Customer Reviews

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

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At last! Two doctors have written a right-to-die book with the patients' interests first. Very readable by the lay person, bundles of good advice on how a patient's best interests should be protected, and straightforward reporting on euthanasia and assisted suicide. Recommend for instant reading, and filing away for future problems. -- Derek Humphry ('Final Exit')

TO DIE WELL: YOUR RIGHT TO COMFORT, CALM, AND CHOICE IN THE LAST DAYS OF LIFE comes from a leader in the right-to-die movement, and a Harvard Medical School psychiatrist who offer insights on turning points in a dying patient's life: one when no reasonable expectation of a cure is possible, the second involving hastening death - the subject of this book. TO DIE WELL focuses on patient rights, physician involvement, and how to stay in control of advance directives. It promises to be an essential addition not just for medical libraries, but for general-interest collections.

As a card-carrying member of two organizations advocating euthanasia, I am gratified that two MDs took the trouble to write a comprehensive book about the subject. They discuss the moral, legal, and the how-to of this controversial subject. Especially significant are the chapters guiding readers about their right to refuse food and hydration, and using helium to bring about their self-deliverance.

Dr. Wanzer is a compassionate physician. He describes his hour-long discussions with patients and their caregivers in their homes and at hospitals. He often refers to the rights of dying patients to dismiss their non-cooperating physicians even when they are already in a hospital, and choosing a more empathetic doctor. The sad reality is that doctors stopped making house call quite a while ago, and found a way around treating their patients in hospitals. They are adamant about seeing patients in their offices for only 15 minutes, which allows precious little time to discuss the various options and methods to exit this world. Medicare (and the majority of dying patients carry this insurance) does not even compensate physicians for discussing questions about imminent death.

On page 145 the authors describe how to "avoid unwanted resuscitative measures." Absent clear instructions prepared beforehand, they advocate that the family avoid calling 911. But if that has been done, they suggest calling the patient's physician to deal with the responding emergency team. In over four decades of living in San Francisco, I have never had physicians answer my call personally. When I was lucky, they returned my call after office hours. Having called 911 makes it is essential for the family to speak to the doctor the moment they are connected to the office. Every second counts to prevent the responding team from commencing resuscitating the patient. That simply won't happen.

Likewise, the suggestion that patients who refuse food and water instruct the hospital staff not to check their vital signs or administer antibiotics when the need arises is extremely unlikely to be followed.

In summary, this pioneering work needs a companion book on how to deal with the present medical realities.

This book should be on the shelf of everyone who thinks he or she might indeed die some day, and on the shelves of caregivers and hospice volunteers and end-of-life professionals everywhere as well. It is honest, easily readable and crammed with useful information every thinking person should have. The authors identify the times - introducing the helpful concept of "turning points" - which most of us will encounter as our health declines, and outline how we can take charge of our lives by recognizing these times. The first is when "there is no reasonable expectation of a cure or of restoring health;" the second is when the prospect of hastening death may appropriately be considered. While the authors are physicians, and some of the writing seems aimed toward physician-readers, the book is for everyone and accessible for the lay reader. Its point-by-point instructions on patient rights and hypothetical situations will enable dying individuals and/or their families to be better informed of potential choices and to remain in control of their own lives. It is this recognition of the individual's right to retain control that makes To Die Well unique among books of its type. Also included are accurate summaries of documents everyone should have, useful histories and information on end-of-life organizations. So pair this book with another favorite - poems, essays, (or perhaps my own Dying Unafraid) - and do yourself and your loved ones a favor by spreading it around.

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' that rejected just such 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 on the Internet:
Search for this exact expression: "26 RECOMMENDED SAFEGUARDS (A-Z)"

If we have decided upon a timely death,
we turn our attention to the various
methods for achieving a voluntary death or a merciful 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 Legal Ways to Choose a Voluntary Death or a Merciful Death":
Search the Internet for this exact expression: "FOUR LEGAL WAYS".

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.

If you are might be interested in other such books,
search the Internet for: "Books on the Right-to-Die".

James Leonard Park, advocate of the right-to-die with careful safeguards.

This is the most informative book that I have read and I have read quite a few since my mother has been in a nursing home for 6 years.

I, along with others, always think doctors know best and let them intimidate us when we ask questions regarding their choice of treatment, etc. After reading this book I will be more assertive and not be put off by asking questions. If in doubt - ask why!

I also will have additional paperwork drawn up to add to my Living Will & Durable Power of Attorney for Health so that there can be no misunderstanding or questions as to what I would want if I was unable to make my own decisions. This will also relieve the guilt-burden from my children.

We all need to address these issues. We need to have our electives known concerning our own health.

This is the book for anyone that desires to have control of their lives and bodies during their last days.

This book is written by doctors who know what they're talking about. They favor palliative care at the end of life, but they also cover possibilities for people who don't want palliative care, and the few for whom pain killers don't work and want assisted suicide, or even may want to take suicide into their own hands, in the absence of legislation about assisted suicide. This may be contentious for some. Not for me. This book doesn't really add to my knowledge, only confirms it. But it may help others.
I'm glad I bought it.

It has many examlpes of possible problems with follwing my wihes. I am circulating to my children. Ver professional