "physician-assisted suicide".

    Holland developed its current policies and laws
by means of a long series of policy recommendations,
court cases, & legislation.

    All of these jurisdictions have at least 10 years experience
with allowing people to choose the best time and place to die.

    Holland was the first to allow physicians to help their patients die.
Systems of training and recording have evolved,
so that now there is wide-spread public acceptance
of the possibility of asking one's family doctor
for help in drawing life to a close.

    Belgium closely followed the Dutch model,
with the inclusion of a few more safeguards.

    Switzerland is known as a death-tourism location
for people who could not get help in dying in their home countries.
Several private organizations have evolved to allow the Swiss
and citizens of other countries to choose death.
Attempts have been made by various levels of government
to control these private right-to-die organizations.
But basically they are allowed to operate
as long as they do not assist in any outrageously-foolish deaths.

    The facts about Oregon's Death with Dignity Act
are well known, but they are summarized here.

    Because this book is written from a legal point of view,
it does not touch on the other forms of life-ending decisions
now used by doctors in all four of these locations.
The more common methods of choosing death
are not subject to any special laws and regulations.


6. Lynn Hagger & Simon Woods, editors

A Good Death?
Law and Ethics in Practice   

(Farnham, UK: Ashgate: www.ashgate.com, 2013)       180 pages  
(ISBN: 978-1-4094-2089-7; hardback)
(Library of Congress call number: KD3410.E88H34 2012)

    Writing in the context of British law and practice,
several academics, lawyers, & doctors discuss the following
questions concerning end-of-life choices and care:
Can the patient demand more care than the doctor offers?
Has modern dying become more a process than an event?
When does personhood begin and end?
Should the United Kingdom allow suicide clinics like Dignitas?
When taxes are paying for health care, what limitations are appropriate?
How can palliative care improve the process of dying?
How shall we make end-of-life decisions for dying children?

    Careful thinking about the last year of each human life
can bring us closer to achieving good deaths.

    These authors explore the subtle dimensions of end-of-life medical care
without taking preconceived ideological positions.



7.  Michael Schiavo with Michael Hirsh

Terri: The Truth

(New York: Dutton, 2006)       360 pages
(ISBN-10: 0-525-94946-1; hardback)
(ISBN-13: 978-0-525-94946-6; hardback)
(Library of Congress call number: R726.S35 2006)

    Terri Schiavo—the author's wife—
became a major name in the right-to-die debate
as she reached the end of her life in 2005,
after 15 years in a persistent vegetative state.

    This book is a personal account in which Michael Schiavo
tells the story of her life and death as known to him,
the person who was closest to her
and to the events that led to her collapse in 1990
and to her being disconnected from life-supports in 2005.

    Michael Schiavo is well aware of other accounts of the same events,
which is the reason he has sub-titled his book The Truth.

    This reviewer also read the book by the Schindler family
in parallel with reading this book,
following the two accounts of the events year-by-year in both books.
It is quite remarkable that a family that was originally very close
could be so dramatically split by this right-to-die controversy.
The same events are often given diametrically-opposite interpretations
by the two sides of this family dispute about the fate of Terri Schiavo.
The Schindlers' book—called A Life that Matters
is reviewed in
the bibliography of Books Opposing the Right-to-Die.

    Immediately after her collapse,
Michael was completely devoted to helping his wife recover.
He spent many days by her bedside
watching for the slightest sign that she was conscious again.
But after several months and many failed attempts to rehabilitate her,
Michael had to agree with the doctors that his wife would never recover.

    The jury in the 1992 malpractice trial determined that Terri herself
was 70% responsible for her own collapse,
which was most likely due to an eating disorder,
which ultimately caused her heart to go into fibrillation,
which deprived her brain of oxygen,
causing a persistent vegetative state that lasted for 15 years
until she was ultimately disconnected from life-supports.
The other 30% responsibility was assigned to her doctors,
who failed to diagnose her eating disorder,
which could have been treated, preventing her death.

    The long, complex legal wrangling over Terri's guardianship and fate
is discussed in full in both books, but that will not be reviewed here.

