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ooks + artsThomas Preston ’55, Patient-Directed Dying: A Call for LegalizedAid in Dying for the Terminally Ill,iUniverse, New York, 200658 : swarthmore college bulletina PeacefulTom Preston leaves few dry eyesas he portrays the dying processof four terminally ill patients inhis newest book. Taking us intothe homes and thoughts of thesepatients and their families, Prestondescribes their suffering andtheir often thwarted attempts toexperience a peaceful death. HeSeekingdescribes them as caught up in“medical dying,” hooked up tomachines in futile attempts todeny death.Although about three-quartersof us report that we would like todie at home surrounded by lovedones, most of us die in the hospitalundergoing aggressive last-Deathditch efforts to keep us alive. Thisgap between how we, as a society,envision the humane death andthe reality of the modern deathexperience needs to be closed. As Preston notes, if more of us sawthe conditions under which our loved ones die, we might be moresupportive of instituting legal measures to help the terminally illachieve a peaceful death. But during medical emergencies, the laymanis usually escorted out of the hospital room. This book helps toeducate the public.One of the greatest contributions of Patient-Directed Dying is itschallenge of the more commonly used phrase “physician-assistedsuicide” to describe what exactly these terminally ill patients areseeking. As Preston argues, suicide carries terrible connotations inAmerican society. When we hear “suicide,” we envision the tragicdeath of someone who had a future. In the cases Preston describes,these patients have fought the good fight, but they are in every senseterminally ill. This is why he argues for our using the term “patientdirecteddying.” There is no question that these patients are dying.He is calling for society and the medical profession to help thesepatients choose how and when to die when all further attempts toextend life are useless. But why is palliative care not enough? Don’twe have morphine and other drugs that help relieve the suffering ofthe dying? Dying is often a difficult process. Even those heavilysedated sometimes suffer unbearable pain and extreme shortness ofbreath. More needs to be done.Preston also helps us to understand why doctors are reluctant tohelp their terminally ill patients die—even if this would require littlemore than writing a prescription for sleeping pills that patientswould take at a time of their choosing. Doctors are driven to savelives. The idea of aiding death is completely antithetical to theirmedical training and worldview. Preston also describes the unfortunateabandonment of some terminally ill patients by their physiciansonce it becomes clear that there is nothing more that can bedone or when patients refuse to undergo one more medical procedurethat is unlikely to help.Why does the doctor run away? The fracturing of the doctorpatientrelationship that has accompanied many structural changesin the delivery of medical care helps explain some of this behavior.Fewer close personal ties between doctors and patients facilitate thiskind of distancing. Some doctors also argue that their time is betterspent helping nonterminal patients. But it is also true that distancing,as death draws near, is a coping mechanism for physicians. AsPreston makes very clear, it is not easy to watch another humanbeing die. And for the physician, the death may be a very direct andpainful reminder of a failure to save this patient. We need to understandbetter how we can train physicians to both save lives and helpthe terminally ill die. This is an area that needs more attention fromthe profession of medicine and the public.We also need to understand better why patients seek the helpof doctors to die. Couldn’t these terminally ill patients tell theirdoctors that they are having trouble sleeping, without saying thatthey intend to end their lives, to get a prescription for sleeping pills?These patients are looking for more than just a way to end theirlives. They are looking for society and the medical profession torecognize and legitimize their decision to die. They are themselvesrecognizing their interconnectedness with the wider society, evenas they face the reality of soon leaving that society. We need tohear their cries for help and act now. Preston has heard and is tryingto help.—Virginia Adams O’ConnellVisiting Assistant Professor of SociologyJANUSZ KAPUSTA/©IMAGES.COM/CORBIS