Managing Death

A guide for patients, family members, and care providers on the medical, ethical, legal, religious, and personal aspects of making end of life decisions.

Half of all dying patients will be in moderate to severe pain in the last few days of life. A third or more of all dying patients will spend at least ten or more of their last days receiving invasive medical technology in the intensive care unit. Most of us probably have no clue what current law and ethics allow. Managing Death charts a positive course of action. The book's intent is both hopeful and practical: to offer information on how to make decisions about ending a life.

Drawing on provocative case studies, personal interviews, and hundreds of documents, James Hoefler examines right-to-die issues in nontechnical language. The book opens with the controversial Pennsylvania court case of Joey Fiori who lived in PVS (permanent vegetative state) for 17 years. The author continues by showing us the consensus on several end-of-life situations among medical organizations from the AMA to the President's Commission to the National Center for State Courts, from mainstream religious views such as the Catholic Church, one of the nation's largest nonprofit health care providers, to public opinion. Nearly all organizations and points of view come to dehydration as a simple and humane way to end one's life. James Hoefler provides a detailed assessment of dehydration as a means toward death and its advantages over assisted suicide at the end of life for the seriously ill. The book carefully describes various medical conditions, from PVS to severe dementia, and the common treatments, such as artificial nutrition and hydration (ANH), antibiotics, and hospice care. Finally, the reader is asked to consider further education and advanced directives such as preparing a living will.

Many Americans, before they die, will go through a stage where they are unable to make competent decisions about their own life-sustaining medical treatment. More and more, family members and care givers are facing these difficult decisions in their stead, engulfed in questions about personal wishes, medical ethics, state and federal law, and quality of life.Drawing on provocative case studies, personal interviews, and detailed research, James Hoefler examines the medical, legal, ethical, and clinical aspects of such right-to-die issues. Beginning with the legal struggle of a woman whose son existed in a persistent vegetative state (PVS) for seventeen years, the author moves into a broader look at consensus among professional organizations, from the AMA to the President’s Commission to the National Center for State Courts; beliefs of mainstream religious groups; public opinion; issues surrounding end-stage Alzheimer’s and other organic brain disorders that can slowly lead to PVS; and the role of artificial nutrition and hydration in these cases.Hoefler concludes with recommendations on how to improve the quality of right-to-die decisionmaking. An absorbing read with a minimum of technical jargon, this book is a valuable guide to care givers, public policy students, medical ethicists, family members, and anyone facing questions about an individual’s right to die.

Includes bibliographical references (p. 183-198) and index.

James M. Hoefler is associate professor of political science and coordinator of the policy studies program at Dickinson College. He is the coauthor with Brian Kamoie of Deathright: Culture, Medicine, Politics, and the Right to Die (WestviewPress 1994) and is the coauthor with A. Lee Fritschler of Smoking and Politics: Policy Making and the Federal Bureaucracy (1996).