New Book Review Death with Dignity

Robert Orfali lost his wife to terminal cancer and has written an excellent book about physician-assisted suicide. I commend it as one that asks the right questions. [Disclaimer: this book reviewer upholds the sanctity of life as upheld in his religious preference.]

I hope you enjoy!  Feel free to leave comments.
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Available at Amazon.com

Death with Dignity: The Case for Legalizing Physician-Assisted Dying and Euthanasia
Robert Orfali
Mill City Press, Inc.
ISBN-13: 978-1936780181
254 Pages (Includes front and back matter)

Americans fear death, doing everything in their power to avoid the topic and the issues it raises. For many of us, death is an unwelcome visitor whose reality is only manifest when someone near to us is impacted. Our lives are lived in the mantra developed by television writer Andrew A. Rooney, ―Death is a distant rumor to the young. We never contemplate the inevitably of death since our culture is inculcated with the idea that if we eat right and exercise, we can stave death off forever. Death is always that happens to someone else and we are conditioned to lament the tragedy. Whether or not we invite her, death will visit us all.

Such a visitation occurred for the author of Death with Dignity, Robert Orfali, when his partner Jeri inevitably succumbed to a terminal illness. By his admission, he was not adequately prepared for the reality which accompanies death – the last moments when the goal of the medical establishment is to help a patient transition with he least amount of pain. Being present for his partner’s last moments, he was haunted by her deathbed confession: I waited too long.

Watching his partner during her last moments on earth launched Mr. Orfali on a quest—to see Oregon’s Death with Dignity Act made law in Hawaii, so that those who are terminally ill can obtain and use prescriptions from their physician to end their lives. The basic premise Orfali elaborates upon is: do the terminally ill have the right to request Nembutal, or Pentobarbital, to end their life at their choosing?

An honest review of this excellently written book requires an initial disclaimer—this writer believes in the sanctity of life as directed by an apprehension of a particular faith. However, having worked in the critical care environment, I have seen the issues which confront patients, and their families, in one’s last moments. As a nurse, I have been witness of, and party to, the saga that is defined as withdrawal of care, to allow a
patient’s natural degradation to unfold. During these instances, a medical practitioner and/or the patient’s family chooses when enough is enough. As I read this book, I kept asking myself, ―Is there a difference morally if a patient chooses when to die?

The book analyzes what have been referred to as ―slippery slope‖ arguments—arising from the fears society has if physician-assisted suicide is ratified. While sometimes it appears that Orfali sneers at a mere faith-oriented objection to physician-assisted suicide, his argument against the slippery slopes of legalizing Nembutal for those who request it seem very sound. Orfali is to be praised for raising the question and encouraging open dialogue, particularly for those in terminal situations.

As I have wrestled with the issues that have arisen while reading this book, something at the core of physician-assisted suicide makes me very uncomfortable. Akin to the debate on abortion, when laws are enacted which seem to devalue human life—is an unfair precedent established which could lead to a further devaluation? Any answer is conjecture: only time substantiates if a precedent has been established and/or develops a causal relationship with future legislation.

Perhaps the main thrust of the proponents can be boiled down to choice: who should choose the appropriate time to die? I must confess— I do not see a moral difference between a physician-family liaison choosing the time or a patient deciding the right time.

More research is needed to determine the motivation behind the requests of those seeking assistance to terminate their lives. Some studies indicate that the greatest motivation stems from a perceived loss of dignity—not necessarily the reality of pain or other manifestations of the disease process. What is the impact of minor depression, the type of depression which easily flies under the radar, upon such requests? While it is true that the Oregonian Death with Dignity Act requires mental competence to be ascertained as a prerequisite, ample studies substantiate the subjective nature of psychoanalysis. Into this mix one must consider the inordinate influence a physician has on the decisions of his patients. Could the legalization of Nembutal lead practitioners to gently persuade this course where it might not be the primary desire of the patient? It is hard to say, but minor depression does make one more susceptible to outside influence.
It will be interesting to see how Orfali’s quest plays out and whether or not Hawaii embraces the Death with Dignity Act. 

It is my privilege to commend this book as one that raises the right questions. Perhaps, reading Death with Dignity will yield the same resolve as the Hagakure did for the Samurai of feudal Japan:

If there is any secret formula in dealing with sure death, it lies in conceiving that nothing one does would do any good to avoid death, that one’s life is but an empty dream. Thus conceived, never be off guard against the shadow of death sneaking up close to your feet. Spare no effort to be prepared early for it.