DEATH WITH DIGNITY

Orfali’s compelling manifesto explores the fraught ethics and surprisingly convenient practical details of physician-assisted dying.

In his Grieving a Soulmate, the author recounted the painful closing hours of his wife’s battle with cancer, an experience that inspired this call for voluntary euthanasia as a merciful way of ending the suffering of terminal patients. Here, Orfali surveys the typical American modes of dying and finds them wanting. Death in a hospital intensive care unit, he writes, is “a high-tech nightmare,” and while hospice care is more humane, it too relies on a kind of passive or slow euthanasia—deep sedation and the withholding of life support, food and water—that he finds full of pitfalls. Orfali prefers Oregon’s system of legal euthanasia by self-administered overdose of the barbiturate Nembutal in liquid form—a drug widely used by veterinarians to put down pets—that, he contends, quickly and reliably induces unconsciousness and a peaceful death. He argues that this is “the ultimate form of existential self-empowerment”—a painless, dignified demise on the patient’s own terms and timetable. Orfali presents a knowledgeable and spirited defense of euthanasia against its detractors: studies of assisted dying in Oregon, the Netherlands and Switzerland, he notes, show no slippery slope toward mass euthanasia nor any evidence that the elderly, the disabled or the poor are being pressured into suicide; and “pro-life vitalists” who insist that life should be prolonged no matter the circumstances, he argues, end up imposing unbearable pain on others in the name of an abstract religious moralism. Orfali approaches this agonizing subject with common sense informed by extensive research and an acute sensitivity to the dilemmas faced by dying patients and their families and doctors. The result is a thought-provoking contribution to the debate over this explosive issue.

A lucid, powerful argument for letting dying patients go gentle into that good night.