    In the year 2000, Michael was first empowered by the court
to remove Terri's feeding-tube.
It took 5 more years of appeals,
intervention by the Florida legislature and governor,
and ultimately the U.S. Congress and the President
before the court cases were ultimately settled
—ordering the removal of Terri's feeding-tube.

    A secret video-tape was made by the Schlinder family,
which was widely shown on television.
It was convincing enough to many viewers
that most public opinion favored keeping Terri 'alive'.
A number of neurologists diagnosed Terri from this tape
as being in a "minimally conscious state"
rather than being in a persistent vegetative state.

    But when the court ordered 5 experts to examine Terri,
the majority determined that she was in PVS,
which was confirmed by autopsy after her final death.
(The two experts selected by the Schindler family
did not agree that Terri was in PVS.)
The autopsy showed that her brain had shrunk to half normal size,
that she could not see, and that there was never any hope of recovery.
Terri's brain was even more gone than most patients in PVS.
The apparent 'responses' seen on the video-tape
were random events originating in Terri's brain-stem,
not actual responses to anything in her environment.

    Even Pope John Paul II got involved indirectly.
He declared the tube-feeding of patients in PVS
is not medical treatment but a normal means of caring for the sick.

    Actually, Roman Catholic priests lined up on both side of the case
some saying that she should be kept on life-supports
and others saying that she should be allowed to die.
Such religious opinions affected the public's responses to the case,
but they did not affect the legal rulings,
which ultimately led to removing Terri's feeding-tube in 2005.

    Michael reminds us at the end of his book
that Terri Schiavo would not have become a 'household name'
if she had had an Advance Directive for Medical Care,
which would have been immediate "clear and convincing" proof
that Terri did not want to be kept 'alive' by a feeding-tube
if she was never going to recover.

    Whatever we want, if ever we are in a similar condition,
we should state our wishes clearly and unambiguously
in our Advance Directives for Medical Care.

    If you would like to see possible language to put into your 'living will'
so that you will not be kept 'alive' indefinitely on life-supports,
go to the following website created specifically
to help others avoid Terri Schiavo's fate:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/TERRI.html



8.  Lois Shepherd

If that Ever Happens to Me:
Making Life and Death Decisions after Terri Schiavo

(Chapel Hill, NC: University of North Carolina Press: www.uncpress.unc.edu, 2009)        222 pages
(ISBN: 978-0-8078-3295-0; hardcover)
(Library of Congress call number: R726.8.S4755 2009)
(Medical call number: WB65S548t 2009)

   
A professor of law and public health sciences
offers a comprehensive review of all the facts and opinions
surrounding the case of Terri Schiavo,
who was sustained by a feeding-tube from 1990 to 2005.

    The chapters:

    1.  Was Terri in a Permanent Vegetative State?
How PVS is diagnosed and distinguished from minimally conscious state.

    2.  Fighting over her body in courts, media, & legislatures.

    3.  How do we choose for patients
who have lost decision-making capacity?

    4.  How do we ascertain the wishes of the patient
who can no longer communicate?

    5.  Would a 'living will' have settled the controversy?

    6.  How should surrogates be selected and empowered?

    7.  How do we evaluate the quality-of-life of a patient who cannot speak?

    8.  What are the purposes of various forms of proving food and water?

    9.  Is the 'preservation of life' for the benefit of the patient or others?

    10.  We should take the specific condition of each patient into account
in making any end-of-life medical decisions.

    Several years later, the case of Terri Schiavo is now a fact of history.
What have we learned from that very public controversy?




9.  Kenneth W. Goodman, editor

The Case of Terri Schiavo:
Ethics, Politics, and Death in the 21st Century

(New York: Oxford University Press: www.oup.com, 2010)       259 pages 
(ISBN: 978-0-19-539908-0; hardcover)
(Library of Congress call number: R726.C358 2009)
(Medical call number: WB33AA1C337 2009)

    Eleven contributors discuss this famous case of the right-to-die. 
In retrospect the following facts are well established:
Terri Schiavo was in a persistent vegetative state for 15 years
before her body was finally disconnected from its feeding-tube.
There was never any chance of rehabilitation
because her brain had shrunk to about half its normal size.
She was blind and unaware of anything that happened to her.

