The Best Way to Say Goodbye: A Legal Peaceful Choice At the End of Life [Paperback]

Stanley A. Terman (Author), Ronald B. Miller (Editor), Michael S. Evans (Editor)

Book Description

Publication Date: November 28, 2007

What are our two greatest end-of-life fears? To endure unnecessary prolonged pain and suffering, and merely to exist in a state of total indignity and dependency such as in Alzheimer's dementia. Uninformed, some people add layers of tragedy to their destiny. Some choose to die prematurely; others, violently; a few risk imprisonment by mercy killing. Often their lament is, If only Physician-Assisted Suicide were legal. Yet there is an alternative that is already legal: Voluntary Refusal of Food & Fluid. While sometimes intentionally maligned as barbaric starvation, ceasing all Food & Fluid is a truly peaceful way to hasten dying by dehydration. While taking an average of 14 days, it allows for the exchange of healing goodbyes with loved ones who can forever be sure it was these patients' intent since they could have changed their mind.
What makes the process peaceful? Knowing how to control thirst. (The author went on two fasts himself to learn what works.) In addition, good discussions with family members before beginning. Consistent with the principles of some religions, this method is available even for patients who are physically too sick to put a lethal dose of medication in their mouths and swallow.
By creating strategically effective documents for a trusted agent or proxy to withhold Food & Fluid on the patient's behalf, this way to Permit Natural Dying can actually extend the quality of life of those with early dementia. They can enjoy living until they reach a point they have previously described in behavioral terms (perhaps with help from using one of the book's forms).
Beyond serving as an authoritative source of information to strive for an ironclad strategy for dementia, the book endorses life's most ironic fact: When people know they can control when they die--they can, and often do--choose to live longer.
Poignant memoirs illustrate its practical guidelines and useful forms; for example, why Proxy Directives are more effective than Living Wills, and how to make Living Wills work better if they are the only available choice.
The book-within-a-book format of this book is as unique as its content is comprehensive. Over 300 citations, an index, a glossary, and further resources... yet its core reading is user-friendly for all. The subject matter is lightened by 22 cartoons and humorous stories; deepened by provocative discussions of the secular meaning of Sanctity of Life ; and broadened by considering the emotional, practical, clinical, legal, moral, ethical, religious, spiritual, and political aspects of a subject that will affect absolutely everyone.

Editorial Reviews

Review

A comprehensive, insightful, and surprisingly entertaining guide through the maze of end-of-life decisions. It calms our greatest fear: that complete strangers can intrude on our most intimate decisions, and worse make decisions that we would not make for ourselves. Dr. Terman offers a close to ironclad strategy to preserve control at the end of life, even for those individuals who may ultimately suffer from severe brain damage or dementia. Every pitfall has been considered and solved! It also guides families through the chaos that results from inadequate advance care planning. This book is so good that our organization keeps copies at every office. It is a mainstay of the recommendations we provide our clients. --Barbara Coombs Lee, PA, FNP, JD; CEO of Compassion & Choices; Chief Petitioner for Oregon s Death with Dignity Act

Dr. Stanley Terman has provided a very insightful analysis of the President's Council on Bioethics' report, Taking Care: Ethical Caregiving In Our Aging Society. His detailed suggestions for wording Advance Directives are very important. While it may be Utopian to hope, as Dr. Terman proposes, that governmental agencies (such as motor vehicle departments) might require individuals to complete Advance Directives, it would be a major improvement over our present laissez faire policy of ignoring this issue. I am very supportive of responsible strategies to encourage individuals to complete such documents. The book's final story, She Revised her Advance Directives from 16 to 86, clearly illustrates how our views can change as we age and mature, and as our situation changes. Clearly, we need to update our Advance Directives on a regular basis. --Janet D. Rowley, MD, DSc; President s Council on Bioethics member; Albert Lasker Clinical Medicine Research Prize recipient

People think if they do not die instantaneously in a car accident or from a heart attack, they are going to be caught between two undesirable options--either to be attached to machines for a very long time, often in a state of unconsciousness with no reasonable hope for recovery, or, at the other extreme, to commit suicide or get someone to murder you so that you can end it all more quickly. In a wise, medically well-grounded, and even witty book, Dr. Terman explores the middle course: refusing tube feeding and hydration --Elliot N. Dorff, Rabbi, PhD; Distinguished Professor of Philosophy, University of Judaism; author of Matters of Life and Death

From the Author

This book is about choices. It also offers you choices in reading:

Start at the beginning and read everything, or if you prefer. . .

A) Read the book-within-a-book. Page 4 explains how to skip flagged portions to reduce the number of pages to just over 300.

B) Focus on Patient Stories and Legal Cases for discussion, Humorous Stories for fun, or Guidelines and FORMS for personal planning. The Table of Contents list all these Titles on pages xxv through xxx.

