A Time to Die: The Place for Physician Assistance by Charles F. McKhann

By Charles F. McKhann

Drawing on in-depth interviews with those that have been death and with the physicians who cared for them, in addition to on his personal reviews as a doctor, Dr. Charles McKhann argues persuasively that physician-assisted loss of life can be made legally to be had below definite conditions.

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Arranging for such a death, though, poses very difficult ethical and legal problems. A few patients with Alzheimer's disease and a few more with Huntington's opt for preemptive suicide and take their own lives at the first signs of illness. Advance directives and instructions to those with durable powers of attorney may include requests not to treat acute infections that may provide < previous page page_24 next page > < previous page page_25 next page > Page 25 "natural" deaths. But these requests are often voided by the family or simply overlooked by the nursing home.

S. " 29 Having looked at many reasons why a person who is seriously ill might wish to shorten his life, we must now recognize the fact that such an act, with or without help, is essentially suicide. Is it ever acceptable? < previous page page_43 next page > < previous page page_44 next page > Page 44 2 Rational Suicide: The Core of the Controversy People who insist that life must always be better than death often sound as if they are choosing eternal life in contrast to eternal death, when the fact is that they have no choice in the matter; it is death now, or death later.

Finally, autonomy is widely accepted on the condition that it does not interfere with the similar autonomy of others. 25 This seems appropriate for team sports or military maneuvers that require integration and precision. But the number of people with whom we interact decreases as we get older < previous page page_37 next page > < previous page page_38 next page > Page 38 or sicker, with fewer people depending on us to fulfill a role. As one's world narrows down to close family or companions, it seems inappropriate to try to enlarge it to a mystical universe of social interaction.

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