    The mass media misled many people into believing
that Terri Schiavo should have been kept 'alive'.
Chapter 10 shows why and how television news got it so wrong.
Neurologist Ronald Cranford presents a convincing case that she was in PVS.
His is perhaps the best chapter in the book.
Another chapter shows how disability-rights groups misused Terri
to support their own agenda of protecting the rights of the disabled.

    At least for people who were uncertain about Terri Schiavo,
this book should lay to rest any lingering doubts.

    If you have time to read only one book on Terri Schiavo, read this one.




10. Arthur L. Caplan, James J. McCartney, & Dominic A. Sisti, editors

The Case of Terri Schiavo:
Ethics at the End of Life

(Amherst, NY: Prometheus Books: www.prometheusbooks.com, 2006)       352 pages
(ISBN-10: 1-59102-398-X; paperback)
(ISBN-13: 978-1-59102-398-2; paperback)
(Library of Congress call number: R726.C357 2006)
(Medical call number: WB60C377 2006)

    This is a collection of writings previously published
having some bearing on the case of Terri Schiavo.
Some are provided as background medical ethics.
Others specifically discuss the case of Terri Schiavo.

    Main sections: Facts and other cases of patients in PVS;
Florida legal decisions; Federal actions: courts, Congress, President;
Roman Catholic positions on patients in PVS; aftermath.

    This reviewer found the Roman Catholic section the most useful.
It shows that many different Catholic moral thinkers
have faced the issue of what to do with patients in PVS.
Most of these thinkers find some situations
in which it would be permissible to disconnect life-support systems.

    This volume can be used mainly as a source book:
It
presents the basic facts and general opinions for further study.
The introduction to each section is rather brief.
And some of the more technical documents, such as the autopsy report,
could have been explained in terms more readily intelligible to laypersons.
Other books about Terri Schiavo
provide deeper analysis of the implications of her case.



11. Shai J. Lavi

The Modern Art of Dying:
A History of Euthanasia in the United States

(Princeton, NJ: Princeton University Press: www.pup.princeton.edu, 2005)       226 pages
(ISBN:  0-691-10263-5; hardcover)
(Library of Congress call number: R726.L3797 2005)

    The process of dying in the United States freshly examined:
In the early years of the USA, dying was more an art,
often with deep religious dimensions.
But in more recent times, regular medical techniques
have shaped the process of dying.

    This history of aid in dying goes up to the 1960s,
altho an epilogue mentions more recent developments.

    One chapter examines palliative care as a new pathway towards death:
Chapter 5: "Lethal Dosing: Technique beyond the Law".
This reviewer discusses these methods of choosing death as
increasing pain-medication and terminal sedation.
Pain-killers have become standard in most managed deaths.
And instead of on-and-off pain-relief, the standard practice has become
to provide a continuous stream of drugs to prevent suffering.

    The use of sedatives at the end of life
has not been included in the discussion of "euthanasia"
because the primary, direct purpose for using the drugs
has not been to cause the patient to die.
Rather, such palliative care eases the process of dying
without explicitly shortening the time between
the beginning of this medical treatment
and the date of the patient's death.

    Hundreds of books debate 'euthanasia' pro and con,
but only a few books acknowledge that many more patients
are meeting death with the help of palliative drugs.

    These medical practices at the deathbed
have become standard health-care without any of the public debate
that surrounds the use of gentle poison to bring death.
Originally palliative drugs came into use under the principle of double effect:
Doctors may prescribe pain-relief in reasonable amounts
as long as the purpose of giving the drugs is not to cause death.
Shortening the process of dying is likely to be foreseen but not intended.

    A few states have modified their laws to allow such use of drugs.
But even without any change of law,
doctors everywhere in the USA are prescribing palliative drugs,
which often do (as a side effect) shorten the process of dying.
This pathway towards death has not aroused any public or legal debate.
While the right-to-die debate rages on and on
with respect to "euthanasia" and "physician-assisted suicide",
which might apply to as many as 10 deaths in a thousand,
palliative drugs are being provided to 500 patients
of the next 1,000 who are on their deathbeds.