C) For a quick overview, read ten pages: "She revised her Advance Directives from age 16 to 86," and "Which documents do I need when?" on pages 383-389; and The Seven Principles of Good End-of-Life Decision-Making on 427-429. View thirst-reducing products on 104.

D) Delve into such general topics as the medical, legal, religious, or family aspects of end-of-life planning. The Table of Contents can guide your choice of chapters.

E) Implement a legal alternative to Physician-Assisted Suicide. You can avoid prolonged unbearable pain and suffering at the end of life as long as you are mentally competent. Read the answers to questions D, & numbers 1-9, 16, 19, 20, 32, 34, 36, 38, & 40.

F) Prevent years of indignity & dependency from Alzheimer's disease, vegetative states, or persistent unconsciousness. Learn how to set the stage now so others will honor your wishes in the future, if you no longer can speak for yourself. Read Chapter 3 and the answers to questions numbers 20-22, 25-31, 40, 41, and 43-45.

G) Expand your knowledge.

See all Editorial Reviews

Product Details

• Paperback: 489 pages
• Publisher: Life Transitions Publications; 1st edition (November 28, 2007)
• Language: English
• ISBN-10: 1933418036
• ISBN-13: 978-1933418032
• Product Dimensions: 9.9 x 7 x 1.2 inches
• Shipping Weight: 2 pounds (View shipping rates and policies)
• Average Customer Review: 4.6 out of 5 stars  See all reviews (14 customer reviews)
• Amazon Best Sellers Rank: #175,571 in Books (See Top 100 in Books)
  • #82 in Books > Health, Fitness & Dieting > Death & Grief > Suicide

Customer Reviews

Most Helpful Customer Reviews

32 of 33 people found the following review helpful:

5.0 out of 5 stars Can you control when you die? Will others honor your Last Wishes??, December 9, 2007

By 

Stephen Pletko "Uncle Stevie" (London, Ontario, Canada) - See all my reviews
(TOP 1000 REVIEWER)   

This review is from: The Best Way to Say Goodbye: A Legal Peaceful Choice At the End of Life (Paperback)

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"Death is not something any one need be afraid of. It is peaceful. What I fear is suffering a long time before I die."

The above is found in this extremely well researched, well-written, and empowering book authored by psychiatrist Dr. Stanley Terman. (It was Terman's mother who said the above quoted statements to her then young son.) Clinical professor & medical ethicist Dr. Ronald Miller and attorney & social worker Michael Evans "provided professional oversight" during the creation of this book by being "critical readers and contributors" to it.

Thus, any potential reader of this book can be assured that the information on its pages is completely accurate especially from legal, clinical-medical, psychological-sociological, ethical-philosophical, and religious perspectives.

This book deals only with the process of dying, not death. It specifically has two goals:

(1) To provide a description of a legal and peaceful choice or method of dying for most of those who are suffering from devastating, terminal conditions (such as permanent brain damage or incurable, progressive dementia). Two things should be mentioned about this method:

First, it gives the suffering patient sufficient time to reconsider his/her decision with no residual effects if the patient does reconsider. Therefore, there is some control.

Second, the author tested the method out on himself!!

(2) To maximize the probability that others will honor your Last Wishes especially if you cannot speak for yourself. Thus, Terman explains why we must create precise, non-ambiguous, strategic, written documents or forms that correspond to our Last Wishes and he shows us how to do that.

The bulk of this book is devoted to questions on the choice of dying advocated by this book and the comprehensive answers to these questions. However the book strives "to maintain balance in the presentation by revealing pros and cons, and by suggesting other strategies [or choices] that may be effective, so you can decide whether or not you wish this option [the one advocated in this book] for yourself or for your loved one." After a chapter that presents five general questions with answers, there are questions with answers that form the basis of chapters pertaining to:

(1) medical aspects (9 questions)
(2) religion versus science (4 questions)
(3) legality, civil rights, and safety (7 questions)
(4) competency, brain function, and Alzheimer's disease & related dementias (4 questions)
(5) creating strategic advance directives with regard to your Last Wishes (7 questions)
(6) the dying patient's family (5 questions)
(7) the role of physicians (4 questions)
(8) obtaining advice, securing a proxy (person designated to make medical decisions for you) , and to feeling secure that others will honor your Last Wishes (5 questions)

Besides having a book set up in a question and answer format where readers can zero in on those questions that pertain to their particular situation, there are many other features of this book. Here are the ones that I found to be particularly interesting and useful:

(1) Patient stories and legal cases (there are sixty):

It is important to read these for their instructive value. One specific thing to especially look for is to see what happens to patients when the advice in this book is not followed or not followed adequately.

(2) Humorous tales and cartoons (over twenty):

Included for two reasons: (i) to provide some comic relief since the book is dealing with a serious and difficult subject (ii) to provide instruction by highlighting a major point found in the main narrative or story. These can be skipped if the reader finds them inappropriate.

