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Index
COVER PAGE TITLE PAGE COPYRIGHT PAGE PREFACE 1: TURNING POINTS AT LIFE’S END
WHAT WENT WRONG MY MOTHER’S LEGACY THE FIRST LIVING WILLS THE MEDICAL PROXY DOCTORS SPEAK OUT A RECENT CATALYST FOR THE PUBLIC’S ATTENTION WHAT ARE THE TWO TURNING POINTS AT THE END OF LIFE? THE FIRST TURNING POINT: OPTING FOR COMFORT CARE ONLY RICHARD: A LONG DYING THE SECOND TURNING POINT: A HASTENED DEATH THE IMPORTANCE OF RECOGNIZING LIFE’S TURNING POINTS
2: RIGHTS OF THE DYING PATIENT
WHAT ARE YOUR RIGHTS? HOW CAN YOU ENSURE YOUR RIGHTS ARE HONORED? THE OFFICE VISIT: AN OLDER PERSON CONFUSED ABOUT RIGHTS
3: THE FIRST TURNING POINT: FROM ACTIVE TREATMENT TO COMFORT CARE
WITHDRAWING UNWANTED TREATMENT, THE FIRST STEP WHAT IS IDEAL COMFORT CARE? UNDERSTANDING WHAT SYMPTOMS ARE PART OF THE DYING PROCESS THE LITTLE THINGS ARE ALSO IMPORTANT WHEN ONE IS DYING SETTINGS FOR COMFORT CARE PROBABILITY, CERTAINTY, AND MEDICAL FUTILITY: IMPORTANT CONSIDERATIONS IN COMFORT CARE
4: PAIN CONTROL
CONTROL OF PAIN, A CRITICAL ISSUE PAIN RELIEVERS IN SUFFICIENT DOSES STAYING AHEAD OF PAIN ADDICTION AT THE END OF LIFE: NOT A PROBLEM SIDE EFFECTS OF PAIN RELIEVERS
5: WHAT YOU SHOULD EXPECT FROM YOUR DOCTORS AND NURSES
HISTORICAL CONSTRAINTS ON DOCTORS QUESTIONS TO ASK WHAT YOU CAN EXPECT FROM THE NURSE IN END-OF-LIFE CARE A FINAL THOUGHT ABOUT THE SYSTEM
6: FAMILY AND FRIENDS
THE VALUE OF ALLOWING HELP TO BE GIVEN AT THE END LETTING THE PATIENT DECIDE THE GROUND RULES SPECIAL ROLE OF FAMILY OR FRIEND WHO IS ALSO DESIGNATED PROXY AGENT EMOTIONAL, SOCIAL, AND SPIRITUAL NEEDS WHEN FAMILY AND FRIENDS DISAGREE WITH THE PATIENT
7: THE SECOND TURNING POINT: MAKING THE DECISION TO HASTEN DEATH
A TERRIBLE OUTLOOK IN A PATIENT WITH CANCER OF THE TONGUE: WHAT TO DO FOR DAVID? HOW HAVE DECISIONS FOR HASTENED DEATH BEEN MADE? QUESTIONS THAT MUST BE ASKED SUMMARY OF ARGUMENTS FOR PLANNED, HASTENED DEATH IN THE INTOLERABLY SUFFERING PATIENT
8: WHAT OPTIONS HAVE BEEN USED IN THE PAST TO HASTEN DEATH?
METHODS USED IN THE PAST THAT ARE OFTEN UNSUCCESSFUL OR PROBLEMATIC SUCCESSFUL MEANS BY WHICH SUFFERING HAS BEEN SHORTENED AND DEATH HASTENED INCREASING DOSES OF MORPHINE THE DOUBLE EFFECT RATIONALE WHEN INCREASING DOSES OF MORPHINE HASTENS DEATH VOLUNTARY REFUSAL OF HYDRATION, ACCOMPANIED BY PHYSICIAN-ADMINISTERED SEDATION AS NEEDED BASIS FOR LEGALITY OF REFUSAL OF FLUIDS AND TERMINAL SEDATION PHYSICIAN AID-IN-DYING USING LETHAL DOSES OF BARBITURATES CHARACTERISTICS OF SECONAL AND NEMBUTAL LEGALITY OF BARBITURATE USE AVAILABILITY OF BARBITURATES DRAWBACKS TO SECRECY
9: HELIUM: NEWLY USED METHOD TO END SUFFERING
PHYSIOLOGY OF THE USE OF HELIUM AT END OF LIFE HELIUM HAS BEEN USED TO END SUFFERING5 A PATIENT WITH LOU GEHRIG’S DISEASE USES HELIUM ADVANTAGES OF HELIUM
10: DIFFERENTIATING SADNESS AT THE END OF LIFE FROM CLINICAL DEPRESSION
REVISITING DAVID’S CASE MARK’S SUICIDAL DEPRESSION SYMPTOMS OF DEPRESSION VERSUS TERMINAL ILLNESS HASTENING DEATH VERSUS SUICIDAL DEPRESSION
11: THE SPECIAL CASE OF IRREVERSIBLE DEMENTIA AND END-OF-LIFE MANAGEMENT
THE DILEMMA OF ALZHEIMER’S DISEASE WITHDRAWAL OF TREATMENTS THAT PROLONG LIFE: NOT A PROBLEM WITHHOLDING FOOD AND FLUIDS: MORE DIFFICULT ASSISTED SUICIDE AND EUTHANASIA IN DEMENTIA: NOT POSSIBLE AT PRESENT WHAT SHOULD BE POSSIBLE, IDEALLY? WHAT CAN BE DONE NOW, PRACTICALLY SPEAKING?