    This book would have achieved its purpose more directly
if the author had avoided the word "euthanasia" entirely. 
The subject of this historical research was practices at the deathbed.
Death used to be accepted more openly and compassionately.
But now standardized medical techniques are applied to all deaths
that take place in hospitals, nursing homes, & hospices.

    Another chapter explores several cases of 'mercy-killing'.
These are deaths caused by the direct actions of a family member.
And they were motivated by the suffering of the 'victim'.
Even tho such acts of killing are against the law everywhere,
the loving perpetrators were seldom punished.

    The application of reasonable safeguards for life-ending decisions
could have prevented all of these cases from ever going to criminal trial.
The present reviewer has laid out four basic differences between
'mercy-killing' and 'merciful death' in an Internet essay entitled:
Will this Death be a "Mercy-Killing" or a "Merciful Death"?
This essay presents 10 powerful safeguards
that will prevent the crime of mercy-killing
while at the same time allowing reasonable life-ending decisions.

    Because this book takes a new look at the history of dying,
it can easily be read alongside other books that cover the same subjects. 



12. Steven W. Smith

End-of-Life Decisions in Medical Care:
Principles and Policies for Regulating the Dying Process

(Cambridge, UK: Cambridge University Press: www.cambridge.org, 2012)       350 pages
(ISBN: 978-1-107-00538-9; hardcover)
(Library of Congress call number: R726.S55 2012)

    This book reviews the philosophical and legal thinking
surrounding the process of making life-ending choices for patients
in the United Kingdom and the United States.
The author deals exclusively with those life-ending decisions
that this reviewer calls "voluntary death" and "merciful death".
These reasonable choices at the end of life
are usually initiated by the patient and/or the family.

    Life-ending decisions initiated by doctors are hardly mentioned.

    The book is based on written materials published previously
rather than original research into how particular patients met death.

    The latest developments in law and practice are included.
But no original or creative insights appear.
Readers deeply interested in right-to-die issues
will be the main readers of this book. 

    An Internet search of the title will discover the specific contents.



 
13. Milton D. Heifetz 

The Right to Die

(New York: Putnam, 1975)

     The best book on the right-to-die: comprehensive, with good examples,
well-documented, readable, insightful, forthright, well-argued.
Deals with: merciful death (for adults and defective infants),
refusing treatment, voluntary death, definitions of death,
organ transplants, & hospices.




14. Derek Humphry & Mary Clement 

Freedom to Die:

People, Politics, and the Right to Die Movement

(New York: St. Martin's Press, 1998)       388 pages
(ISBN: 0-312-19415-3; hardback)
(Library of Congress call number: R726.H844 1998)

     No single individual is more central to the right-to-die movement
than Derek Humphry, who founded the Hemlock Society in 1980
and who has written several book on the subject. 
(In 2003 the Hemlock Society renamed itself End-of-Life Choices.
And in 2004 it merged with Compassion in Dying,
taking the new name Compassion & Choices.)
This book is a summary of the history
of the right-to-die movement up to 1998.
The right-to-die emerged in response to modern medical technology,
which can keep bodies 'alive' longer than ever before imagined.
Humphry and Clement summarize the most famous right-to-die cases:
Quinlan, Cruzan, Kevorkian, Quill.
They summarize the then-current policies in the Netherlands,
which allow a physician to assist a patient to die
when specified safeguards are fulfilled.

     Detailed accounts are given to the efforts to win the right-to-die
on the West coast of the United States: California, Washington, Oregon.
These states have referendum laws,
allowing the people to create laws directly by a popular vote
—when the elected lawmakers are too timid to enact a particular law.
One drawback of this means of changing the laws
is that the debates tend to be reduced to 30-second television ads.
Oregon was the first state to allow physicians to aid a voluntary death
—by prescribing lethal drugs after careful safeguards were fulfilled.
(The complete text of the Oregon law is included as an appendix.
The Oregon law with annual reports is also available on the Internet.)

     The U.S. Supreme Court found no right-to-die in the Constitution,
but the justices left the door open for states to write new laws.

