Book Review – Death with Dignity: The Case for Legalizing Physician-Assisted Dying and Euthanasia

Death with Dignity: The Case for Legalizing Physician-Assisted Dying and Euthanasia, by Robert Orfali. Mill City Press, 2011. ($14.95, softcover, ISBN 9781936780181, 254 pages).

Death with Dignity: The Case for Legalizing Physician-Assisted Dying and Euthanasia was written in the aftermath of the death of author Robert Orfali’s beloved wife, Jeri, after a long struggle with ovarian cancer. Jeri was unable to find a legal way to end her life on her own terms–peacefully, painlessly, without undue anxiety and stress, and at a time and place of her choosing. Since witnessing his wife’s death, Orfali has become a fervent advocate of the legalization of physician-assisted dying. He argues that a dying patient should have the right to actively end his or her own life at a time of his or her choosing, not only by the removal of life support systems and the withholding of nutrients, but by the physician-assisted administration of the drug Nembutal, the drug of choice for those wanting a swift and painless death. Orfali’s volume, Death with Dignity, is a non-scholarly treatment of the legal, philosophical, and practical issues surrounding assisted suicide. It is suitable for all libraries, but law school and law firm libraries would certainly want to supplement this book with more heavily researched treatises on the topic of end-of-life treatment. 

In Chapter 1, Orfali explains that for most of human history, death usually came fairly swiftly, after a traumatic injury or brief illness. Today advancements in medical technology have made it possible for a human being with many chronic conditions, such as cancer, heart disease, lung disease, and kidney and brain failure, to be kept alive for years but often with an inexorable decrease in quality of life. Chapter 1 also includes anecdotal evidence of the horrible suffering that can accompany a slow, lingering death. The accounts of dying patients begging to be relieved of their suffering are both heartbreaking and frightening, including the one by television commentator Keith Olbermann. Olbermann recounts the truly terrible ordeal of his dying father, in intractable pain, begging Olbermann to smother him with a pillow. Orfali compares this to ancient Greece and Rome, where citizens had the option of an “easy death” (the literal meaning of the word “euthanasia”), either by administering poison to themselves or by requesting the assistance of a physician. His opinion is that in America, dying pets receive more compassionate treatment than dying human beings. 

Chapter 2 relays the experience of the author’s wife as she tried to take measures to ensure that she would be in control of the timing and circumstances of her death. However, she had no legal access to Nembutal, and obtaining the drug underground was not a suitable solution for many reasons that Orfali explores. In Chapter 3 Orfali explains the limits of palliative care, hospice, and pain management.  Despite his praise for hospice and palliative care, he likens much end-of-life treatment to torture. Chapters 4 and 5 explore the evolution of end-of-life care from a legal standpoint. In detail, Orfali compares legal end-of-life options in Oregon, Washington, and the Netherlands. Orfali embraces the system in Oregon, with its multiple requirements that safeguard the patient’s autonomy, the integrity of the medical profession, and the well-being of the vulnerable. Chapter 6 and 7 discuss the moral, ethical, and philosophical debates surrounding assisted suicide. Anti-euthanasia arguments (the “slippery slope,” health care rationing, possible discrimination against the vulnerable, the sanctity of life) are dissected and refuted to Orfali’s satisfaction. In Chapter 8, Orfali makes an impassioned and emotional plea for the legalization of physician-assisted dying, presenting strenuous arguments in favor of his views. 

The book concludes with a bibliography of books, articles, and websites on both sides of the issue. An index would have been helpful as would have more consistent use of footnotes and better documentation of certain sources. Death with Dignity is an emotional and subject book, but this slim volume is nevertheless a good introduction to a complicated and difficult subject.

Reviewed by Donna M. Fisher, law librarian at Senniger Powers LLP in St. Louis.