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Final Acts

Death, Dying, and the Choices We Make

Edited and with an Introduction by Nan Bauer-Maglin and Donna Perry

Publication Year: 2009

Today most people die gradually, from incremental illnesses, rather than from the heart attacks or fast-moving diseases that killed earlier generations. Given this new reality, the essays in Final Acts explore how we can make informed and caring end-of-life choices for ourselves and for those we loveùand what can happen without such planning.

Contributors include patients, caretakers, physicians, journalists, lawyers, social workers, educators, hospital administrators, academics, psychologists, and a poet, and among them are ethicists, religious believers, and nonbelievers. Some write moving, personal accounts of "good" or 'bad" deaths; others examine the ethical, social, and political implications of slow dying. Essays consider death from natural causes, suicide, and aid-in-dying (assisted suicide).

Writing in a style free of technical jargon, the contributors discuss documents that should be prepared (health proxy, do-not-resuscitate order, living will, power of attorney); decision-making (over medical interventions, life support, hospice and palliative care, aid-in-dying, treatment location, speaking for those who can no longer express their will); and the roles played by religion, custom, family, friends, caretakers, money, the medical establishment, and the government.

For those who yearn for some measure of control over death, the essayists in Final Acts, from very different backgrounds and with different personal and professional experiences around death and dying, offer insight and hope.

Published by: Rutgers University Press

Title Page, Copyright

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pp. v-vi

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pp. vii-x

When we issued a call for contributions to a book on death and choice, we hoped for strong, convincing essays: personal stories, professional analysis, some historical background, political and social contexts. We wanted essays that would explore how complicated it is to put death and choice in the same sentence, particularly when one is talking about terminal illness. Given...

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pp. 1-12

Most of us don’t want to think about death and dying. We know that someday we may have to be caretakers to the terminally or chronically ill, and we may have strong opinions about issues like suicide or aid in dying or the government’s role in end-of-life decision making. But, generally, we choose to avoid what we consider a depressing subject. Feeling powerless to control...

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Part One: Personal Stories

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pp. 13-148

Part One contains personal stories about death and dying. Individuals with terminal illnesses write in strikingly different voices about their uneasy standoff with death. Daughters (and a daughter-in-law), sons, and nieces write about their struggles as caretakers of and/or witnesses to the death and dying of family members. Their experiences differ—in significant ways—in these accounts of loss and...

Notes on My Dying

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pp. 19-28

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Live Longer or Live Better?

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pp. 29-32

When my doctor told me I have metastasized cancer, my first reaction was: “Hey, this isn’t as bad as I thought it would be.” Why not? Well, one reason is being really old, eighty-eight, as is my husband, ninety-two. Recently we’ve been forced to take note of the fact that we absolutely have to die of something pretty soon. Another reason is that for me the prospect of being the first to sneak off rather than be the one left behind...

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“Life which is ours to know just once”

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pp. 33-54

I will never know whether my mother wished, when the time came, that she had been able to end her own life. Everything I know about this woman—her personality, her biography, and her politics—would have predicted that she would be the one to decide, by herself, as she did most things. But it’s not surprising that she never said anything about the possibility. My mother, who relished serious...

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Caregiving Beulah: A Relentless Challenge

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pp. 55-66

I have spent my entire working life dedicated to improving the quality of life for older people; however, nothing prepared me for my mother’s final journey. I have sat by the side of the dying, sharing their last wishes and stories. I have worked in long-term care, hospice, and assisted-living facilities and in many capacities—as a teaching artist, program developer, social worker, educator, and...

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E-mails to Family and Friends: Claude and Maxilla—Declining Gently

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pp. 67-90

From the summer of 2005 until the end of 2008, I stayed in touch with a growing list of family and friends as my parents weathered a series of health crises. At the time this chain of messages picks up, in October 2006, they shared a room in the nursing home at Givens Retirement Community in Asheville, North Carolina. Having arrived at different times, they were not in...

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Whose Death Is It, Anyway?

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pp. 91-110

It was a nasty, icy morning in January when I drove my father for his first biopsy. I knew he would need someone to drive him home after the procedure, but I was very surprised when he asked me to drive him there as well. My father was very invested in control in all aspects of his life and it seemed uncharacteristic of him to relinquish the driving to me...

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The Family Tree

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pp. 111-122

I have often made the comment “when the time comes, I’m moving to Oregon.” Oregon is that pioneer state far from my home where the citizenry and medical profession seem to support a person’s right to die . . . to take control of the end of life. I suppose, if I were really honest, I should say that I hope “when the time comes, as Oregon goes...