    Humphry and Clement even include a chapter on
the high cost of medical care at the end of life,
—an argument for the right-to-die that is open to easy attack by opponents,
who will suggest that some people will be put to death to save money.
Voluntarily-created 'living wills' or Advance Directives for Medical Care
can accomplish the same goal, but few people have written them.
And sometimes doctors do not know about 'living wills' or ignore them.

     This book is an excellent place to begin reading
about the right-to-die movement.  
It is based on Derek Humphry's personal experiences
and all published sources.




15. William H. Colby

Unplugged:
Reclaiming Our Right to Die in America


(New York: American Management Association: www.amacombooks.org, 2006)       272 pages
(ISBN: 978-0-8144-0882-7; hardcover)
(Library of Congress call number: RC726.C637 2006)

   
William Colby is the attorney who represented the Cruzan family
in the famous case of Nancy Cruzan, who was finally allowed to die in 1990.
This book also deals with other right-to-die cases.
Terri Schiavo is given three chapters at the beginning of the book.
Medical technology is now able to keep bodies 'alive'
for many years after the death of the person.
And the law has been slow to respond to these new medical situations.

    Some of the other issues explored:
definitions of death, Advance Directives, Do-Not-Resuscitate orders,
deciding medical care for patients
who have lost the capacity to decide for themselves,
the power of doctors to follow their own standard medical procedures,
artificial nutrition and hydration,
opposition to the right-to-die, including the worries of disabled people,
physician assistance in dying, & hospice care.

    Colby has written a lucid and informative book
exploring many issues surrounding the right-to-die.
He often explores the historical background of current controversies.




16. Sidney Wanzer, MD & Joseph Glenmullen, MD

To Die Well:
The Right to Comfort, Calm, and Choice in the Last Days of Life

(Cambridge, MA: Da Capo Press: www.dacapopress.com, 2007)       209 pages
(ISBN: 978-0-7382-1083-4; hardback)
(Library of Congress call number: not given in book)

   
Dr. Wanzer is physician who believes in the right-to-die.

    He begins his book by telling the story of his own mother,
who was inappropriately given a pacemaker at age 92,
even tho she had a 'living will' rejecting life-prolonging treatments.
She had been diagnosed with Alzheimer's two years before,
which prevented her from rejecting the pacemaker at the time.
Her doctor just proceeded to 'save her life'
because that was his standard operating procedure.
The pacemaker kept her 'alive' for another 5 years.

    This all took place back in the last century, in the 1980s,
but even then there should have been better communication
between the treating physician and the family.
And there should have been some written consent
by the authorized proxy before any such medical procedure.

    At the time Dr. Wanzer did not think he could do anything
to reverse this "medical travesty", as he now calls it.
If anything like this were to happen today,
it should be possible for the duly-authorized proxies
to reverse the medical decision
and decide that the pacemaker would not be maintained.
And that death would be permitted at the next legitimate opportunity.
A Do-No-Resuscitate order could now be placed in the patient's chart.

    The first half of this book deals with terminal care,
patients' rights, pain-control, etc.
And one original contribution might be the explicit shift in medical care
from trying to cure the patient to giving comfort care only.
Frequently this shift takes place without meaningful discussions.

    Another shift takes place when life-ending decisions are taken.
Here we enter the realm of the right-to-die,
which is the subject of the second half of this book.

    Sometimes patients take their own lives.
And such deaths are probably recorded as "suicide".
Wanzer warns against some do-it-yourself methods.

    But when physicians are involved in life-ending decisions,
Dr. Wanzer proposes 15 questions or safeguards,
which will help to separate harmful choices we do not want
irrational suicides and mercy-killings
from wise, helpful choices we can all endorse
voluntary death and merciful death.

1. treatment options:
Have all reasonable medical options at least been considered?

2. pain control:
Is the patient receiving all appropriate means of controlling pain?

3. misery and distress:
Are other forms of suffering being appropriately addressed?

4. consultation for second professional opinion:
Has a second doctor or specialist examined the patient
and suggested other possible modes of care or treatment?

5. clinical depression:
Has the patient been evaluated by a psychological professional
to see if he or she is depressed
more than should be expected in terminal illness?

6. hospice and similar services:
Is the patient benefiting from the best possible terminal care?

7. comfort care:
Is the patient being made as comfortable as possible?

