New York: Delta Trade Paperback (a division of Random House);
2002. ISBN: 0-38533653-5.
256 pages; $15.00 |
Final
Exit: The Practicalities of Self-Deliverance and Assisted Suicide
for the Dying. 3rd edition
| to pdf >>
by
Derek Humphry
Review by Richard D Della Penna, MD
|
The revised,
updated edition of Final Exit: The Practicalities of Self-Deliverance
and Assisted Suicide for the Dying, by Derek Humphry, is a "must-read"
for all physicians, nurses, social workers, ethicists, and other health
professionals--but especially those who care for people with advanced
illness. The intended audience of the book is nonprofessionals, whether
well or seriously ill.
Final
Exit addresses contemporary human anguish and fear of dying without
control, whether over pain, shortness of breath, incontinence, or just
an unacceptable condition. Most people die from a chronic disease after
protracted distress from symptoms and functional decline. Humphry sees
the right to end one's life as an evolving one: Currently, Humphry would
limit the right to those with medical illnesses, but the author does
not preclude future inclusion of mentally ill people without apparently
meaningful lives and whose condition resists treatment.
Most readers
of this book will never avail themselves of the methods described, but
growing numbers of people want options to be available "just in
case." Indeed, the popularity of Humphry's book highlights the
growing acceptability of ending one's life when disease makes life personally
unacceptable. That decision varies over time and from person to person
as their illness progresses, but the "medicalization" of dying
has nonetheless created a new death-related anxiety: fear of becoming
trapped in a soulless, technology-centered system of care from which
no exit is possible.
Final
Exit does not address the ethics of individual choice in end-of-life
decisions. Nor does Humphry try to convince anyone; he attempts only
to empower people with information.
The book
suggests such concrete steps as:
- Make
an advance directive, and consider hospice care.
- Ensure
that your insurance is in order and that suicide would not preclude
your beneficiaries from receiving a payout.
- Arrange
for quick cremation so that measurement for lethal levels of drugs
will be impossible.
- Take
steps to ensure that you do not have treatable depression.
Other recommendations
include asking your physician about his or her views on the subject.
Humphry also recommends that you leave a copy of Final Exit next
to where you die, so that your intent is clear.
Humphry
is a pragmatist and recognizes that many people will be unable to find
a sympathetic physician to prescribe needed medications. Moreover, some
people will be unable to ask; for these people, he offers specific instruction
for how to end their lives.
Since the
book's first appearance in print, Oregon voters twice approved the Death
with Dignity Act,2 and a 1994 Oregon law established specific
guidelines under which physicians in that state may lawfully prescribe
medications for terminally ill adult patients to end their lives at
a time chosen by the patient. The Death with Dignity Act defines "terminal"
disease as a medically confirmed, irreversible, incurable disease that
will probably produce death within six months.2 At present,
Oregon is the only US state where physician-assisted suicide is legal.
Final
Exit and its topic are uncomfortable for many people but should
not be dismissed a "fringe" book. Failure of clinicians to
communicate with seriously ill people and to adequately address their
concerns, fears, and symptoms has been repeatedly documented. Although
some people will choose to end their lives during the course of decline
or serious illness, most will not; most people hope and expect that
their physicians and health care systems will ensure that terminally
ill patients die with dignity and that these patients will not feel
the need for self-deliverance. Living up to that expectation will be
a major challenge for clinicians and for a health care system driven
by technology and by the philosophy that there is always one more thing
that can be done for the patient.
