I tried to keep the chapters focused and packed with information. Each chapter covers an issue in depth and some may be quite long. Here’s the plan:
* Chapter 1 sets the tone. It gives you a feel for the despair, confusion, and emotional chaos that surround death. I introduce the strongest of these dilemmas: mercy killings. Then I contrast this chaotic environment with the civilized death which our pets are offered. I introduce the terminology and technology of modern-day euthanasia. I go over the different flavors of euthanasia—including active, passive, slow, voluntary, involuntary, and physician-assisted dying. I decipher the confusing terminology and discuss some of the moral and legal issues. Finally, I present the results of opinion polls to give you a feel for how society at large views euthanasia.
* Chapter 2 explains the logic, as well as the lure, of euthanasia. First, I go over what it means to have that choice. Then, I explain why Jeri wanted that option. Next, I recount the dilemma she faced in a state where assisted dying is not a legal option. Again, the discussion is not about Jeri. However, she was a professional problem solver during her life and she subscribed to the principle, “My life, my death, my choice.” So, it’s enlightening to follow her decision process when she faced her terminal prognosis. She contemplated that decision with a lot of clarity and documented some of it. I use Jeri as a case study to help you understand the anguish which the terminally ill face. Their terminal anxiety is shared by their caregivers and loved ones. I will tell you how Jeri’s decision could have affected me in a very dramatic way. Yes, caregivers can turn into mercy killers out of deep love. It’s a very emotional time filled with sadness, fear, and angst. I try to deconstruct the decisions that take place during that emotional pressure cooker and present them as objectively as possible.
* Chapter 3 is about how we die today without the assisted dying option. I explain how to navigate the end-of-life maze in hospital ICUs and hospices. I cover the advances in palliative care, hospice, and pain management. I tell you how to avoid the worst type of end-of-life torture—death in the ICU. Then, I provide the best-case scenario for hospice and palliative care, using Jeri’s death as an example. Finally, I tell you what’s missing and why the system “as is” has reached its limits. I suggest a quick fix. However, the real solution is to add physician-assisted dying to the palliative-care repertoire. I go over the advantages and synergy that this added choice provides.
* Chapter 4 is about where we are today and how we got here. I trace the major milestones of the modern end-of-life choice movement—the court decisions, senate bills, parliamentary laws, and country and state battles. In the U.S., physician-assisted dying for the terminally ill is now legal in the states of Oregon, Washington, and Montana. In Europe, various forms of euthanasia are legal in Switzerland, the Netherlands, Belgium, and Luxembourg. The passive and slow versions of euthanasia are now legal and widely accepted in most advanced countries. They’ve become part of the standard medical practice.
* Chapter 5 is about euthanasia as it is practiced in the real world. I cover the lessons learned from three decades of experience in the Netherlands. Then, I analyze 12 years of data from the state of Oregon’s experiment with physician-assisted dying. The Oregonians have created a fine-tuned system that maximizes the dying patient’s autonomy, while providing maximum safeguards with minimal bureaucracy. In many ways, Oregon may have discovered the perfect system of palliative care; it’s Yankee ingenuity at its best.
* Chapters 6 and 7 are about euthanasia’s detractors and their concerns. This is not a traditional “left versus right” issue. Today, the main groups that are aligned against the passing of euthanasia bills are: the Catholic church, the pro-life movement, and Not Dead Yet (an advocacy group for the disabled). In 2010, they were joined by the populist They’re Trying to Kill Granny movement. The issue is also a cause for concern for some civil libertarians, physicians, and hospice workers. The arguments against euthanasia fall into three broad categories: 1) the sanctity of life must be preserved, 2) the slippery slopes must be prevented, and 3) the medical system can alleviate end-of-life pain. I’ll address each of these concerns in great detail. I’ll provide points and counterpoints and let you be the final judge.
* Chapter 8 is a call to action to make physician-assisted dying legal. I start the chapter with a review of the “euthanasia underground” and its implications for society. Baby boomers are very Internet-savvy. Consequently, when their time comes, they’ll know where to find the necessary pills, exit bags, and helium tanks. Necessity is the mother of invention; it’s just a matter of time before a budding entrepreneur starts marketing a single-pill solution—an exit pill that is both legal and widely available. So, we will have a free market solution to fulfill this missing option. The implications are self-evident. One way or another, the assisted-dying option will become widely available. Will it be underground? Or, will it be legally available as a palliative-care option with safeguards? We must decide. I end the chapter with an interview with the politician who is spearheading the legalization movement in Hawaii—house majority leader Blake Oshiro. We go over the bill that he is proposing and the safeguards it contains. I also quiz him on what it will take to pass this bill. Maybe, Hawaii will become the fourth state to legalize physician-assisted dying for the terminally ill.
The bottom line is that there is no real lobby for the terminally ill. Instead, there’s a grass-roots movement that is both altruistic and selfish. It’s altruistic because we want to help our loved ones die better. It’s selfish because we are also helping ourselves die better. Let’s face it—we’re all going to die someday. In the words of the late Elizabeth Edwards, “The days of our lives, for all of us, are numbered.” It follows that we all have a vested interest in understanding and effecting the workings of an end-of-life system that controls how we die. This book is my modest contribution towards a better understanding of that system.