(3) Forms (six):

These are what you must create in writing (using the forms or documents in this book as guides) to insure that the probability that your Last Wishes will be honored.

(4) Choice of how to read this book (one page at the very beginning):

You can start at the beginning and read everything or you can choose one of the seven options of different ways to gain immediate value from this book. Especially note the option that gives a "quick overview" of the entire book.

(5) Comprehensive glossary (defines over fifty key terms):

Even though key terms are defined once in the main narrative, this glossary comes in handy if you forget a key definition. It also provides more information about key terms.

Finally, it should be emphasized that the important information in this book is not designed for minors, or for people with serious emotional disorders, or for use for illegal purposes.

In conclusion, Dr. Terman says the following in his preface:

"I hope that my writing this book honors my [deceased] mother."

From one who has thoroughly scrutinized this book and has been wowed by its comprehensiveness and sensitivity, I can confidently say that she would be quite honored and proud of her son for writing this much-needed and necessary tome!!

(first published 2007; your reading choices; foreword; acknowledgements; preface; prologue; 12 chapters; conclusion; epilogue; main narrative 440 pages; medical references and legal citations; glossary; further resources; index; about those who provided professional oversight; about the author and his end-of-life beliefs)

<<Stephen Pletko, London, Ontario, Canada>>

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17 of 17 people found the following review helpful:

5.0 out of 5 stars Very informative book that helps us face choices, December 28, 2007

By 

C. Campbell "ckc07" (Seattle, WA) - See all my reviews
(REAL NAME)   

This review is from: The Best Way to Say Goodbye: A Legal Peaceful Choice At the End of Life (Paperback)

After my Grandpa's massive stroke he could not speak. Some family members argued he'd want 'to join' his recently deceased wife of 70 years and would not want to live so inactive. Yet others interpreted statements in his Living Will as wanting to live. I dreaded that a conflict was about to begin. We'd never go to court, like Terri Schiavo's family, but old feelings and different perspectives on what it means to provide care and reduce suffering could have divided our family. A crisis was impending. Then, we all read a story in this book, A Time To Be Sure, and discussed using its series of questions. On three occasions, Grandpa was consistent as he shook or nodded his head to indicate what he wanted: To my surprise, he wanted to continue tube feeding. All of us felt relief. We could be sure that we knew what he wanted, and we were all united to provide that. My Grandfather passed in August of 2007. This time he looked at his caregiver and she told him its okay to go if he is ready and he died then. Peacefully and the way he wanted. This is an amazing book that helps us when making decisions about death. I recommend everyone read it!

17 of 18 people found the following review helpful:

5.0 out of 5 stars Fascinating Look at Controversial Topic!, December 14, 2007

By 

Jacqueline Marcell "Author, Speaker, Radio Host" (Irvine, CA United States) - See all my reviews

This review is from: The Best Way to Say Goodbye: A Legal Peaceful Choice At the End of Life (Paperback)

Dr. Terman offers many suggestions on how to make the process of dying peaceful... for patients, for physicians, and for family members--all of which makes this book both comprehensive and useful. He presents a compelling case for a legal and peaceful alternative to Physician-Assisted Suicide, which he terms: 'Physician-Aided, Patient-Hastened Dying.' He also provides a step-by-step guide for those who want to avoid lingering in a state of total dependency and indignity that can result from illness, including Alzheimer's and other dementias.

We learn that voluntary refusal of food and fluid is legal and has significant advantages for terminally ill patients: They have opportunities to change their mind, and precious days to make amends and say goodbye to loved ones. This was particularly meaningful for me, as I had a dear friend who was dying from a brain tumor recently who ended her life this way. Now I more fully understand her difficult decision and that of the late Mrs. Billy Graham who also refused tube-feeding.

The book gains depth from the contributing editors: a medical ethicist and an end-of-life attorney. Psychiatrist Terman strengthens his argument by sharing captivating and poignant memoirs by recognized authors (a favorite 'An October Morning'), as well as many from his patients. One, 'A Time To Be Sure,' so intrigued the attorneys for Terri Schiavo's parents that they included it in Dr. Terman's declaration to the Florida court, after asking him to help determine if Terri really wanted to continue tube-feeding.

Also included is: the importance of creating effective Advance Directives and why Proxy Directives can be more powerful than Living Wills to ensure our last wishes; a fascinating look at fourteen religious views on the refusal of food and fluid; and Terman's personal story of experimenting with a total fast, which taught him so much about controlling the symptoms of dry mouth he created a site called ThirstControl in addition CaringAdvocates.

-Jacqueline Marcell, Author of 'Elder Rage', International Speaker on Eldercare & Alzheimer's, and Host of the 'Coping With Caregiving' Internet Radio Show at wsRadio