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Elegy for an Optimist

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pp. 123-125

“So Doc, when do we start?” my father-in-law said, hunched over from stomach cramps. My husband and I refrained from asking the oncologist, who had just prescribed a powerful, six-cycle dose of chemotherapy, a lot of what-if questions. How could we, after being warned that if we did nothing, “your father will starve to death, and that isn’t a pretty sight!” Besides, this...

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Buddhist Reflections on Life and Death: A Personal Memoir

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pp. 126-138

When I was eight years old, my mother came home one day with fresh donuts. When I greeted her in the kitchen, my excitement over her offering yielded to the seriousness of her tone and the dampened nature of her energy. She told me that a neighborhood boy whom I knew had hanged himself following an illness. His mother found him in the closet with the belt...

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Death as My Colleague

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pp. 139-148

I am a medical examiner, a term that is now familiar across the world. Television, film, and the written press have made this and words like forensics household terms. Courses are taught in college, high school, and even at the elementary level that emphasize solving crimes, evidence analysis, and legal medicine...

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Part Two: Perspectives

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pp. 149-313

In Part Two, writers from diverse backgrounds and representing sometimes conflicting points of view examine death and dying in essays less personal and more overtly political than those in Part One.
We open this section with two powerful essays that present sharply contrasting opinions on what constitutes...

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The Transformation of Death in America

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pp. 163-182

The nation’s leading cause of death for much of the past century has been heart disease, and its most common manifestation in 1976 was the heart attack. Back then Americans suffered more than 750,000 heart attacks annually. Stroke—the bursting of a blood vessel in the brain—was another major cause of death. Accidents rounded out the top tier of the list...

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Unintended Consequences: Hospice, Hospitals, and the Not-So-Good Death

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pp. 183-203

Some families find hospice a dependable, even indispensable resource, a way to avoid hospital care and instead provide a warm environment for the terminally ill family member. More than a mere alternative to hospital care at the end of life, hospice can offer a terminal patient and his or her family dignity and security during difficult times. Unfortunately, my family found...

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The Hospital Ethics Committee: Solving Medical Dilemmas

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pp. 204-219

An eighty-three-year-old comatose woman, Mrs. J., came in to our hospital with a very poor prognosis. Although she was comatose, the staff became extremely attached to her. They were so attached that in the two months she was in the hospital, her skin never broke down and she never developed any bedsores. Her family, who lived in a distant state, would occasionally call to...

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Ethical Principles for End-of-Life Decision Making

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pp. 220-237

I trained as a philosopher, with a specialty in ethics, but my interest in health-care ethics started when I began teaching bioethics at the University of North Carolina–Wilmington twenty years ago. Over the years I have refined my thinking on the ethics of health care, particularly concerning end-of-life issues. I am convinced that we need to develop a more ethical way...

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Life or Death: Who Gets to Choose?

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pp. 238-251

The word euthanasia comes from the Greek root meaning “good death.”1 There are two types of euthanasia: 1) passive euthanasia, which involves the withholding of life-sustaining treatment; and 2) active euthanasia or physician-assisted suicide, which involves the patient taking a lethal dose of medication to hasten...

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Empowering Patients at the End of Life: Law, Advocacy, Policy

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pp. 252-267

Imagine you have a cancerous tumor growing in your neck that continues to grow even after surgery, radiation, and chemotherapy, and is spreading cancer throughout your body.
Imagine that the surgery required removal of most of your tongue, so that you can barely swallow or speak, cannot eat, and are often choking on secretions...

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Dying Down Under: From Law Reform to the Peaceful Pill

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pp. 268-287

In Australia, voluntary euthanasia (VE) has attracted a consistent 70 percent support among the Australian community for the past forty years. Yet where public policy is concerned, governments of all political convictions have done little to address this growing social need.
As one who has been working in the field of end-of-life choices in Australia for over a decade...

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Ageism and Late-Life Choices

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pp. 288-300

A sizable body of work on ageism has been published in the past fifteen years, but ageism’s impact on a wide range of late-life and dying issues hasn’t attracted the attention it deserves, either from academics or from community-based workers who deal with elderly persons. One reason may be that ageism in employment or in the media has seemed more obvious...

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Physician-Assisted Suicide: Why Both Sides Are Wrong

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pp. 301-311

For the past three decades, the debate over whether physicians should be legally able to write lethal prescriptions has been the dominant medium through which American society has wrestled with what to do when someone who is seriously ill is suffering. In state after state, lawyers and legislative champions act as warriors for right-to-die and right-to-life organizations. In each camp, meetings are held, bills and citizen initiatives...

End of days

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pp. 312-313

About the Editors and Contributors

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pp. 315-320


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pp. 321-326

E-ISBN-13: 9780813549088
E-ISBN-10: 0813549086
Print-ISBN-13: 9780813546278

Page Count: 344
Publication Year: 2009