Selected and reviewed by James Park,
existential philosopher and advocate of the right-to-die.
Organized in the order of quality, beginning with the best.
Comments in red are the views of this reviewer.

A note to authors of books supporting the right-to-die:
Please avoid the following four misleading words:
euthanasia, suicide, hasten, medication.

(New York: Putnam, 1975)

     The best book on the right-to-die: comprehensive, with good examples,
well-documented, readable, insightful, forthright, well-argued.
Deals with: merciful death (for adults and defective infants),
refusing treatment, voluntary death, definitions of death,
organ transplants, & hospices.

2. Derek Humphry & Mary Clement 
Freedom to Die:
People, Politics, and the Right to Die Movement

(New York: St. Martin's Press, 1998)       388 pages
(ISBN: 0-312-19415-3; hardback)
(Library of Congress call number: R726.H844 1998)

     No single individual is more central to the right-to-die movement
than Derek Humphry, who founded the Hemlock Society in 1980
and who has written several book on the subject. 
(In 2003 the Hemlock Society renamed itself End-of-Life Choices.
And in 2004 it merged with Compassion in Dying,
taking the new name Compassion & Choices.)
This book is a summary of the history
of the right-to-die movement up to 1998.
The right-to-die emerged in response to modern medical technology,
which can keep bodies 'alive' longer than ever before imagined.
Humphry and Clement summarize the most famous right-to-die cases:
Quinlan, Cruzan, Kevorkian, Quill.
They summarize the then-current policies in the Netherlands,
which allow a physician to assist a patient to die
when specified safeguards are fulfilled.

     Detailed accounts are given to the efforts to win the right-to-die
on the West coast of the United States: California, Washington, Oregon.
These states have referendum laws,
allowing the people to create laws directly by a popular vote
—when the elected lawmakers are too timid to enact a particular law.
One drawback of this means of changing the laws
is that the debates tend to be reduced to 30-second television ads.
Oregon was the first state to allow physicians to aid a voluntary death
—by prescribing lethal drugs after careful safeguards were fulfilled.
(The complete text of the Oregon law is included as an appendix.
The Oregon law with annual reports is also available on the Internet:
http://www.oregon.gov/DHS/ph/pas )

     The US Supreme Court found no right-to-die in the Constitution,
but the justices left the door open for states to write new laws.

    Humphry and Clement even include a chapter on
the high cost of medical care at the end of life,
—an argument for the right-to-die that is open to easy attack by opponents,
who will suggest that some people will be put to death to save money.
Voluntarily-created 'living wills' or Advance Directives for Medical Care
can accomplish the same goal, but few people have written them.
And sometimes doctors do not know about 'living wills' or ignore them.

     This book is an excellent place to begin reading
about the right-to-die movement.  
It is based on Derek Humphry's personal experiences and all published sources.

Seduced by Death 
moved to Books Opposing the Right-to-Die

3. James M. Hoefler 
Managing Death

(Boulder, CO: Westview Press, 1997)       206 pages
(ISBN: 0-8133-2816-0; hardcover)
(Library of Congress call number: R726.H564 1997)

     Hoefler documents a broad consensus among almost all groups
(doctors, nurses, hospitals, religious organizations)
that have taken official positions
concerning how to manage the process of dying:

1. Forgoing medical treatment and life-supports is not suicide.
2. Withholding and withdrawing life-supports are ethically the same.
3. Family members can decide for incapacitated patients.
4. Terminal illness is not required
    as a precondition for making life-ending decisions.
5. Food and water need not always be provided.

7. Severe dementia is a condition in which the patient is no longer able
to make any meaningful decisions about life or death.
The number of such patients is measured in the millions at any given time.
But common sense and public opinion is slowly moving in the direction
of a consensus that the severely demented need not be kept alive by artificial means.
In other advanced countries, they are not routinely put on life-supports
—as is quite common in the United States.
But America as a society does not yet have a consensus
about how to treat former persons who have permanently lost
such capacities as consciousness, memory, language, & autonomy.

     Hoefler discusses artificial nutrition and hydration
as end-of-life treatments.
Dying from lack of water is much quicker and easier than starvation.
Two months is a typical time to die from lack of food
—if there are no other physical diseases or problems.
A week or 10 days is all it takes to die
if all water and other fluids are given up.
According to all objective reports, this is a quick and easy death,
often without the need for pain medication.

    The following points about voluntary death by dehydration (VDD)
come from this reviewer rather than from James Hoefler:

     Giving up water and other fluids has some additional advantages
over other methods of bringing life to an end:

1. The patient can always change his or her mind.
Since it takes at least a week to die using this method,
the patient might see life quite differently
after a few days without food and water.
People tempted to commit irrational suicide
will probably recover from their suicidal urge before they die.
Then they will decide to begin eating and drinking again
—and continue to live indefinitely.
Other people will probably know about this decision to die
—which gives them ample opportunity to intervene
if they do not believe that death at this time is the best option.