8. informed consent:
"Is the suffering person fully informed about all alternatives?"

9. second doctor confirms the terminal condition:
Does a second doctor agree
that the patient is likely to die within 6 months?

10. capable medical decisions:
Is the patient still able to make wise medical choices?
If not, who decides?

11. clearly voluntary decision:
Is the patient obviously making a free choice?

12. patient decides what suffering is too much:
Has the patient evaluated his or her own degree of suffering?

13. impact on survivors:
How many family members agree with the life-ending decision?

14. participation by primary physician:
Has the doctor been part of the death-planning process?

15. readiness for death:
Is the patient ready (in every respect) for life to end?

    These questions do not ask for "yes" or "no" answers.
Rather, they are intended to lead to more complete discussion
among all concerned about the possibility of choosing a timely death
not too soon and not too late.

    A more formal set of 26 safeguards
recommended by this reviewer will be found here:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-A-Z.html

    If we have established that death now is better than death later,
we turn our attention to the various methods for achieving death:
1. disconnecting life-supports.
2. increasing pain medication.
3. terminal sedation.
4. terminal dehydration.
5. helium.
6. (where legal) life-ending chemicals.

 
   An Internet explanation of the first four of these is found here:
"Four Medical Methods of Managing Dying":
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-L-END.html

    Other chapters discuss in detail:
'clinical depression';
deciding for victims of Alzheimer's disease;
advance directives for medical care.
The full table of contents can be found on the Internet.




17. Tom Preston, MD

Patient-Directed Dying:
A Call for Legalized Aid in Dying for the Terminally Ill.

(New York: iUniverse: www.iuniverse.com, 2006)     180 pages 
(ISBN-10: 0-595-38144-8; paperback)
(ISBN-13: 978-0-595-38144-9; paperback)
Library of Congress call number: not given in book)

    Dr. Tom Preston is a cardiologist 
who has been involved in the last days of several patients.
This book consists mainly of the stories of dying persons,
first the author's mother and then 4 other fictionalized stories
of families confronting their end-of-life choices.

    These accounts illustrate the problems
and decisions-making processes involved in terminal care.
Some were empowered to die according to their own advance plans.
But others had problems because of the standard operating procedures
of the medical establishment.

    In a final chapter, Dr. Preston argues for liberalizing laws
so that patients who are already on the way towards death
can shorten the process of dying and omit some unnecessary suffering.



18. Samuel Greenberg, MD

Euthanasia and Assisted Suicide:
Psychosocial Issues

(Springfield, IL: Charles C. Thomas, 1997)       164 pages 
(ISBN: 0-398-06785-6; hardcover)
(Library of Congress call number: R726.G74 1997)

    This is an open-minded book on the right-to-die
written by a psychiatrist.  
He does not break any new ground.  
And he does not prejudge any of the difficult cases he discusses.  

    The following summary of the contents shows the wide-range of this book:
Ch. 1  a good summary of the issues and the sides taken.
Ch. 2  a good summary of the high-profile cases of the previous 20 years.
Ch. 3  experiences in other countries: Netherlands, Great Britain, Germany.
Ch. 4  learning from the practices of veterinarians.
Ch. 5  physicians' attitudes are divided,
            but moving in the direction of the right-to-die.
Ch. 6  legal aspects: definitions.
Ch. 7  religion, morals, & bioethics.
Ch. 8  the hospice movement.
Ch. 9  right-to-die societies.
Ch. 10  a case of a severely defective newborn.
Ch. 11  looking toward the future.



19. Mary Warnock & Elizabeth Macdonald

Easeful Death:
Is There a Case for Assisted Dying?

(Oxford, UK: Oxford University Press, 2008)       155 pages
(ISBN: 978-0-19-953990-1; hardcover)
(Library of Congress call number: R726.W36 2008)
(Medical call number: WB60W285e 2008)

    Two British philosophers discuss the philosophical principles
behind the discussion of allowing physicians to help their patients to die.

    They draw especially on right-to-die cases
widely discussed in the media in Great Britain.

    Perhaps because they begin with media discussion of the right-to-die,
the main method of choosing a voluntary death they consider
is using lethal drugs prescribed by a doctor.

