Tag Archives: assisted dying

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.

Darke Matter by Rick Gekoski (Blog Tour Review)

Back in 2017, I enjoyed Rick Gekoski’s debut novel, Darke, in which curmudgeonly Dr. James Darke, a retired English teacher, literally seals himself off from the world after his wife Suzy’s death from cancer. I was pleasantly surprised to learn that a sequel was released last year – how appropriate to revisit themes of grief and isolation in 2020! – and right away was reminded of the delights of his grumpy, pompous first-person narration. As the second book opens, Darke is preparing to host his daughter Lucy with her partner Sam and son Rudy for Christmas and is in a Scrooge-like mood: “In my own home, I am blessedly safe from the canvassers, beggars and importuners spreading bubonically from house to house at Yuletide.”

Soon two things happen to shatter his peace: one is an invitation to join a poetry reading club hosted by a literary associate of his late wife – but he soon realizes it’s more of a support group for bereaved spouses. The second and much more serious interruption is a knock on the door from the police, who require more information about Suzy’s death. You see, early on in this book, Darke tells us himself that he gave Suzy a “soothing drink to carry her away,” and even in the face of others’ horror he maintains two seemingly contradictory facts: that he did not want for her to die, but that he did give her a fatal concoction to ease her terrible pain.

By coincidence, I was reading a nonfiction study of assisted dying, The Inevitable by Katie Engelhart, at the same time, and I’d also read That One Patient, a collection of interviews with Dutch medical professionals, some of whom have helped terminally ill patients to commit suicide, earlier this year. It was amusing, but also touching, to see Darke becoming an unwitting spokesman for this movement. He writes a manifesto headed “Easeful Death – Do you love your dog more than your wife?” and gets help disseminating it from a journalist acquaintance. Media attention follows and a scandal erupts.

One of the joys of this pair of novels is Darke’s fondness for literary allusions. In the previous book, these were mostly to Dante and Dickens. Here, the greatest debt is to Jonathan Swift: Darke has been reading Gulliver’s Travels to his grandson at bedtime, and decides to write a pastiche sequel to entertain the boy. Gradually, this turns into a coded story by which he can explain to Rudy what might happen to his grandfather. Will Captain Gulliver be found guilty of heresy? Will he have to flee to avoid jail?

Because we only ever experience Darke’s point of view, he is something of an unreliable narrator, and because he delivers the novel’s finale via his italicized Swiftian narrative, there is some uncertainty about what actually happens to our antihero. I didn’t enjoy this quite as much as the first book, but together they form a striking and witty character study. I especially appreciated how the sequel adds in a gentle note of controversy without allowing it to overtake the pleasures of the voice.

 

Darke Matter was first published in the UK by Constable in May 2020. The paperback edition came out on April 1st. My thanks to the publisher for the free copy for review.

I was happy to take part in the blog tour for Darke Matter. See below for details of where other reviews and features have appeared or will be appearing.