2. Doctors do not need to be involved in the dying process at all.
Thus, there are no moral or legal questions
about doctors aiding in the process of dying.
Death by dehydration can be conducted completely at home,
without the need for any special equipment or drugs,
and without the involvement of any health-care institutions.

3. Giving up food and water is completely legal.
There are no laws against choosing this means of dying.
This eliminates all the secrecy involved in underground means of death.

4. Families can be informed ahead of time about the planned death,
so they can gather for the last days of their loved one if they please.

     Death by dehydration might become
a preferred method for voluntary death
in the first few decades of the 21st century,
because it does not involve the state
or health-care institutions or personnel.
Patient autonomy is certainly preserved
because the decision to die must be affirmed over and over again
during the last week or 10 days of life.
And when the patient slips into unconsciousness,
the proxies and medical personnel can continue the decision to withhold fluids.

     No new legislation is required to permit this method of choosing death.
We already have the power to end our lives in this way.
The danger of irrational suicide is sharply diminished.
(Irrational suicide is a danger in all methods that bring death suddenly.)
The patient will go to sleep at night and wake up again in the morning
several times during the period of dying from dehydration
which will give new perspectives on problems
that might otherwise lead to an irrational suicide.
If this plan for achieving a voluntary death is announced to others,
they might decide to provide new support or better medical care,
which might postpone dying until some later time.

    (This reviewer has written a cyber-sermon on this subject:
Voluntary Death by Dehydration .
And he has begun a website on the same subject.)

     Hoefler hopes that death will be better managed in the future.
He suggests that the following ways to improve the process of dying:

1. New standards of care will be developed for mortally-ill patients.
Then they will no longer suffer the default decision,
which is always to provide maximum aggressive medical care:
Because it can be done, it will be done
—until someone decides otherwise.

2. We will make better use of hospice care.
Now it is often used just for the last week of life—or last few hours.
Taking advantage of hospice services
for several weeks or months 
can greatly improve the process of dying.

3. We will develop a clearer concept of medical futility.
Research will show more clearly than ever before
which medical treatments are useful and which are useless
in the various situations in which such treatments might be used.
Not only the medical profession but also the general public
will reach a more reasonable consensus
about when to omit or withdraw
high-tech medical care at the end of life.

4. End-of-life decision-making will become more open and rational.
Both health-care professionals and the general public
will be better educated in order to make wiser end-of-life decisions.
Death can be better managed rather than fought every step of the way.

5. We will reject the slippery-slope arguments
of those who oppose making any life-ending decisions.
By paying close attention to the particulars of each case
rather than trying to enforce rigid rules of morality,
wise decisions will emerge that can be embraced by everyone involved.

6. Advance Directives will be used more fully and wisely,
so that we can choose our own pathways towards death,
rather than being handled according to the standard operating procedures
of the hospital or the medical profession.

     Managing Death is a basic and moderate book about process of dying.
Hoefler does not attempt to break new ground.
Rather he clarifies the consensus that we already have achieved
—and projects the elements of a new consensus
that is now beginning to emerge in our collective thinking.

    Everyone concerned about the process of dying
should read Managing Death.

4. Michael Schiavo with Michael Hirsh
Terri: The Truth

(New York: Dutton, 2006)       360 pages
(ISBN-10: 0-525-94946-1; hardback)
(ISBN-13: 978-0-525-94946-6; hardback)
(Library of Congress call number: R726.S35 2006)

    Terri Schiavo, the author's wife,
became a major name in the right-to-die debate
as she reached the end of her life in 2005,
after 15 years in a persistent vegetative state.

    This book is a personal account in which Michael Schiavo
tells the story of her life and death as known to him,
the person who was closest to her
and to the events that led to her collapse in 1990
and to her being disconnected from life-supports in 2005.

    Michael Schiavo is well aware
that there are other accounts of the same events,
which is the reason he has sub-titled his book The Truth.

    This reviewer also read the book by the Schindler family
in parallel with reading this book,
following the two accounts of the events year-by-year in both books.
It is quite remarkable that a family that was originally very close
could be so dramatically split by this right-to-die controversy.
The same events are often given diametrically-opposite interpretations
by the two sides of this family dispute
about what should be done for Terri Schiavo.
The Schindlers' book—called A Life that Matters—is reviewed in
the bibliography of Books Opposing the Right-to-Die.

