But medically assisted death is not new. It has been present and debated since at least Greco-Roman antiquity and probably much earlier. However, its current status in various countries and within them is fraught with controversy even after legalization. For their involvement, euthanasia providers have been celebrated – and they have gone to jail. They have been portrayed as heroes or as villains, prominent among them American pathologist, Jack Kevorkian (1928-2011). Sometimes, health care workers are wrongly accused of killing their patients, especially when an unusual cluster of deaths arises – one example being the vicious prosecution of Canadian pediatric nurse Susan Nelles in 1981 for having murdered unhealthy neonates. She was later vindicated, absolved of all blame.  

Yet those of us who have worked with seriously ill people on the hospital wards know that a therapeutic choice to help suffering can run the risk of shortening those few remaining days. I recall more than half a century ago, a diminutive, elderly patient, writhing in agony on her bed. A much-respected senior clinician on his rounds demanded to know why we had not given “enough” morphine. “But chief!” we protested, “to raise the dose could stop her breathing!” “Why are you giving morphine?” he asked. “To relieve the pain.” “Have you succeeded?” “No.” “Then give enough; enough to make her comfortable” We did. She stopped moaning and died soon after. Unforgettable. We realized that decisions like this must be happening everywhere, but they occur within a cloud of trepidation, as bereaved family members might choose to make accusations. 

Prior to Canada’s 2016 legalization of medical assistance in dying (MAiD), people seeking help to end their lives with dignity would sometimes go to Switzerland. There, providing assistance to a person able to voluntarily self-administer lethal drugs had been legal (with variations) since the 1940s. In 1998, the Swiss non-profit organization Dignitas was founded to offer assisted death (or assurances thereof) to its members. In 2010, 89-year-old Kay Carter of Vancouver, who was suffering from spinal stenosis, went to Switzerland to end her life. It seemed outrageous that “death with dignity” was available to citizens who could afford to leave the country– yet everyone else was deprived. After her death, the Supreme Court decision that struck down Canada’s law against assisted suicide is known as “Carter vs Canada.” Considering that ordinary suicide had been illegal in Canada until 1972, these changes reflect a remarkable and relatively rapid shift in attitudes to death and dying.  

But the controversies are not over. And Canada is far from alone. Religious objections can be found in many communities. Vulnerable and disabled people together with their caregivers worry that they could be targeted or urged to accept assisted suicide by institutions wanting to save money. The prohibitions on access for children or the mentally ill are repeatedly challenged and have been overturned in some jurisdictions. Psychiatrists argue that assisted suicide would rarely be contemplated if more mental health services were available. Palliative care doctors resent the implication that they should be the administrators of euthanasia; they saw themselves as purveyors of comfort for life, not death. They pointed to the World Health Organization emphasis on the global need for more palliative care, and they complained that the new law made patients even more hesitant to accept their help. Swirling throughout these debates is the well-intentioned question about how a society should treat the least of its members: humane treatment or humane killing. 

It is scarcely surprising, then, Assistedlab.ch comes out of Switzerland; nor is it surprising that it finds a rich supply of sources. Launched in 2023, it claims to be “a living archive of assisted dying” that strives neither to endorse nor criticize the movement. Led by Anna Elsner, a professor of French Culture and Medical Humanities at the University of St Gallen whose 2011 doctorate from Cambridge focused on mourning in the work of Marcel Proust. Her polyglot team includes three other investigators and a manager, all with doctorates in either history or literature, all with Swiss affiliations. They are supported by ten assistants, mostly graduate students, seven from Canada and one each from the Netherlands, Switzerland, and the United Kingdom. They rely on an advisory board of four distinguished scholars from Montreal, Glasgow, London, and Garrison, New York (the Hastings Center).  

Funded in part by a starting grant from the European Research Council for five years (2023-2028), assistedlab.ch also acknowledges support from several other universities. It is active on Bluesky with 1400 followers and, in mid-2025, launched a newsletter to feature the latest entries and events of interest. 

Aside from its specific subject-matter, assistedlab.ch has many features in common with our own Medhum, the most obvious being the preparation of reviews by team members. The site is plain but attractive and color-coded for analysis of textual, performance, visual and audio sources, the majority being textual sources. Each menu entry sports a black and white image, which sometimes turns to color upon clicking. The sources – fiction and non-fiction books, short stories, essays, films, plays, artwork, podcasts, memoirs, news reports, and farewell letters from the recently deceased. Most sources are linked from the articles describing them, most from recent decades but some dating back to the 1990s. A bibliographic list of further reading in print or other media accompanies each entry. Keyword tags and an efficient search function make exploration easy. 

At the time of writing, assistedlab gathers more than a hundred articles, all in English, although the works examined can be in other languages. In addition, a news section, similarly color-coded, provides information about upcoming and recently past events: lectures, theatre, conferences, workshops, interviews and new publications. Thoughtful description takes precedence over hyperbolic criticism or praise, making the site welcoming for anyone approaching this dire matter with curiosity for themselves or their loved ones in terms of personal or professional life. It will be fascinating to learn usage statistics for assistedlab.ch, not only the numbers, but also the geographic origins and user traits, for it should serve a wide array of human beings as we wrestle with the most fundamental of existential questions facing us all.  

