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Editorial Review Product Description
What are our two greatest end-of-life fears? To endure unnecessary prolonged pain and suffering, and merely to exist in a state of total indignity and dependency such as in Alzheimer's dementia. Uninformed, some people add layers of tragedy to their destiny. Some choose to die prematurely; others, violently; a few risk imprisonment bymercy killing.Often their lament is,If only Physician-Assisted Suicide were legal.Yet there is an alternative that is already legal: Voluntary Refusal of Food & Fluid. While sometimes intentionally maligned asbarbaric starvation,ceasing all Food & Fluid is a truly peaceful way to hasten dying by dehydration. While taking an average of 14 days, it allows for the exchange of healing goodbyes with loved ones who can forever be sure it was these patients' intent since they could have changed their mind.
What makes the process peaceful? Knowing how to control thirst. (The author went on two fasts himself to learn what works.) In addition, good discussions with family members before beginning. Consistent with the principles of some religions, this method is available even for patients who are physically too sick to put a lethal dose of medication in their mouths and swallow.
By creating strategically effective documents for a trusted agent or proxy to withhold Food & Fluid on the patient's behalf, this way to Permit Natural Dying can actually extend the quality of life of those with early dementia. They can enjoy living until they reach a point they have previously described in behavioral terms (perhaps with help from using one of the book's forms).
Beyond serving as an authoritative source of information to strive for an ironclad strategy for dementia, the book endorses life's most ironic fact: When people know they can control when they die--they can, and often do--choose to live longer.
Poignant memoirs illustrate its practical guidelines and useful forms; for example, why Proxy Directives are more effective than Living Wills, and how to make Living Wills work better if they are the only available choice.
The book-within-a-book format of this book is as unique as its content is comprehensive. Over 300 citations, an index, a glossary, and further resources... yet its core reading is user-friendly for all. The subject matter is lightened by 22 cartoons and humorous stories; deepened by provocative discussions of the secular meaning ofSanctity of Life ; and broadened by considering the emotional, practical, clinical, legal, moral, ethical, religious, spiritual, and political aspects of a subject that will affect absolutely everyone. ... Read more Customer Reviews (14) 
VOLUNTARY DEATH BY DEHYDRATION (VDD)
Stanley Terman, MD, PhD
The Best Way to Say Goodbye:
A Legal and Peaceful Choice at the End of Life
(Carlsbad, CA: Life Transitions Publications, 2007) 482 pages
(ISBN: 978-1-933418-03-2; paperback)
(Library of Congress call number: R726.2.T47 2007)
This is probably the first book promoting
what I call "voluntary death by dehydration" (VDD)
and what Dr. Terman calls "voluntary refusal of food and fluid" (VRFF).
Other expression used in medical ethics are "terminal dehydration"
and SToping Eating and Drinking (STED).
The idea of choosing death by giving up eating and drinking is so simple
that we should ask why so few have discussed it before.
But someone had to speak first.
Dr. Stanley Terman is that first voice,
at least in a book-length discussion.
When the patient is too far gone to participate in any life-ending decisions,
it should be called "merciful death by dehydration" (MDD).
The most common form of this practice is
withdrawing a feeding tube from a patient in a persistent vegetative state (PVS).
This life-ending decision falls within the right to refuse any medical treatment.
As Stanley Terman says in the sub-title,
voluntarily giving up food and water
is a completely legal choice anywhere in the world.
And this book argues that death by dehydration
can be a very peaceful and even painless way to die.
Several ways to alleviate the discomforts
experienced in such a method of choosing death
are discussed in detail, p. 102-112:
mouth care, thirst-reducing aids, pain-relief, & even deep sedation.
And Dr. Terman has experimented with such fasts himself.
So he writes from experience about the discomforts and how to cope with them.
Of course, he has not yet fasted himself into unconsciousness or into death.
But I will not be surprised to learn in some future year
that Dr. Terman has followed his own advice
and chosen VRFF as his best way to say goodbye.
Dr. Terman does not spend much time discussing
safeguards for life-ending decisions,
but the very process he recommends for ending our lives
contains very important safeguards within the process itself.
For one, it will take a week or 10 days to die by this means.
During any such period of continuing to refuse food and fluids,
we will have numerous opportunities
to reconsider any foolish decisions to end our lives.
People who want to commit irrational suicide
will probably never consider dehydration as their means.
The range of attitudes within major religious traditions are discussed.
But almost no religious authorities have addressed directly
the possibility of voluntary death by dehydration.
Most of the religious perspectives deal with refusing treatment
and withdrawing life-supports.
Perhaps only after VDD becomes more widely discussed
will we find religious authorities specifically discussing
this option for ending life.
Several advantages of voluntary death by dehydration
are explored in an on-line essay entitled:
"Voluntary Death by Dehydration".
Search on the Internet for that exact title.
Another major theme of this book is creating a good Advance Directive.