    Immediately after her collapse,
Michael was completely devoted to helping his wife recover.
He spent many days by her bedside
watching for the slightest sign that she was conscious again.
But after several months and many failed attempts to rehabilitate her,
Michael had to agree with the doctors
that his wife would never recover.

    The jury in the 1992 malpractice trial determined that Terri herself
was 70% responsible for her own collapse,
which was most likely due to an eating disorder,
which ultimately caused her heart to go into fibrillation,
which deprived her brain of oxygen,
causing a persistent vegetative state that lasted for 15 years,
until she was ultimately disconnected from her life-supports.
The other 30% responsibility was assigned to her doctors,
who failed to diagnose her eating disorder,
which could have been treated, preventing her death.

    The long, complex legal wrangling
over Terri's guardianship and fate
is discussed in full in both books,
but that will not be reviewed here.

    In the year 2000, Michael was first empowered by the court
to remove Terri's feeding-tube.
It took 5 more years of appeals,
intervention by the Florida legislature and governor,
and ultimately the US Congress and the President
before the court cases were ultimately settled
—ordering the removal of Terri's feeding tube.

    A secret video-tape was made by the Schlinder family,
which was widely shown on television.
It was convincing enough to many viewers
that most public opinion favored keeping Terri 'alive'.
A number of neurologists diagnosed Terri from this tape
as being in a "minimally conscious state"
rather than being in a persistent vegetative state.

    But when the court ordered 5 experts to examine Terri,
the majority determined that she was in PVS,
which was confirmed by autopsy after her final death.
(The two experts selected by the Schindler family did not agree that Terri was in PVS.)
The autopsy showed that her brain had shrunk to half normal size,
that she could not see, and that there was never any hope of recovery.
Terri's brain was even more gone than most patients in PVS.
The apparent 'responses' seen on the video-tape
were random events originating in Terri's brain-stem,
not actual responses to anything in her environment.

    Even Pope John Paul II got involved indirectly.
He declared the tube-feeding of patients in PVS
is not medical treatment but a normal means of caring for the sick.

    Actually, Roman Catholic priests
were lined up on both side of the Schiavo case,
some saying that she should be kept on life-supports
and others saying that she should be allowed to die.
Such religious opinions affected the public's responses to the case,
but they did not affect the legal rulings,
which ultimately led to removing Terri's feeding-tube in 2005.

    Michael reminds us at the end of his book
that Terri Schiavo would not have become a 'household name'
if she had had an advance directive for medical care,
which would have been immediate "clear and convincing" proof
that Terri did not want to be kept 'alive' by a feeding tube
if she was never going to recover.

    Whatever we want, if ever we are in a condition similar to Terri Schiavo,
we should state our wishes clearly and unambiguously
in our advance directives for medical care.

    If you would like to see suggested language to put into your 'living will'
so that you will not be kept 'alive' indefinitely on life-supports,
go to the following website created specifically
to help others avoid Terri Schiavo's fate:
http://www.tc.umn.edu/~parkx032/TERRI.html

    Michael Schiavo has established a political action committee
to insure that end-of-life choices
are not taken away from the duly-authorized persons:
http://www.TerriPAC.com.

(New York: iUniverse: www.iuniverse.com, 2006)     180 pages 
(ISBN-10: 0-595-38144-8; paperback)
(ISBN-13: 978-0-595-38144-9; paperback)
Library of Congress call number: not given in book)

9. Samuel Greenberg, MD
Euthanasia and Assisted Suicide:
Psychosocial Issues

(Springfield, IL: Charles C. Thomas, 1997)       164 pages 
(ISBN: 0-398-06785-6; hardcover)
(Library of Congress call number: R726.G74 1997)

    This is an open-minded book on the right-to-die
written by a psychiatrist.  
He does not break any new ground.  
But he does not prejudge any of the difficult cases he discusses.  

    The following summary of the contents shows the wide-range of this book:
Ch. 1  a good summary of the issues and the sides taken.
Ch. 2  a good summary of the high-profile cases of the previous 20 years.
Ch. 3  experiences in other countries: Netherlands, Great Britain, Germany.
Ch. 4  learning from the practices of veterinarians.
Ch. 5  physicians' attitudes are divided,
            but moving in the direction of the right-to-die.
Ch. 6  legal aspects: definitions.
Ch. 7  religion, morals, & bioethics.
Ch. 8  the hospice movement.
Ch. 9  the right-to-die societies.
Ch. 10  a case of a severely defective newborn.
Ch. 11  looking toward the future.