    But what about patients who want to die
because of mental, non-physical problems?
'Clinical depression' is widely assumed
to be a major cause of irrational suicide.
Should we allow patients with cloudy thinking to choose death?
Should patients be protected from irrational urges toward self-destruction?
What should happen with mental suffering
prevents patients from evaluating their end-of-life options?

    The solution suggested by this reviewer
is the careful selection of a Medical Care Decisions Committee,
which will be empowered to make medical decisions for the patient
whenever the mental capacity or rationality of the patient is in question.
They will always listen to the immediate 'wishes' of the patient,
but they will not always agree to cooperate.
In other words, the patient selects wise persons
who are known to have the patient's best interests at heart
who will protect the patient from possibly-irrational suicidal decisions.
If and when the patient has good reasons for choosing a voluntary death,
then he or she should be able to convince
the close family members and friends who make up the MCDC
of the wisdom of the patient's chosen pathway towards death.

    This approach to the right-to-die focuses on the individual patient.
The life-ending decisions will be taken by the patient himself or herself,
possibly with the assistance of the people who are closest to the patient.
Whether or not to approve a specific chosen death
is not left to a group of strangers,
who will apply abstract guidelines for life-ending decisions.

    As an illustration of psychological reasons for wanting to die,
the authors discuss the Chabot case in the Netherlands:
A suicidal woman came to a psychiatrist, Dr. Chabot,
and explained her wish to die.
She had previously tried to kill herself, unsuccessfully.
And she wanted professional help to achieve a good death.
All of the members of her family were dead
and she could find no further reason to go on living.
Dr. Chabot felt that he could not prevent her suicide,
so he agreed to help.
The court ruled he should have sought the opinions of other physicians.
But no penalty was imposed.
However, the fact that the court could have ruled otherwise
shows some problems with the right-to-die in the Netherlands.
Those who help others to die do not always know
how they will be treated by the law and the courts.

    In this case, the application of additional safeguards
would have helped to clarify the options.
Perhaps other solutions beside death would have emerged.
Dr. Chabot now recommends voluntary death by dehydration.
This pathway towards death would have forced the woman
to re-examine her reasons for wanting to die several times
during the process of dying.
And she might have changed her mind.
Friends, previously-distant relatives, and even neighbors
might have helped her to adjust to her new situation of grief.
Many people have eventually found ways to recover from bereavement.
Sometimes just the passage of time
allows the early urge toward irrational suicide to dissipate.

    Dr. Chabot determined that the woman was not clinically depressed.
It was a philosophical suicide:
She had decided to die
with or without his help.
And Dr. Chabot believed that his role was
merely to determine whether she really wanted to die.

    Mary Warnoch and Elizabeth Macdonald also discuss neonates
who are born with serious birth defects.
Sometimes governments have set standards
that go beyond what the parents want.

    Another chapter discusses adults who cannot decide for themselves.

    And another deals with the question of the 'sanctity of human life'.

    If we allow some wise deaths to be chosen,
how will we prevent other, premature deaths?
Does the right-to-die create a slippery slope?

    Most doctors do not want to kill their patients,
but they are sometimes open to allowing death to come.

    Another chapter explores specific methods of choosing an easeful death:
(1) giving up food and water;
(2) terminal sedation
keeping the patient unconscious until natural death;
Here increasing pain medication without causing coma is also discussed.
(3) lethal drugs prescribed by a doctor;
(4) back-up euthanasia in case other methods are impossible or if they fail.
But, in general, these authors favor only assisted dying,
not directly causing death.
In their terms, they say yes to "assisted suicide" and no to "euthanasia".

    The authors foresee changes in laws
to allow doctors to give more direct assistance in dying.

    This is a small, useful, supportive book,
which reviews the right-to-die issues as already present in media discussion.
The authors do not go beyond the depth of educated readers
and they do not break any new ground.
But Easeful Death could be a good place to begin reading about the right-to-die.




