We may ask ourselves early in life: How should I live? Later, as we ripen into ourselves, our question shifts to “How have I lived? Aging, like illness, may include a constantly shifting perspective in reflective moments in answering both questions. 

Diane Rehm’s new book, When My Time Comes: Conversations About Whether Those Who are Dying Should Have the Right To Determine When Life Should End, brings us two additional areas to contemplate: How shall I die? And “Under what circumstances?” Perhaps we add a third: “Who will make the final decision: I who am dying from a terminal illness or others?”

Many of you may know Rehm from her 37 year career hosting The Diane Rehm Show and who now offers a podcast, On My Mind. From her own experiences with her mother’s death, which was very painful, to her husband of many decades who also suffered the pains of terminal illness the last months of his life, she has become a strong advocate for a growing movement,  Medical Assistance in Dying (MAID). Her book of 23 interviews embraces a wide range of voices who are for and who resist such “interference” in the natural death of a terminally ill patient who has been judged to have less than six months to live and who wishes to preserve their own agency surrounding when they die and under what conditions. 

Currently in the United States there are nine states that have passed laws allowing medically assisted dying; they are careful, generally, not to use the phrase “medically assisted suicide” because proponents do not see it as assisting suicide, but assisting dying. I bring this up because even the language of the debate is under constant scrutiny and discussion, if not heated legal, ethical, medical and religious perspectives.

Doctors, palliative care physicians, priests, ministers, spouses and loved ones of those who suffered intensely at the end of their lives, directors of spiritual care and hospice programs, professors of medicine, terminal cancer patients, attorneys, state legislators and Rehm’s own grandson are among those interviewed, with the special gifts and skills  Rehm brought to her show that over 3 million people listened to regularly. I found the interviews both engaging, disturbing, persuasive and thought-provoking on a subject that in the United States is in many quarters are still taboo. Rehm’s intention is to begin/continue conversations, not drub the reader with her favored position.

Some of the key questions posed include:

• What terms or condition should be present when it is decided — and by whom? — to keep an individual alive, and to what end?

• Who is one terminally ill and suffering benefiting or comforting by being kept alive beyond their own desire to die?

• Should the religious or moral beliefs of a doctor or medical professional in charge of a patient be the final arbitrator of one who is suffering intensely while dying?

• Should the wishes of the patient be held foremost so they have control over their own deaths?

• What is one’s definition of a good death? Rehm asked every person interviewed to respond to this question.

• What do you want when you are near the end of life?

• Should the “End of Life Option Act” be decided by legislators in each state?

• Who should have a voice in such a challenging topic and what weight should their opinion hold?

• Is medical aid in dying in fact a form of cloaked suicide?

• What does it mean, finally, to “die a natural death” with the aid of pain-relieving drugs?

I found reading this book challenging my own beliefs. I ended completely supporting Rehm’s desire to deepen authentic conversations  about our options for dying which is part of the natural cycle of life.

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