Summary:

The first sentence of the introduction indicates the author's intention to talk about "how we do it--and how we could do it". Ending life, she says, is an issue under sustained debate in the United States and in much of the developed world. The argument over physician-assisted suicide is the central framework. The described debates on euthanasia and suicide include two pro and three con arguments in American and international contexts. This collection includes essays, practical notes, historical explorations, policy analyses, fiction, and creative non-fiction written by the author.

The author describes the role of fiction and creative non-fiction as offering a recognition of narrative as a respected form of investigation of social issues. Included are two selections that are in this genre and they are very powerful. The essay on the ethics of self-sacrifice is timely and well written. The author's final conclusion is that Stoic and Christian thinking are still in active collision in much of our consideration of these issues and that this means that advance personal policy making remains in the fullest sense an exercise for each individual.

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Except for her canary and cat, Martha (Sheila Florance) lives alone in an apartment containing fragments and memorabilia of the past which speak to a rich and complex life comprised of various relationships and wartime horrors. Many of the fragments are further referenced in flashback scenes. Three current relationships--with her caretaker, her son, and her dependent and declining neighbor, Billy (Norman Kaye)--are central to this moment in time and provide an illuminating portrayal of Martha’s struggle for independence and undiminished zest for life. While her kind caretaker, Anna (Gosia Dobrowolska), respects the old woman’s fierce need for autonomy, her son, concerned about her frailty and safety, is intent on relocation to a nursing home where she can be supervised. Martha, on the other hand, provides gentle and kind care for Billy, who has been abandoned by his family; during the night, when he is unable to find the bathroom, Martha provides gentle and unobtrusive assistance. Martha’s strength comes from character and spirit, remarkable traits which leave an indelible impression about our tendencies to conventionalize aging.

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In the videotape, She's Finally Free . . ., Joe Cruzan and Christy Cruzan White, Nancy Cruzan's father and sister, tell the story of their eight-year struggle for the right to let Nancy die, after a January 11, 1983 car wreck left her in a persistent vegetative state. The Cruzans see their story as a means of enlightening health care professionals and the community at large about the concerns and frustrations experienced by the families of critically ill patients. After a brief pictorial overview of Nancy Cruzan's life, the remainder of the video presents a chronological series of vignettes/stories told by Christy and Joe Cruzan.

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Ten months after being burned over 68% of his body, Dax Cowart was interviewed on videotape at the University of Texas Medical Branch in Galveston by Dr. Robert B. White. Blind, disfigured and helpless, Dax had consistently asserted his right to refuse medical treatment, including further corrective surgery on his hands (useless, unsightly stumps) as well as the daily, excruciatingly painful baths in the Hubbard tank.

At the time of his admission to UTMB, he had become adamant that he be allowed to leave the hospital and return home to die--a certain outcome since only daily tankings would prevent overwhelming infection. Dr. White had been called in as a psychiatric consultant, and much of the twenty-nine minute documentary is a conversation between patient and psychiatrist.

Calm and coherent, Dax states his wishes clearly and presents his case compellingly. He does not "want to go through the pain"; he does not "want to go on as a blind and a crippled person"; and he does not understand or accept any physician’s "right to keep alive a patient who wants to die."

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The setting is the California coast (presumably in the Los Angeles area). The narrator recalls her one and only hospital visit to her best friend, who was dying. Why has it taken her so long to make this visit? Because she is afraid.

When she arrives, her friend is wearing a surgical mask, and so must she. They talk about inconsequential things, bantering, but then her friend says that there "is a real and present need here . . . like for someone to do it for you when you can’t do it yourself." The narrator tells her sick friend the story of a dog who "knows when to disobey."

The narrator remembers how she and her friend played a word-game to ward off earthquakes. Now, however, it is not a question of "if" but only of "when." When the narrator returns to her friend’s hospital room after taking a walk on the beach, there is a second bed there. The narrator knows it is meant for her, so that she can keep vigil. Both women take a nap, but on awakening, the narrator says, "I have to go home."

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A doctor has become fascinated by mesmerism. He is curious to see what would happen to an individual put under hypnosis while dying. Would it stave off death? Would dying make hypnosis impossible? A friend agrees to be the subject of this experiment.

Seven months later, the doctor is called to the dying man’s bedside. As the patient’s breath and heartbeat slow, the doctor successfully hypnotizes him. The dying man feels no pain and responds to questions without rising from his trance. He asks the doctor not to wake him, but to let him die without pain. The next day, the patient’s eyes roll upward, his cheeks lose their color, and his mouth falls open. The man is apparently dead.

As they prepare him for burial, however, the tongue begins to vibrate and a minute later, answers the question the doctor put to the patient just before his death. "Yes; - no; - I have been sleeping - and now - now - I am dead," says the corpse. The amazed doctors leave the patient in exactly the same state for seven months. Finally, they resolve to wake him. As he begins to wake, the doctor asks what the patient’s wishes are. The dead man cries out that he is dead and must be awakened. The doctor wakes him and the corpse immediately falls apart into "a nearly liquid mass of loathsome - of detestable putridity."

