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.
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.
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.
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.
4. Richard N. Côté
In Search of Gentle
Death:
The Fight for Your Right to Die with Dignity
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.
Some chapters profile a
single leader of the right-to-die movement.
Other chapters deal with major themes such as new methods of dying.
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.
"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
Holland developed its current policies and laws
All of these jurisdictions have at least 10 years experience
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".
by means of a long series of policy recommendations,
court cases, & legislation.
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
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.
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 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.
(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.
(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)
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,
This same review
also appears in two other bibliographies:
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.
Safeguards
for Life-Ending Decisions---the Best Books.
Books
on
Life-Ending Decisions.
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:
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.