First Books on

VOLUNTARY DEATH BY DEHYDRATION

(VDD)

Copyright © 2015 by James Leonard Park

Books selected and reviewed by James Leonard Park,
existential philosopher and medical ethicist.
The text in black presents the basic facts about each book.
The comments in red are the evaluations and opinions of this reviewer.

~~~~~~~~~~~~~~~~~~~~~

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).
Other expression used in medical ethics are "terminal dehydration",
"medical dehydration", "voluntary terminal dehydration",
& STopping Eating and Drinking (STED).

    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,
at least in a book-length discussion.

    When the patient is too far gone to participate in any life-ending decisions,
it might 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.
Often this decision to give up food and water
is coordinated with other life-ending decisions
such as increasing pain-medication, terminal sedation,
and/or giving up all forms of curative treatments and other life-supports.

     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 numerous opportunities
to reconsider any foolish decisions to end our lives.
People who want to commit irrational suicide
will probably never consider dehydration as their method.

    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 religious authorities specifically address this option for ending life.

    Several advantages of voluntary death by dehydration
are explored here:
"VDD:
Why Giving Up Water is Better than other Means of Voluntary Death":

http://www.tc.umn.edu/~parkx032/CY-VD-H2.html.
And comprehensive safeguards are suggested here:
"Voluntary Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice":
http://www.tc.umn.edu/%7Eparkx032/CY-VDD-SG.html

    Another major theme of this book is creating a good Advance Directive.
Most of the well-known right-to-die cases would never have happened
if the patients had created Advance Directives.
Dr. Terman has many specific suggestions for advance care planning,
so that our documents say exactly what we want under various circumstances.
We also want to make certain that our Advance Directives cannot be 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.

    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.
Dr. Terman or some other expert in VDD might create a how-to guidebook,
which would 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 such a 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 all 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 terminating 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:
See my essay: "Pulling the Plug: A Paradigm for Life-Ending Decisions":
http://www.tc.umn.edu/~parkx032/CY-PLUG.html.
(But other countries keep having cases
where disconnecting life-supports is still controversial.)

    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 of BEST WAY 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




2. Boudewijn Chabot, MD, PhD

Taking Control of your Death by Stopping Eating and Drinking


(Amsterdam, NL: Foundation Dignified Dying: www.dyingathome.nl, 2014)       87 pages
(ISBN: 978-90-816194-3-1; paperback)
(Library of Congress call number: not given in book)

    This is a short, non-technical book about one method of dying
Stopping Eating and Drinking (SED).
Because this is a completely legal pathway towards death
everywhere on the planet Earth, legal complications will not arise.
And no problems with law-enforcement or prosecutors are discussed.
In the Netherlands, doctors are only required
to categorize a death as "natural" or "not natural".
So SED deaths in the Netherlands are reported as natural.
(And they are not recorded as suicide.)

    Whichever jurisdiction on Earth first makes the distinction between
irrational suicide and voluntary death
will probably classify SED deaths as voluntary deaths.

    If there might be any question of your capacity
to choose this method of dying,
then a psychological professional could be asked
to meet with you and issue a written opinion. 
An open-minded psychiatrist should be able to distinguish
irrational suicidal urges from wise end-of-life plans.

    Other safeguards include creating an Advance Directive for Medical Care,
wherein you can affirm your right-to-die,
including possibly your plan to exercise your right to refuse food and water.
In your Advance Directive (or in a separate document)
you should also appoint a proxy who will carry your plans forward
if and when you can no longer enforce them yourself.
You might also create a document refusing certain kinds of treatment
or even an explicit request for death.

    This reviewer suggests several other safeguards that might be employed,
especially in uncertain situations and cases that might create public controversy:
Voluntary Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice:
http://www.tc.umn.edu/~parkx032/CY-VDD-SG.html


    Accounts are given of four deaths achieved by Stopping Eating and Drinking.

    One chapter deals with oral care during the process of dying by dehydration.

    Another chapter suggests various medications
that might be prescribed by a cooperating physician
to ease some of the discomforts of this method of dying.

    Only a few studies have included SED deaths.
And probably only 1% of all deaths are achieved by this method.
But we can probably expect more people to choose this
as a peaceful and painless way to draw their lives to a close.
Greater public awareness of this life-ending decision
will make it less controversial and more acceptable.

    Because the family understands the background reasons for choosing death,
they usually cooperate in all of the preparations required
for choosing death by dehydration.

    Order Taking Control of your Death directly from the publisher.




3.  Joanne Lynn, MD, editor

By No Extraordinary Means:
The Choice to Forgo Life-Sustaining Food and Water

(Blooming, IN: Indiana University Press, 1986)       272 pages
(ISBN: 0-253-31287-6; hardcover)
(Library of Congress call number: R726.B9 1986)
(Medical call number: W50B993 1986)


    27 contributors presented these papers at a conference in 1984.
In those days, almost all medical decisions were made by doctors.
So the patient's perspectives are mostly absent from this book.
But it does explore in depth the medical ethics surrounding
the practice of discontinuing food and water
for patients near the end of their lives.
Experts speak from their perspectives: law, medicine, & religion.

    One contributor even argues that food and water
should never be withdrawn from a patient in PVS.

    This book is now mainly of historical interest,
since both medical practice and medical ethics have advanced since the 1980s.
But it does show some careful thinking about this life-ending decision
three decades ago.
And all careful students of VDD should at least have a look at this book.




4. Boudewijn Chabot, MD, PhD

A Hastened Death by Self-Denial of Food and Drink


(Amsterdam, NL: B. Chabot, 2008)       64 pages
(ISBN: 978-90-9023678-0; paperback)
(Library of Congress call number: not given in book)
(now out of print, replaced by #2 above)

    Dr. Chabot studied several deaths by dehydration in Holland.
The Netherlands was one of the first countries to allow physicians to aid in dying.
But sometimes the patient who wants to die does not meet the guidelines.
For example, he or she does not have unbearable suffering.
Some of these people chose another route towards death:
They decided to give up eating and drinking.
This book begins with examples of three people
who chose this pathway towards death.

    The author's preferred expression for this choice is
"stopping eating and drinking" (STED).

    Some of the important themes covered in this small book:
duration of dying, mouth care, Advance Directives, palliative care,
dying at home, ethical issues for those who help others to die by dehydration.

    Dr.Chabot projects another book that will deal with all issues in greater depth.
See Taking Control of your Death above.




Go to a portal on Voluntary Death by Dehydration.

The Right-to-Die Portal
deals with all methods of choosing death.



Created April 20, 2008; Revised 1-30-2009; 2-16-2008; 3-24-2009; 4-3-2009; 12-8-2009; 8-9-2010; 10-25-2010;
2-10-2012; 5-17-2013; 3-13-2014; 3-20-2014; 1-20-2015;



See related bibliographies:

Medical Methods of Choosing Death


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 Advance Directives for Medical Care


Books on Terminal Care


Books on Helping Patients to Die



Go to the Right-to-Die Portal.


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to discover 350 other reviews
organized into 60 bibliographies.


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