"The Last Goodnights" is lawyer John West's account of how he helped assist both his gravely ill parents with their deaths after he received the dreaded calls for help. He was first approached by his father "Jolly," a UCLA psychiatrist, who was diagnosed with cancer, and was told he only had a few months to live. In his cry for help, Jolly tells his son, "I am a physician. I know when my number is up.... My body is full of cancer. If I knock off a little ahead of schedule, nobody's going to know the difference." His mother Katherine, or K, was a clinical psychologist at the West Los Angeles VA Hospital, and was rapidly declining due to Alzheimer's. Both parents turned to their son to help them end their lives with dignity.
West accepted both cries for help, and the book is about how he made it happen in a state where there is a legal prohibition on physician-assisted dying. In effect, West documents the paranoia that is associated with underground euthanasia: the climate of secrecy, the anxiety over dosages, and the constant deceit and coverup. There are no proper goodbyes because even the family must not be brought into the secret: "The Plan." As West puts it, "I couldn't talk about this with anyone, not even my closest friends, because it might put me, and possibly them, in legal jeopardy.... Because of one small slip I could be doing two to four in Folsom."
The Plan didn't include any guns. Each parent wanted to end life by going to sleep forever in their own bed. Unfortunately, the coverup that is required to achieve such a death is incredibly complicated. For example, even though his bones were riddled with cancer, Jolly underwent hip replacement surgery so as not to attract attention. He then went home to end his life instead of recovering from his surgery.
Because Jolly was a physician, he had "accumulated more pill bottles than a drugstore." However, the more-lethal pills needed were not easily available, and they needed to be handled with the utmost secrecy. Helping Jolly achieve "death with dignity" turned out to be a deeply clandestine and nerve-wracking ordeal. At the end, Jolly gets his wish but there were no proper goodbyes: "Instead of savoring a few last quiet moments together, Jolly and I had to skulk and scheme--and work."
Nine months later, West responded to the call from his mother. As he explains it, "K was not being a martyr; she was looking after her own best interests. She was choosing to end her life because it had become horrible to her. There was no cure, no hope of improvement.... K is finally taking back control of her life by taking control of her death, living the way she wants to by dying the way she wants to, making her choices once again--and for the last time." For West, it was a repeat performance fraught with anxiety and the fear that something may go wrong.
In both cases, West's elaborate planning resulted in success: both his parents avoided terminal suffering. In addition, the family doctor signed both death certificates without even seeing the bodies. However, the ordeal took a toll on West's own physical and mental health, and he hit the bottle. "Not much dignity for me, apparently. But this wasn't about me. It was about Jolly and K. It was about their personal autonomy, their wishes, their choice. I just honored their wishes and did my part. But what a hard part."
West has some excellent observations on why assistance in a "suicide" is needed by some. As he points out, available sure-thing methods of suicide--such as using a gun or jumping off a tall building--are available, but they require mobility; none offer dignity. "So, for people with disabling illnesses, there really aren't readily available options. Such people need help if they want to die, and that places a double burden of medical and legal worries on the loved one who helps. And although I was willing and able to share the burden, it shouldn't have had to be this way." Later West adds, "Assisted suicide should not be attempted by amateurs, and it should be a legally accepted part of the doctor-patient relationship."
The real questions this book raises are: Why is physician-assisted dying illegal in most states? Why not let terminally-ill patients have the dignity and peace they deserve? As West puts it, "It would certainly end all the skulking around and remove a ton of stress and anxiety from everyone. Dignity, finally. What's so wrong with that?" He asks the reader: "K called her condition torture. Do you want to be tortured to death? Is that what you want for yourself and for your loved ones? Or do you want a choice? I certainly do. I bet you do, too."
Disclosure: Like West, I want to change the laws. I recently published a book on "Death with Dignity" to help lift this cruel prohibition. I admire West's courage and the love he had for his parents. He took a big risk by publishing his book. Clearly, he wanted to share this information with the public so that laws are changed "to provide dignity for those who want it and need it. Because we will all want it and need it eventually."
Robert Orfali, Author, "Death with Dignity: The Case for Legalizing Physician-Assisted Dying and Euthanasia."
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