The Dying Experience: Expanding Options for Dying and Suffering Patients

This vitally important book attempts to move beyond the current death-denying culture. The use of euphemistic and defiant phrases when dealing with terminal disease such as “She lost her battle with cancer” was more appropriate when medical doctors could do little to prolong life. But treatments and technologies have significantly changed. Now life prolonging interventions have outpaced our willingness to use medical intervention to secure patient control over death and dying. We now face a new question: When is it morally appropriate for medical intervention to hasten the dying process? LiPuma and DeMarco answer by endorsing expanded options for dying patients. Unwanted aggressive treatment regimens and protocols which reject hastening death should be replaced by a patient’s moral right, in carefully defined circumstances, to hasten death by means of medical intervention. Expanded options range from patient directed continuous sedation without hydration to physician assisted suicide for those with progressive degenerative disorders such as Alzheimer’s. The authors’ overriding goal is to humanize the dying process by expanding patient centered autonomous control.

Table of Contents:
Introduction / Part I: Death and Dying: History and Contemporary Issues / 1. A Brief History of Death and Dying / 2. Medical and Technological Issues regarding Death and Dying / 3. Brain Death / 4. Death and Dying: International Perspectives / 5. What is a good death? / 6. Physician and Patient Discussions of Death and Dying / Part II: Hospice and Palliative Care / 7. The Hospice and Palliative Care Movements / 8. Critical Analysis of the Hospice and Palliative Care Movements / Part III: On Hastening Death: Old and New Perspectives / 10. New Perspectives: Expanding the Options for Hastening Death / 11. Special Cases of Dementia and Degenerative diseases / 12. Drawing the line / 13. Concluding remarks

About the Author :
Samuel H. LiPuma is Associate Professor of Philosophy at Cuyahoga Community College. Joseph P. DeMarco is Professor Emeritus in the Department of Philosophy at Cleveland State University

Review :
LiPuma (Cuyahoga Community College) and DeMarco (Cleveland State Univ.)—both philosophers—offer an informed, well-argued, and boundary-pushing defense of expanded medical interventions at the end of life. Drawing on data indicating serious limitations in current pain management strategies, the authors argue that physician assistance in hastening death is a morally appropriate option that demonstrates compassionate concern for terminal patients facing unbearable suffering and loss of dignity. The authors argue that public policy should open options currently unavailable to those whose suffering exceeds the limits of pain relief through palliation. They present a strong case for the humaneness of assisted suicide even in cases of progressive dementia disorders. While protecting those suffering decision-making impairments, the authors center ethical concern at the end of life on the competent and autonomous patient making decisions grounded in informed consent, and they defend medical interventions to hasten death, including physician assisted suicide and euthanasia. This bold, thoughtful, and mature study revisits end-of-life issue with ethical sophistication, challenging six-month limits for defining "terminal" and questioning the usefulness of the double effect doctrine. Case studies demonstrate the end-of-life problems the authors are seeking to rectify. Summing Up: Recommended. Advanced undergraduates through faculty and professionals. LiPuma and DeMarco boldly challenge us to consider end of life options that align with realities of medicine, palliative care, and social supports in the US today. Through riveting case studies and exploration of religious and secular thought, moral theory, and ethics, they propose a framework for broadening approaches to what they unapologetically acknowledge as “hastening death.” Clinicians, educators, policy-makers, and the informed public must read this work. This book moves brilliantly between philosophy, clinical studies, and the analysis of medical cases taken from different jurisdictions. The authors firmly argue that as a matter of public policy the options for patients to hasten their death should be expanded, also to include PAS and euthanasia. For judging such requests, they present criteria that might do within American (medical) culture.