VOLUNTARY DEATH BY DEHYDRATION

1. Stanley Terman, MD, PhD
The Best Way to Say Goodbye:
A Legal and Peaceful Choice at the End of Life

(Carlsbad, CA: Life Transitions Publications, 2007)       482 pages
(ISBN: 978-1-933418-03-2; paperback)
(Library of Congress call number: R726.2.T47 2007)

    This is probably the first book promoting
what I call "voluntary death by dehydration" (VDD)
and what Dr. Terman calls "voluntary refusal of food and fluid" (VRFF).
Another expression used in medical ethics is "terminal dehydration".

    The idea of choosing death by giving up eating and drinking is so simple
that we should ask why so few have discussed it before.
But someone had to speak first.
Dr. Stanley Terman is that first voice.

    When the patient is too far gone to participate in any life-ending decisions,
it should be called "merciful death by dehydration" (MDD).
The most common form of this practice is
withdrawing a feeding tube from a patient in a persistent vegetative state (PVS).
This life-ending decision falls within the right to refuse any medical treatment.

     As Stanley Terman says in the sub-title,
voluntarily giving up food and water
is a completely legal choice anywhere in the world.
And this book argues that death by dehydration
can be a very peaceful and even painless way to die.
Several ways to alleviate the discomforts
experienced in such a method of choosing death
are discussed in detail, p. 102-112:
mouth care, thirst-reducing aids, pain-relief, & even deep sedation.
And Dr. Terman has experimented with such fasts himself.
So he writes from experience about the discomforts and how to cope with them.
Of course, he has not yet fasted himself into unconsciousness or into death.
But I will not be surprised to learn in some future year
that Dr. Terman has followed his own advice
and chosen VRFF as his best way to say goodbye.

    Dr. Terman does not spend much time discussing safeguards for life-ending decisions,
but the very process he recommends for ending our lives
contains very important safeguards within the process itself.
For one, it will take a week or 10 days to die by this means.
During any such period of continuing to refuse food and fluids,
we will have ample opportunity
to reconsider any foolish decisions to end our lives.
People who want to commit irrational suicide
will probably never consider dehydration as their means.

    The range of attitudes within major religious traditions are discussed.
But almost no religious authorities have addressed directly
the possibility of voluntary death by dehydration.
Most of the religious perspectives deal with refusing treatment
and withdrawing life-supports.
Perhaps only after VDD becomes more widely discussed
will we find religious authorities specifically discussing this option for ending life.
This and other advantages of voluntary death by dehydration
are explored in a cyber-sermon entitled:
"Voluntary Death by Dehydration":
http://www.tc.umn.edu/~parkx032/CY-VD-H2.html.

    Another major theme of this book is the necessity of having a good Advance Directive.
Most of the well-known right-to-die cases would never have happened
if the patients had had written Advance Directives.
Dr. Terman has many specific suggestions for creating Advance Directives,
so that they say exactly what we want for various circumstances
and so that our ADs will not be vulnerable to being overturned
by people who would make different choices at the end-of-life.

     I am not a neutral observer of this book,
since Dr. Terman and I have exchanged over 100 e-mails
discussing the details of this book since the pre-publication
edition was distributed to interested persons like me.

    Most of these discussions are too detailed and technical
to include in any book-review.
But some of them have been incorporated into the first edition of BEST WAY.
And I hope future editions will also take even more of my comments into account.

    My most basic criticism is that the book is far too long
for the basic purpose it set out to accomplish.
Everything we readers need to know about voluntary death by dehydration
could be explained in 100 pages or less.
And Dr. Terman is in the process of creating a how-to book,
which will be a guide to taking the actual steps
towards death by giving up food and water.
It should tell us how to cope with the problems
created by this method of voluntary death
and give us some good examples of actual people
who chose this pathway towards death.
I believe this how-to-die book could become more popular
than Derek Humphry's best-selling Final Exit.

    Most of the pages of BEST WAY
will be of interest to professionals in medical ethics.
I found the rest of the book quite interesting.
This is because I am interested in all issues of medical ethics.
While I was reading the book, I made 64 pages of notes and responses.
I have summarized and expanded on these issues
in the many e-mails that Dr. Terman and I have exchanged.

    Dr. Terman has created a sprawling book of almost 500 pages.
He wants to share all of his thoughts about medical ethics.
And he brings in recent items from the news in unexpected places.
We do not know where to find his comments about Terri Schiavo,
for example, because they keep popping up everywhere.
There are 23 references to her case in the index,
which enables careful readers to find Dr. Terman's comments.
But few readers begin with the index.

    A better-organized book would naturally fall into 2 or 3 separate volumes.
Each of these could focus on some specific issues
already alive in the minds of potential readers.
Dr. Terman's original contribution is voluntary refusal of food and fluid.
But this gets lost in his discussion of many other issues in medical ethics,
which others authors have already dealt with.
For example, he does not need to deal with ending life-supports
and all other forms of refusing medical treatment.
In my opinion, those battles have already been won:
We already have the right to pull the plug:
http://www.tc.umn.edu/~parkx032/CY-PLUG.html.

    If Dr. Terman follows my advice,
he will create at least two books from this one.
The first—very short—
book will tell laypersons everything they need to know
about choosing to end their lives by giving up food and water.
The rest of the content is mainly of interest
to professionals in medicine, medical ethics, & law.
Besides the small how-to-die book for laypersons,
he could reorganize his material into one book on medical ethics
and one book on the right-to-die.
There might even be a place for a book
just about creating Advance Directives for Medical Care.
All of these books could refer to one another.
And each one would have a better chance of reaching its intended audience.

    You can find the complete contents by searching the Internet
using the title: "The Best Way to Say Goodbye".
The website for this book is: www.TheBestGoodbye.com

Created April 20, 2008; Revised

See related bibliographies:

Best Books on Voluntary Death

Best Books on the Right to Die


Books Opposing the Right-to-Die


Best Books on Preparing for Death


Books on Terminal Care


Books on Helping People to Die

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