Most of the well-known right-to-die cases would never have happened
if the patients had created Advance Directives.
Dr. Terman has many specific suggestions for advance care planning,
so that our documents say exactly what we want under various circumstances.
We also want to make certain that our Advance Directives cannot be overturned
by people who would make different choices at the end-of-life.
I am not a neutral observer of this book,
since Dr. Terman and I have exchanged over 100 e-mails
discussing the details of this book since the pre-publication
edition was distributed to interested persons like me.
Most of these discussions are too detailed and technical
to include in any book-review.
But some of them have been incorporated into the first edition of BEST WAY.
My most basic criticism is that the book is far too long
for the basic purpose it set out to accomplish.
Everything we readers need to know about voluntary death by dehydration
could be explained in 100 pages or less.
And Dr. Terman is in the process of creating a how-to guidebook,
which will be a guide to taking the actual steps
towards death by giving up food and water.
It should tell us how to cope with the problems
created by this method of voluntary death
and give us some good examples of actual people
who chose this pathway towards death.
I believe this how-to-die book could become more popular
than Derek Humphry's best-selling Final Exit.
Most of the pages of BEST WAY
will be of interest to professionals in medical ethics.
I found the rest of the book quite interesting.
This is because I am interested in all issues of medical ethics.
While I was reading the book, I made 64 pages of notes and responses.
I have summarized and expanded on these issues
in the many e-mails that Dr. Terman and I have exchanged.
Dr. Terman has created a sprawling book of almost 500 pages.
He wants to share all of his thoughts about medical ethics.
And he brings in recent items from the news in unexpected places.
We do not know where to find his comments about Terri Schiavo,
for example, because they keep popping up everywhere.
There are 23 references to her case in the index,
which enables careful readers to find all Dr. Terman's comments.
But few readers begin with the index.
A better-organized book would naturally fall into 2 or 3 separate volumes.
Each of these could focus on some specific issues
already alive in the minds of potential readers.
Dr. Terman's original contribution is voluntary refusal of food and fluid.
But this gets lost in his discussion of many other issues in medical ethics,
which others authors have already dealt with.
For example, he does not need to deal with ending life-supports
and all other forms of refusing medical treatment.
In my opinion, those battles have already been won:
We already have the right to pull the plug:
See my essay: "Pulling the Plug: A Paradigm for Life-Ending Decisions".
The best search term for the Internet is:
"LIFE SUPPORT SYSTEMS (Critical Care)".
But other countries keep having cases
where disconnecting life-supports is still a matter of controversy.
If Dr. Terman follows my advice,
he will create at least two books from this one.
The first (very short) book
will tell laypersons everything they need to know
about choosing to end their lives by giving up food and water.
The rest of the content of BEST WAY is mainly of interest
to professionals in medicine, medical ethics, & law.
Besides the small how-to-die book for laypersons,
he could reorganize his material into one book on medical ethics
and one book on the right-to-die.
There might even be a place for a book
just about creating Advance Directives for Medical Care.
All of these books could refer to one another.
And each one would have a better chance of reaching its intended audience.
More information is available about this book on the Internet.
Search the exact title: "The Best Way to Say Goodbye".
If you would like to read other books promoting VDD,
search the Internet for this exact phrase:
"Voluntary Death by Dehydration".
James Leonard Park, author of YOUR LAST YEAR:
CREATING YOUR OWN ADVANCE DIRECTIVE FOR MEDICAL CARE.
Here is help for end-of-life decisions!
Dr. Terman has clarified the many different aspects of a complex process, dying. It is about the family, medical, legal, financial, and religious choices one needs to make, as the best hope of death as one would wish it. The lesson for me was to complete three documents: a Will, a Financial Power of Attorney, and an Advance Healath Care Directive (also called a Living Will), appointing a Surrogate with Durable Health Care Power of Attorney. AND one also needs these wishes to be entered in one's medical record by one's doctor. It seems that one can take charge of when and how to die: no liquid, no food. It takes about two weeks. It is not uncomfortable, with care for one's dry mouth. I bought two copies, hoping people I love could read it and plan good deaths.
very helpful and comprehensive discussion of end of life issues
excellent, comprehensive discussion.this book clearly identifies end of life issues and provides useful counsel to achieve a given individuals goals.highly recommend.
most informative
Dying is not a problem: it is the process of dying that can be terrible> Dr. Stanley A. Terman's "The Best Way To Say Goodbye" isas good as anythig I read in being able to make better choices for the transition.
Everything you need to know
The content of this reference provides everything you need to know about voluntary refusal of food and fluid.I encourage readers to purchase a copy for themselves as well as family and friends because it is the most comprehensive of its kind!Dr. Terman's approach is solidified in knowledge of the subject matter and personal experience.I commend him on his ability to address such a sensitive and important topic in ways that help his audience feel at ease and at times entertained as they explore a legal peaceful way to say goodbye.
Stephanie Mason, MA, PsyD Candidate
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