This vitally important book attempts to move beyond the current death-denying culture. The use of euphemistic and defiant phrases when dealing with terminal disease such as "She lost her battle with cancer" was more appropriate when medical doctors could do little to prolong life. But treatments and technologies have significantly changed. Now life prolonging interventions have outpaced our willingness to use medical intervention to secure patient control over death and dying. We now face a new question: When is it morally appropriate for medical intervention to hasten the dying process? LiPuma and DeMarco answer by endorsing expanded options for dying patients. Unwanted aggressive treatment regimens and protocols which reject hastening death should be replaced by a patient's moral right, in carefully defined circumstances, to hasten death by means of medical intervention. Expanded options range from patient directed continuous sedation without hydration to physician assisted suicide for those with progressive degenerative disorders such as Alzheimer's. The authors' overriding goal is to humanize the dying process by expanding patient centered autonomous control. Review LiPuma (Cuyahoga Community College) and DeMarco (Cleveland State Univ.)--both philosophers--offer an informed, well-argued, and boundary-pushing defense of expanded medical interventions at the end of life. Drawing on data indicating serious limitations in current pain management strategies, the authors argue that physician assistance in hastening death is a morally appropriate option that demonstrates compassionate concern for terminal patients facing unbearable suffering and loss of dignity. The authors argue that public policy should open options currently unavailable to those whose suffering exceeds the limits of pain relief through palliation. They present a strong case for the humaneness of assisted suicide even in cases of progressive dementia disorders. While protecting those suffering decision-making impairments, the authors center ethical concern at the end of life on the competent and autonomous patient making decisions grounded in informed consent, and they defend medical interventions to hasten death, including physician assisted suicide and euthanasia. This bold, thoughtful, and mature study revisits end-of-life issue with ethical sophistication, challenging six-month limits for defining terminal and questioning the usefulness of the double effect doctrine. Case studies demonstrate the end-of-life problems the authors are seeking to rectify. Summing Up: Recommended. Advanced undergraduates through faculty and professionals.-- "Choice" This book would be an excellent choice for those looking for a comprehensive review on societal views on death, suffering, and suicide, as well as thought-provoking opinions on how to optimize the patient death process in the United States. -Stephanie K Fabbro, Chair of the Ethics Committee for the Ohio Dermatological Association and co-editor of the BENO Bio Quaterly LiPuma and DeMarco boldly challenge us to consider end of life options that align with realities of medicine, palliative care, and social supports in the US today. Through riveting case studies and exploration of religious and secular thought, moral theory, and ethics, they propose a framework for broadening approaches to what they unapologetically acknowledge as "hastening death." Clinicians, educators, policy-makers, and the informed public must read this work.--Kathryn L. Weise, MD, MA Bioethics This book moves brilliantly between philosophy, clinical studies, and the analysis of medical cases taken from different jurisdictions. The authors firmly argue that as a matter of public policy the options for patients to hasten their death should be expanded, also to include PAS and euthanasia. For judging such requests, they present criteria that might do within American (medical) culture.--Freddy Mortier, Professor of Ethics,
