The Inevitable: Dispatches on the Right to Die by Katie Engelhart

Why, she wanted to know, was I so interested in the subject?

“Why isn’t everyone?” I asked.

The fact that I read a lot more books about death than the average person is something I attribute not to some morbid curiosity, but to pragmatism. As the title of Canadian reporter and documentary filmmaker Katie Engelhart’s book makes clear, this is the one subject none of us can avoid indefinitely, so why not learn about and understand it as much as possible? The Inevitable focuses on the controversial matter of assisted dying, also known as assisted suicide, euthanasia, or physician-assisted death. It’s a topic that’s already come up in my reading a couple of times this year: in the Dutch context of That One Patient by Ellen de Visser, and as a key part of the narrative in Darke Matter by Rick Gekoski.

Engelhart spends time with doctors and patients who are caught up in the assisted dying argument, chiefly in Western Europe and the United States. Ten states plus Washington, D.C. have assisted dying laws, sparked by Oregon’s Death with Dignity Act in 1994. In California, the author follows Dr. Lonny Shavelson for a month, observing all the meticulous regulations surrounded a physician-assisted death: patients with a terminal diagnosis and less than six months to live have to complete multiple forms, give many signatures, deliver oral testimony, and be able to drink the fatal concoction by themselves (whereas in other countries doctors can administer lethal injections). And if, when the time comes, a patient is too far gone to give spoken consent, the procedure is cancelled.

Other chapters consider specific cases that are not generally covered by current legislation but can drive people to seek assisted suicide: the ravages of old age, chronic degenerative illnesses, dementia, and severe mental illness. Each of these is given its own long chapter, like an extended magazine profile.

  • Meet Avril Henry, a former Exeter University professor in her eighties, now living alone with a failing body but no specific diagnosis that would qualify her for AD. Pain has long since outweighed pleasure in her life, so she illegally imports Nembutal from a veterinary supplier in Mexico and makes a careful plan for what will happen with her body, home, and possessions after she takes the drug in the bathtub.
  • Meet Maia Calloway, a 39-year-old former filmmaker confined to a wheelchair by multiple sclerosis. Her medicines cost $65,000 a year, not all covered by Medicare, and she can no longer rely on the patience of her boyfriend, who acts as her carer. She decides to raise the money to travel from Taos to a Swiss assisted dying clinic.
  • Meet Debra, a 65-year-old widow so rapidly declining with dementia that she knows she has to make her arrangements at once. She contacts the Final Exit Network, which gives advice and equipment (e.g. a nitrogen tank) that can make a death look unexplained or like a standard suicide.
  • Meet Adam, a 27-year-old in daily distress from OCD, anxiety, and depersonalization disorder. Though he’s lobbied for the inclusion of mental illness, he doesn’t qualify for AD under Canada’s laws. In 2017 he starts a Facebook livestream from a hotel room, intending to take poison off-screen. He loses his nerve this time, but is determined to try again.

These stories are so wrenching, but so compassionately told. Engelhart explores the nuances of each situation, crafting expert portraits of suffering people and the medical professionals who seek to help them, and adding much in the way of valuable context. Hers is a voice of reason and empathy. She mostly stays in the background, as befits a journalist, but occasionally emotional responses or skepticism come through – Exit International’s Philip Nitschke, vilified as a “Dr. Death” like Jack Kevorkian, is too much of a maverick for her.

And while her sympathy for the AD cause is evident, she also presents opposing arguments: from hospice doctors, from those afraid that the disabled will be pushed into assisted suicide to free up resources, from the family members of her subjects, and from those who have witnessed abuses of the system. There are those who frame this as a question of rights, and others who recognize a rare privilege; some who scorn the notion of escape, and others who speak of dignity and the kindness one would show a dying pet. The book is a vital contribution to an ongoing debate, with human stories at its heart.


With thanks to Atlantic Books for the free copy for review. The Inevitable was published in the UK on March 11th and is available from St. Martin’s Press in the USA.

15 responses

  1. This is such an important issue, not one that should be ducked. I’ll add this one to my list.

    Liked by 1 person

    1. Agreed. Some parts were hard to read, but I found the whole very valuable. In the wrong hands the tone could have been off, but Engelhart is sensitive and compassionate.

      Liked by 2 people

  2. Does this issue deal with the other important matter of keeping the body existing, when the patient is to all intents and purposes dead? As it keeping a pacemaker going, so that the heart continues beating, but little else? We’ve recently witnessed this happening to someone we know: it causes great suffering to the family, while the patient, comatose, knows nothing, and will never recover. ‘Thou shalt not kill; but need’st not strive/Officiously to keep alive’ -Arthur Hugh Clough

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    1. What an awful situation. In the introduction she mentions two U.S. cases of women who were in vegetative states and the decision to remove a feeding tube was made by judges. (I vaguely remember the Terri Schiavo case.) This forms part of the background but isn’t a major element of the book, because it is more about patient choice.

      Liked by 1 person

      1. Luckily it wasn’t actually vegetative state. But bad enough. It’s right that protections are in place, but there needs to be more debate round this issue.

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      2. How heartbreaking for the family. More people talking about this could only be a good thing.

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  3. Sounds right up my street, as you know 🙂

    Liked by 1 person

    1. It gives lots to think about, but the issues don’t overwhelm the storytelling. Why oh why isn’t the Wellcome Book Prize back?!

      Liked by 1 person

  4. “A vital contribution to an ongoing debate, with human stories at its heart.” One of the best kinds of non-fiction books, I think. And I agree with your pragmatic stance — though, in that case, why am I delaying decisions about my funeral? Hmm.

    Liked by 1 person

    1. Well, I do plenty of reading about death, but it’s true that I haven’t thought about practical arrangements for myself. That may be because I’m 37 and don’t have children, so making a will, etc. doesn’t feel like a pressing need. But I’m sure it’s never too early to be prepared.

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      1. Yep, I see your point! As people twice your age (!?!) and with children and grandchildren we sorted out our wills long ago; but no firm ideas about the final send-off…

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  5. buriedinprint | Reply

    We’d thought about making the arrangements when we were your age, but the money we set aside for it had to go elsewhere and, since, it has become a much more complicated matter. I vote for getting it done sooner rather than later, even though that isn’t what I’ve done.

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  6. A weird select-and-cut and enter sent off the second paragraph of my comment alone up there…here’s how I actually started off…

    This sounds like a vitally important read and I love the way you’ve described the contents and the experience of reading it. From an author’s perspective, I wonder how difficult it is to get a work like this to market; it seems like something that would have to suit an editor’s predilection perfectly.

    Liked by 1 person

    1. I think Engelhart coincided with a Louis Theroux documentary, so that may have given her a leg up. Atlantic tends to publish more niche books from the U.S. market, which is all to the good in my opinion.

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  7. […] The Inevitable by Katie Engelhart: Engelhart spends time with doctors and patients who are caught up in the assisted dying argument, chiefly in Western Europe and the United States. Each case is given its own long chapter, like an extended magazine profile. The stories are wrenching, but compassionately told. The author explores the nuances of each situation, crafting expert portraits of suffering people and the medical professionals who seek to help them, and adding much in the way of valuable context. A voice of reason and empathy. […]

    Like

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