This important book was written by a physician practitioner who was intimately involved with dying patients: it is not another ivory tower discussion of physician-assisted dying. Over the course of thirty years, Dr. Rodney Symes helped numerous terminally-ill patients die with dignity. The book covers, in detail, fifteen representative cases, "those for whom records and memory allow an accurate, and reasonably detailed, account."
"The Good Death" provides a rare view of the profound emotions and difficulties that doctors experience when they receive that cry from help. It's also about the clarity and certainty of the dying patients who ask for help. "I wrote the book to reveal the context in which these experiences take place to illuminate the black hole of misunderstanding and ignorance." The book is a journey of discovery for Rodney as he grapples with the moral and practical issues that surround assisted dying and palliative care. His conclusion: "Physician-assisted dying, by whatever method, is palliative treatment--let people choose what's best for them."
The journey began in 1974 when Rodney received a cry for help from Betty who was experiencing acute respiratory distress: "She stimulated my conscience, through emotions of guilt and shame, anger and frustration, to a belief that, as a doctor, I had a duty to respect autonomy and to relieve suffering, if requested." Even though Rodney was a trained physician, he had to learn about dying with dignity the hard way: through trial and error. Over the years, he learned how to evaluate the patients' requests and alleviate their anxiety. He learned how not to abandon his patients in their time of greatest need. He learned through experimentation about lethal drugs and their dosages. Quite by accident, he discovered the arcane practice of "terminal sedation" and the legal cover it provided via the principle of the double effect. He also discovered the various shortcomings of that practice, which he describes with acute medical acumen.
Rodney's journey takes place in Australia where assisted dying is illegal: it can land you twenty years in jail. Because of his strong principles, Rodney decided to test the envelope of the law. He documented every one of his cases and then informed the authorities. Some of his cases appeared in "The Age." He even wrote this book. Unlike Jack Kevorkian in the U.S., Rodney was never prosecuted. Why? Maybe it's because 85% of Australians support physician-assisted dying. Maybe it's because none of his patients died by lethal injection. In any case, Australia's prosecutors chose to avoid a confrontation. It seems that any open discussion of death and dying is taboo. The conspiracy of silence worked in Rodney's favor; it kept him out of jail.
Disclosure: I discovered this book after completing my own book on death with dignity. An Australian friend asked me what I thought of the Symes' book. Incredibly, I had completely missed this powerful contribution by a physician who is totally in accord with my own views on assisted dying. Like Rodney, I make the case that physician-assisted dying must be added to the palliative care repertoire of choices for dying patients. Like Rodney, I believe that filling the prescription can relieve the dying patients' toxic anxiety--a source of great suffering--as they face their approaching death. The prescription gives the patients some level of control at a time when they control very little. For some, it is just a form of insurance which they may never use. In all cases, it has a highly palliative effect: it allows patients to face their death with dignity. I thank Rodney for his important contribution. His fifteen case studies must be required reading for all palliative care practitioners. Had I read this book earlier, I could have made an even more powerful case for the legalization of physician-assisted dying.
Robert Orfali, Author, "Death with Dignity: The Case For Legalizing Physician-Assisted Dying and Euthanasia"
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