Death With Dignity: The Final Cocktail Sets The Bar

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“Aid-in-dying sets the gold standard for a good death,” says Robert Orfali author of the recently-published book Death with Dignity. Named “Best of 2011” by Kirkus Reviews, Orfali’s book provides an in-depth look at how we die in America today.

A lucid, powerful argument for letting dying patients go gentle into that good night.
— Kirkus Star Review

In his recently published book Death with Dignity Robert Orfali states that aid-in-dying sets the gold standard for end-of-life palliative care. Says Robert Orfali, “My wife Jeri wanted to drink a final cocktail and die peacefully on her own terms. The cocktail sets the bar for a good death.  Hospice and palliative care  must be at least as good as the final cocktail alternative.” As Orfali explains: “In states where the cocktail option is available, the palliative care people must work harder to meet the competition.” When it comes to pain management, even hospice is not always a panacea. According to Orfali’s research, the practice of “palliative sedation” in hospices is highly uneven. In 2010, the numbers varied between 1% and 52%. Says Orfali, “If you fall on a physician who does not agree with the practice, you could really get tortured at the end.” Even in hospices that provide palliative sedation, the torture can last for hours. Why? Because the morphine is slowly titrated to a level that induces coma. They go slow to maintain a moral distance and not have it called euthanasia. Unfortunately, a patient who is dying can greatly suffer during that “titrating” period. The numbers show that among hospice patients who were asked about their pain level one week before death, 5% to 35% rated their pain as “severe” or “unbearable.” An additional 25% reported their shortness of breath to be “unbearable.” And it’s twice as bad in ICU units. Orfali concludes, “In our end-of-life system, it pays to be an informed consumer. Ultimately, you must do everything you can to protect yourself and your loved ones from a bad death.”

Robert Orfali’s recent book Death with Dignity: The Case for Legalizing Physician-Assisted Dying and Euthanasia is an in-depth exploration of the shortcomings of our end-of-life system. The reader will learn about terminal torture in hospital ICUs and about the alternatives: hospice and palliative care. With laser-sharp focus, Orfali scrutinizes the good, the bad, and the ugly. He provides an insightful critique of the practice of palliative sedation. The book makes a strong case that assisted dying complements hospice. Oregon, by providing both, now has the best palliative-care system in America.  Oregon leads the nation in the number of deaths occurring at home, effective use of pain medication, early patient referrals to hospice care, and improved quality of end-of-life care.

“Orfali approaches this agonizing subject with common sense informed by extensive research and an acute sensitivity to the dilemmas faced by dying patients and their families and doctors. The result is a thought-provoking contribution to the debate over this explosive issue. A lucid, powerful argument for letting dying patients go gentle into that good night.”
— Kirkus Star Review (April 15, 2011)

Robert Orfali, the guru of client/server systems in the early days of Silicon Valley, co-authored three best-selling books that demystified the complexity of these mission-critical systems and made them understandable to a whole new generation of programmers. The books sold over a million copies. In this book, Robert uses his analytical skills to deconstruct the most complex system he has yet encountered: our modern end-of-life system. He wrote this book after helping his soulmate and coauthor, Jeri, navigate her death from ovarian cancer in 2009. The deep emotions Robert felt allowed him to look at how we die from a different perspective, another angle. Robert also wrote Grieving a Soulmate

Paperback: 254 pages
Publisher: Mill City Press, Inc. 
Publication date: April 15, 2011
ISBN-10: 1936780186
ISBN-13: 978-1936780181
Paperback list price: $14.95
E-book list price: only $ 0.99 “almost free.”

Book and e-book available from Amazon, Barnes and Noble, Apple Store, and others.
E-book formats include Kindle, iPad, iPhone, Nook, Android, and others.
Book website:


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