{last} James Leonard Park

How to Die:
Safeguards for Life-Ending Decisions

(Minneapolis, MN: Existential Books, in process)       600 pages
(ISBN:                                        )
(Library of Congress call number:             )

    Rather than being another suicide-manual,
as might be suggested by the provocative title,
this book is strongly opposed to irrational suicide.
Instead of endorsing the right-to-die
as an implication of the right-to-commit-suicide,
this careful book fully embraces modern medicine
as doctors, their patients, and/or the patient's proxies
attempt to make wise, end-of-life medical choices.

    All of the readers of this book will die,
no matter when they were born.
But all who were born in the 20th century
and who were still alive in the 21st century long enough to read this book
will probably die while under some kind of medical care. 
And in more than half of these deaths
there will be a meaningful element of choice.

    As the practice of modern medicine evolves,
there will be ever greater recognition
of significant choices being made at the end of life.
Life-ending decisions that used to be downplayed and obscured
will come more into the open.
And with this greater honesty about how life ends,
there will be an emerging need for better safeguards
for the process of making decisions that terminate human lives.

    The core of this book presents 26 careful safeguards,
which can be applied selectively to all life-ending decisions.
Fulfilling these safeguards will involve several other people
beyond the patient and his or her doctors.
Depending on the specifics of each life-coming-to-an-end,
some safeguards will be more relevant than others.
And some will become completely impossible.
If, for instance, the patient is already in a coma,
the patient can no longer be asked about medical decisions.

    Fulfilling the most relevant safeguards
will be the most practical and convincing way to separate
irrational suicide from voluntary death
and mercy-killing from merciful death.

    Consistent and faithful use of the most meaningful safeguards
will enable the right-to-die movement to emerge from the shadows
of its early attempts to empower people to choose a reasonable death.
Even before right-to-die laws are enacted to embody such safeguards,
consulting the recommended people and getting their written approval
will almost guarantee that everyone who helps other people
to choose a timely death will not face prosecution
wherever a jury of their peers would decide their guilt or innocence.
Common sense will prevail when the fulfilled safeguards
point toward a chosen death as the best solution.

    This volume concludes with 7 bibliographies (63 pages),
reviewing dozens of other books on themes related to the right-to-die.

    Best of all, the compete text of How to Die:
Safeguards for Life-Ending Decisions
is available free-of-charge on the Internet:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/HTD.html

    And even after the printed and bound book is finally ready,
the revised text will remain as an Internet Book.

   A Facebook Group will discuss this book and offer advice for revisions:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/ED-HTD.html.

    This same review also appears in two other bibliographies:
Safeguards for Life-Ending Decisions---the Best Books.
Books on Life-Ending Decisions.




Because there are so many books on the right-to-die worthy of review,
this file was divided into two files in the middle of 2009.

The following file starts a new numbering system at 20.
In other words, the next file contains books lower in this reviewer's evaluation.
But readers are encouraged to judge for themselves.
There are 20+ more books here:
More Books on the Right-to-Die.


revised 4-17-2009; 5-29-2009; 6-15-2009; 7-1-2009; 4-19-2010; 8-12-2010;
2-8-2012; 2-15-2012; 2-29-2012; 3-23-2012; 4-5-2012; 8-30-2012; 9-8-2912; 10-18-2012; 10-29-2012;
4-13-2013; 4-24-2013; 5-2-2013; 7-3-2013; 7-17-2013;
2-18-2014; 6-12-2014; 3-25-2015; 4-14-2015; 9-5-2015; 7-26-2017; 3-3-2018;

    Please suggest additional books that should be included
in this (two part) bibliography supporting the right-to-die.
Send your suggestions to James Park: e-mail: PARKx032@TC.UMN.EDU

Several reviews from this bibliography are also included in the reviewer's book:
How to Die: Safeguards for Life-Ending Decisions.


    See related bibliographies:

Best Books on Voluntary Death

Best Books on Preparing for Death


Books on Terminal Care

Books on Hospice Care

Books on Helping Patients to Die


Medical Methods of Choosing Death

Books Supporting the Right-to-Die

Books Opposing the Right-to-Die


Go to the Right-to-Die Portal.


Go to the Book Review Index
to discover 350 other reviews organized into 60 bibliographies.


Return to the DEATH page.


Go to the Medical Ethics index page.


Go to the beginning of this website
James Leonard Park—Free Library