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Levertov structures this poem in many ways like a Biblical psalm: repetition, irregular rhythms, direct address. The poem is also reminiscent of a Catholic litany in which saints are invoked in repetitive phrases. It moves forward by piling particularity upon particularity. The movement of the first part of the poem corresponds to the process of aging, preparing to die, letting go of the world, a natural flow or rhythm. However, this natural process is aborted: "She did not die."

The second part of the poem invokes the unnatural state in which she "lies half-speechless, incontinent, / aching in body, wandering in mind . . ." and describes the tubes and sores. "She is not whole." While the psalmist praises "O Lord of mysteries" for the beauty of sudden death, she cries "how baffling, how clueless / is laggard death . . . ." Death "that steals / insignificant patches of flesh" is a mystery.

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Faustus was born into lowly circumstances. He studies hard and masters all the knowledges known to man, but he is still dissatisfied. Faustus determines to study magic, the one knowledge that can break the limits of all others. He engages two master magicians to teach him. While he awaits their arrival, a good and an evil angel appear. The good angel urges him not to go through with his plans, but Faustus is determined. He learns quickly and for his first act calls up Mephistophilis, Satan’s messenger. Faustus is very pleased, thinking he has control over the forces of evil, but Mephistophilis says he only showed up because Faustus had rejected God. Faustus offers to give his soul to Lucifer if Mephistophilis will wait on him for twenty-four years. Lucifer agrees.

Faustus is not troubled by this pact because he does not believe in eternal life. With Mephistophilis’ help, Faustus makes a great career for himself. He amazes the Pope by becoming invisible and stealing things from his hands. He calls forth the spirit of Alexander the Great for the Emperor. As his twenty-four years draw to a close, he begins to fear Satan and nearly repents. Instead, he asks Mephistophilis to bring him Helen of Troy to be his lover in his final moments. Just before his end, he reveals to his fellow scholars how he gained his powers. He is then carried off by a group of devils.

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In this first person narrative, Dr. Edward Haggard addresses his story to James, the son of his former lover Fanny Vaughn. Haggard, once a surgical registrar at a major hospital in London, has isolated himself in a coastal town, where he serves as a general practitioner. The "present" of Dr. Haggard’s story is the early stages of World War II, when James Vaughn, a Royal Air Force pilot, lies dying in Edward Haggard’s arms.

The story’s "past" has multiple dimensions. The outermost, framing story recounts the relationship between James and Edward that began several months before the war and a year or so following Fanny Vaughn’s death from kidney disease. James sought out the reclusive Dr. Haggard to discover the "truth" about Haggard’s relationship with his mother.

The inner story consists of Haggard’s description of his reckless and passionate love affair with Fanny, an ultimately hopeless liaison between a young registrar and the wife of the hospital’s senior pathologist. Their few brief months of happiness ended when Dr. Vaughn learned of the affair, and Fanny made the realistic choice to remain with her husband and adolescent son. In a confrontation between the two men, Vaughn knocked Haggard to the floor, causing a leg injury that resulted in chronic pain and permanent disability.

Haggard resigned from the hospital and withdrew to a solitary life, in which "Spike" (the name he gives to his deformed and painful leg) is his only companion. He must constantly "feed" Spike with intravenous morphine to quell the emotional, as well as physical, pain. The situation only worsens when Haggard learns of Fanny’s death from kidney failure.

The obsession worsens further still after James Vaughn shows up at his door. As Haggard treats the young pilot for a minor wound (he has become the local RAF surgeon), he notices that James has a feminized body habitus--gynecomastia, lack of body hair, broad hips, narrow shoulders, and pre-pubertal penis. He interprets this as "a pituitary disorder" and attempts to convince James that he needs treatment. James is repulsed by these advances, which eventually escalate.

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This remarkable book takes the reader into a Dutch nursing home where many of the 300 patients are terminally ill. The main protagonist is Anton, a competent, tough, and compassionate physician who tries to discover some meaning in the suffering of his patients, while at the same time disavowing any such meaning. Anton’s colleagues include Jaarsma, a somewhat detached and bureaucratic older physician, and Van Gooyer, a young physician who still believes that science has all the answers.

The first-person narrative consists of short, punchy segments (almost like an endless series of discrete physician-patient interactions) detailing the stories of Anton’s patients and his reactions to them. Many of these persons request assisted suicide or euthanasia. Anton reveals what he feels about these requests, how he goes about judging their validity, and the manner in which he actually carries out assisted deaths. A strong spiritual theme permeates the book; while Anton denies the relevance of God and religion, he seems constantly to be searching for a spirituality that "makes sense" of contemporary life.

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