Book Review: A Dignified Ending: Taking Control Over How We Die

by Lewis Mitchel Cohen, MD
London: Rowman & Littlefield, 2019
ISBN: 1538115743​

Lewis Cohen’s book, A Dignified Ending, is a comprehensive history of the movement towards medical aid in dying since the time of Socrates. It presents the pros and cons, the pioneers in promoting it, and the growing number of citizens who want it as their ultimate civil right. 

Dr. Cohen is a professor of psychiatry, a palliative medicine practitioner, and a researcher who has been studying end-of-life issues for forty years. He decided to write this book because he wanted to understand the issue fully. Advances in medical treatment are often having the unintended consequence of allowing us to live longer at the expense of living well. What is the proper response to this?

There are many who believe that legislatures and religious institutions should be the arbiters of what is ethical. While Dr. Cohen is respectful of those who oppose medical aid in dying, he does not think they should prevail. No one has to choose this ending; he asks only that we be allowed to choose it if we want to. 

A Dignified Ending weaves together scientific research, personal stories (including the ethical dilemma experienced by Sigmund Freud), and up-to-date information on the status of assisted dying today, both nationally and globally. It is at the same time a reference book that can be read by physicians, legislators, and religious leaders for a fully informed discussion of the use of medication that allows us to end our lives peacefully at the time of our choosing. 

Cohen believes that legalized medical aid in dying may be coming to all of America soon. “America was founded on the concept of self-determination,” he writes. “We like to think for ourselves.” As our population lives longer, and children no longer live close to their parents, and the cost of long term residential care continues to be unaffordable for many, there will come a tipping point. We will ask whether prolonging life for the sake of prolonging life is still a worthy goal. 

Cohen recognizes the difference between physical suffering and existential suffering. He concludes: “Medical aid in dying should be linked to irremediable suffering and not solely to the imminence of death. It should be available to those individuals who have had a consistent and unwavering desire for it. People should have the right to insist on controlling the end of their lives when life as they know it – when the identity that they have proudly forged – has already ceased to exist.” His book is a worthy contribution to the discussion and a keeper for the bookshelf. 

Review by Susan Gillotti, PCV Advisory Committee Member

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