10. Mary Warnock & Elizabeth Macdonald
Easeful Death:
Is There a Case for Assisted Dying?

(Oxford, UK: Oxford University Press, 2008)       155 pages
(ISBN: 978-0-19-953990-1; hardcover)
(Library of Congress call number: R726.W36 2008)
(Medical call number: WB60W285e 2008)

    Two British philosophers discuss the philosophical principles
behind the discussion of allowing physicians to help their patients to die.

    They draw especially on right-to-die cases
widely discussed in the media in Great Britain.

    Perhaps because they begin with media discussion of the right-to-die,
the main means of choosing a voluntary death they consider
is using lethal drugs prescribed by a doctor.

    But what about patients who want to die because of mental, non-physical problems?
'Clinical depression' is widely assumed to be a major cause of irrational suicide.
Should we allow patients who are not thinking very clearly to choose death?
Or should they be protected from their own irrational urges toward self-destruction?
What should happen if their mental suffering
causes them to lose perspective on the choices that lie before them?

    The solution suggested by this reviewer
is the careful selection of a Medical Care Decisions Committee,
which will be empowered to make medical decisions for the patient
whenever the mental capacity or rationality of the patient is in question.
They will always listen to the immediate 'wishes' of the patient,
but they will not always agree to cooperate.
In other words, the patient selects wise persons
who are known to have the patient's best interests at heart
who will protect the patient from possibly-irrational suicidal decisions.
If and when the patient has good reasons for choosing a voluntary death,
then he or she should be able to convince
the close family members and friends who make up the MCDC
of the wisdom of the patient's chosen pathway towards death.

    This approach to the right-to-die puts the emphasis on the individual patient.
The life-ending decisions will be taken by the patient himself or herself,
possibly with the assistance of the people who are closest to the patient.
Whether of not to allow or approve chosen death
is not left to a group of strangers,
who will apply abstract guidelines to life-ending decisions.

    As an illustration of psychological reasons for wanting to die,
the authors discuss the Chabot case in the Netherlands:
A suicidal woman came to a psychiatrist, Dr. Chabot,
and explained her wish to die.
She had previously tried to kill herself, unsuccessfully.
And she wanted professional help to achieve a good death.
All of the members of her family were dead
and she could find no futher reason to go on living.
Dr. Chabot felt that he could not prevent her suicide,
so he agreed to help.
The court ruled that he should have asked for the opinions of other physicians.
But no penalty was imposed.
However, the fact that the court could have ruled otherwise
shows some problems with the right-to-die in the Netherlands.
Those who help others to die do not always know
how they will be treated by the law and the courts.

    In this case, the application of additional safeguards
would have helped to clarify the options.
Perhaps other solutions beside death would have emerged.
Dr. Chabot now recommends voluntary death by dehydration.
This pathway towards death would have forced the woman
to re-examine her reasons for wanting to die several times
during the process of dying.
And she might have changed her mind.
Friends, previously-distant relatives, and even neighbors
might have helped her to adjust to her new situation of grief.
Many people have eventually found ways to recover from bereavement.
Sometimes just the passage of time
changes the early urge toward irrational suicide.

    Dr. Chabot merely determined that the woman was not clinically depressed.
It was a philosophical suicide:
She had decided to die—with or without his help.
And Dr. Chabot believed that his role was
merely to determine whether she really wanted to die.

    Mary Warnoch and Elizabeth Macdonald also discuss neonates
who are born with serious birth defects.
Sometimes governments have set standards
that go beyond what the parents want.

    The authors also present a chapter on adults who cannot decide for themselves.

    Another chapter deals with the question of the 'sanctity of human life'.

    If we allow some wise deaths to be chosen,
how will we prevent other, premature deaths?
Does the right-to-die create a slippery slope?

    Most doctors do not want to kill their patients,
but they they are sometimes open to allowing death to come.

    Another chapter discussed some specific methods of choosing an easeful death:
(1) giving up food and water;
(2) terminal sedation—keeping the patient unconscious until natural death;
Here increasing pain medication without causing coma is also discussed.
(3) lethal drugs prescribed by a doctor;
(4) back-up euthanasia in case other methods are impossible or if they fail.
But, in general, these authors favor only assisted dying, not directly causing death.
In their terms, they say yes to "assisted suicide" and no to "euthanasia".

    The authors foresee changes in laws
to allow doctors to give more direct assistance in dying.

    This is a small, useful, supportive book,
which reviews the right-to-die issues as already present in media discussion.
They do not go beyond the depth of educated readers
and they do not break any new ground.
But Easeful Death could be a good place to begin reading about the right-to-die.

    Please suggest additional books that should be included
in this bibliography on the right-to-die.
Send your suggestions to James Park: e-mail: PARKx032@TC.UMN.EDU

    See related bibliographies:

Books on the Right-to-Die

Books Opposing the Right-to-Die