12: PLANNING AHEAD WITH ADVANCE DIRECTIVES: STAYING IN CONTROL
PLANNING AHEAD IS ESSENTIAL ADVANCE DIRECTIVES USUALLY AVOID THE NEED FOR COURTS TO INTERVENE TYPES OF ADVANCE DIRECTIVES REMINDERS ABOUT ADVANCE DIRECTIVES WHAT CAN FAMILIES DO WHEN THE PATIENT IS INCAPABLE OF MEDICAL DECISION MAKING AND AN ADVANCE DIRECTIVE DOES NOT EXIST? THE ESSENTIALS FOR STAYING IN CONTROL
13: ALLOWING A MERCIFUL DEATH
ATTITUDES TOWARD AID-IN-DYING RESPECTING THE BELIEFS OF OTHERS WHERE TO GO FROM HERE?
APPENDIX A HISTORICAL BACKGROUND OF THE END-OF-LIFE MOVEMENT AND CURRENT NATIONAL ORGANIZATIONS
THE HEMLOCK SOCIETY AND ITS SUCCESSOR, END-OF-LIFE CHOICES COMPASSION IN DYING MERGER: THE NEW COMPASSION AND CHOICES FINAL EXIT NETWORK DEATH WITH DIGNITY NATIONAL CENTER NEED FOR ONE POLITICAL AND STRATEGIC APPROACH IN THIS COUNTRY EUTHANASIA RESEARCH AND GUIDANCE ORGANIZATION (ERGO) DR. JACK KEVORKIAN, HISTORICALLY A SPECIAL CASE HOSPICE MOVEMENT
APPENDIX B OREGON AND PHYSICIAN-ASSISTED DYING
OREGON’S LEGAL EXPERIMENT WITH ASSISTED DYING THE OREGON LAW’S PROVISIONS USE OF THE OREGON LAW EIGHTH ANNUAL REPORT ON OREGON’S DEATH WITH DIGNITY ACT
APPENDIX C THE INTERNATIONAL SCENE
THE NETHERLANDS, BELGIUM, AND SWITZERLAND: LEGALIZED ASSISTED DYING AUSTRALIA: A SPECIAL CASE DYING WITH DIGNITY, CANADA WORLD FEDERATION OF RIGHT-TO-DIE SOCIETIES
APPENDIX D END-OF-LIFE ORGANIZATIONS APPENDIX E SAMPLE LIVING WILL APPENDIX F HEALTH CARE PROXY FORM WITH OPTIONAL ATTACHMENT APPENDIX G PROPOSED AUTHORIZATION FOR ENDING LIFE IN SITUATIONS OF IRREVERSIBLE AND PROGRESSIVE COGNITIVE DECLINE
CRITERIA WITH WHICH I WOULD NOT WANT TO CONTINUE LIVING
NOTES
PREFACE CHAPTER 1 TURNING POINTS AT LIFE’S END CHAPTER 3 THE FIRST TURNING POINT CHAPTER 4 PAIN CONTROL CHAPTER 5 WHAT YOU SHOULD EXPECT FROM YOUR DOCTORS AND NURSES CHAPTER 7 THE SECOND TURNING POINT CHAPTER 8 WHAT OPTIONS HAVE BEEN USED IN THE PAST TO HASTEN DEATH? CHAPTER 9 HELIUM: NEWLY USED METHOD TO END SUFFERING CHAPTER 10 DIFFERENTIATING SADNESS AT THE END OF LIFE FROM CLINICAL DEPRESSION CHAPTER 11 THE SPECIAL CASE OF IRREVERSIBLE DEMENTIA AND END-OF-LIFE MANAGEMENT CHAPTER 13 ALLOWING A MERCIFUL DEATH APPENDIX A HISTORICAL BACKGROUND OF THE END-OF-LIFE MOVEMENT AND CURRENT NATIONAL ORGANIZATIONS APPENDIX C THE INTERNATIONAL SCENE APPENDIX G PROPOSED AUTHORIZATION FOR ENDING LIFE IN SITUATIONS OF IRREVERSIBLE AND PROGRESSIVE COGNITIVE DECLINE
ACKNOWLEDGMENTS ABOUT THE AUTHORS Index
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