Permission To Die: Candid Conversations About Death And Dying

How does a conversation begin about a topic that we can’t talk about—that no one really talks about? Where is the jumping off point to cut through the intellectual definitions and the sterile antiseptic medical terminology to reach a place in which real words, experiences and feelings can be used to speak about the unspeakable? Who has the capability, the depth of experience, the sensitivity, knowledge, or even more, the audacity to give themselves license to discuss our universally shared last act on the planet? 

All of our respective cultures acknowledge the magnitude of death as the major event it is with structured behaviors and traditions. Afterlives, reincarnation, heaven and hell are all constructs that may help us deal with the consuming emotions of loss and humanly unanswerable questions surrounding the permanence of our souls. We would like to present for consideration, from a perspective of our own personal experience and that as healthcare workers, the idea that since death is inevitable, reasonable and appropriate we should embrace the concept and give ourselves and our loved ones the opportunity to die in a well-planned, dignified manner.

Without any pomp or ceremony, and with considerable humility, the authors of this volume attempt to advance the conversation that we’ve all never had about death—not someone else’s death—not the stages of dealing with death—not the objective chemical reactions associated with death—and certainly not the legal definitions or issues of outside agencies’ involvement in death—but of our own, not be denied, impending exit from this life. 

We, who live with death each day of our professional careers, want to reach and speak out. Beyond our own individual indoctrinations, we, who have seen untold unnecessary suffering of patients and their families, want an opportunity to contribute to changing the conversation from life at all emotional, physical, spiritual and financial costs toward a release from fear and guilt and acceptance and celebration of life’s natural conclusion. We offer: Permission to Die.

“Permission To Die” is a worthy successor to the classic, “On Death and Dying” by Elisabeth Kübler-Ross. I wish I had had this book as we cared for my father in his last days. This is a passage we all make- this book will help you or loved one make the passage with courage and grace.

Joe Tye, CEO and Head Coach, Values Coach Inc., Author, “The Florence Challenge,” “All Hands On Deck,” “ Building A Culture Of Ownership In Healthcare,” and “Pickle Pledge.”

This is a very special book. It is written by four individuals-two physicians, a clinical psychotherapist, and a Rabbi- who were touched by death in their own unique way. This led to the common realization that dying is inevitable and, while it can be postponed, it is not always right to do so. Treatment can worsen suffering in all its domains-physical, existential and spiritual- without improving quality or helping the patient. They learned that respecting autonomy is more than just asking what one wants, but also explaining what the treatment will do (informed consent) and working with the individual towards a common goal, driven by the results of a thoughtful conversation. They learned that it is OK to allow a patient with an incurable illness to let go; to give them permission to die. Each of the authors reached into their most private spaces and shared deeply personal stories that help bring the message to life.

As a hospice and palliative medicine physician, I found the book a source of reflection and insight. I recommend it, not just to other hospice doctors, but to students, residents and, most importantly, all practicing physicians. Just because we have tools to treat, it doesn’t mean we use them or should use them. Giving permission to die is not giving up. It is letting go. We need to learn how to do that. This book helps us put this into perspective.

Faustino Gonzalez MD, FACP, FAAHPM, Chief Medical Officer- Hospice, Trustbridge

This book is a most important contribution to a question many if not all of us face in the death
of those whom we love and care.  The authors approach the issues both personally and
professionally, a unique approach sharing with us what they experienced and what went
through their hearts and souls. Their understanding, lessons derived, emotional reality,
religious and medical approaches all add up to the significance of what they are sharing so
honestly with us about the death of others as well as our own mortality.  Whatever our
feelings, predispositions and religious values, these most "human" questions and what the
authors have learned and shared warrant full and sensitive thought and discussion.  Given as
well the realities of modern medical technology, we thank you for your honest and open
sharing of your experiences and conclusions.

Rabbi Sheldon Zimmerman, Past President of the Central Conference of American Rabbis