Web image from Assistedlab.ch.

Modern medicine’s emphasis on extending the human lifespan has, in some cases, transformed dying, once a communal and spiritual event, into a cascade of arduous procedures. Deftly synthesizing the wisdom of many experts with his own insights and experiences, Palmer offers compelling, accessible, and refreshingly honest advice on how to shape our lives and legacies so that we are better prepared to die as we see fit—highlighting agency in aging in the face of ageist norms. 

Just last week, New York Governor Kathy Hochul announced that the state will join 11 others and Washington, D.C., in legalizing medical aid in dying (MAID), or when physicians prescribe a lethal dose of medications to patients with fewer than six months to live. 

“New York has long been a beacon of freedom,” Hochul said, “and now it is time we extend that freedom to terminally ill New Yorkers who want the right to die comfortably and on their own terms.” 

The governor’s rhetoric emphasizes a collective cognitive dissonance: As physician (and fellow politician) Dan Morhaim observes, “our culture celebrates personal autonomy,” but when it comes to death and dying, “we collectively abdicate” that value. 

Citing Morhaim and others, Palmer provides valuable context for our relationship with mortality (along with additional information about MAID). During the nineteenth and early twentieth centuries, the average death was relatively quick and happened at home, with little involvement from healthcare providers and medical technology. Today, dying is protracted and tends to take place in hospitals or nursing homes; healthcare providers and medical technology are highly involved; and life can be prolonged with organ transplants, chemotherapy, and more. 

“There is a significant difference between dying peacefully in your bed at home and dying yoked to tubes and machines in an ICU,” Palmer writes, “receiving futile care that only prolongs the dying process for perhaps a few days while providing a horrendous quality of life.” 

Drawing on surgeon Atul Gawande’s [1] work, Palmer argues that, at best, physicians are uneducated about aging and dying and what might matter to patients approaching the end of their lives. At worst, they are financially motivated to perform aggressive interventions that may do more harm than good.  

According to numerous studies, frail patients do poorly in hospitals, and Palmer points out that doctors nearing death tend to eschew the very treatments they give to their older patients, such as surgeries and radiation. 

“I don’t want my last conscious thought to be of doctors stabbing needles into my veins, my ribs breaking from chest compressions, and a large-bore tube thrust into my throat and lungs,” the end-of-life activist writes. “When a patient is young and robust, such curative measures may make good sense despite their violence, but not for an old, debilitated, frail patient.” 

But we have choices: “where to die, how much treatment to have, and how to spend the limited time we have left.” 

“While, in a real sense, no death is ever ‘good,’” Palmer underscores, “planning and preparation can make death less awful and painful.” 

Legislation to make MAID available to the terminally ill is one step in that direction. However, critics argue that MAID may endanger the elderly and disabled, who might feel pressured to end their lives out of fear of causing hardship to their families. Opponents also contend that such policies reinforce the toxic notion that a life with a disability or chronic illness is not worth living. Also, some individuals may seek MAID due to high treatment costs, but MAID should not substitute for accessible care and support. 

Racial inequities in healthcare are also relevant; Black people might opt for MAID because they are more likely to receive inadequate pain management due to stereotypes that they are drug-seeking or pain-tolerant.[2] Palmer could have engaged more fully with these valid concerns. Fortunately, the Medical Aid in Dying Act in New York has a number of guardrails meant to ensure the patient’s decision is informed and voluntary, including a conflict-of-interest prohibition and a mandatory mental health evaluation. 

Well before we are terminally ill, we need to be having routine conversations about dying with our loved ones and physicians. To that end, Palmer endorses The Conversation Project. He also suggests creating an advance directive, or a legal document outlining your healthcare wishes, and choosing a healthcare proxy—not necessarily your closest relative—when you’re young or in good health. One way to think about your healthcare wishes is to complete the sentence “I would want to live as long as I could still…”, as recommended by physician Eleanor Tanno. Another is to consider an “exit strategy,” or an illness for which you would decline treatment.[3] 

Some other tips from Palmer for a “good” death: 

• Write a personal mission statement; letters of gratitude to loved ones; and legacy letters, also known as ethical wills, that capture your essence, beliefs, and stories to pass on to future generations. 

• Make a folder containing everything your children must handle when you die. 

• Join a “village,” or “virtual retirement community.” 

The author also illuminates the benefits and limitations of palliative and hospice care, delineates various eco-friendly alternatives to embalming (reader: as of writing this, I’d like to be affordably composted), and presents ideas for making funeral and memorial services more substantive—and even fun. 

Achieving a Good Death is a touch dogmatic, but Palmer demonstrates in the book’s rich appendices that he practices what he preaches. In a letter to his family about his own end-of-life wishes, he shares the pain of witnessing his mother’s final years in a nursing home: “I want to prevent what happened to her from happening to me.” 

“If my mental function is seriously compromised with little chance for full recovery, please seek opportunities to encourage death’s approach… Are my kidneys faltering? Let them,” he writes, giving new meaning to author Mel Robbins’ self-help concept. 

The book’s main flaw—one the author himself acknowledges—is that it is primarily aimed at those with friends and families. Readers without such connections may feel less comforted than grimly recognized by Palmer’s planned memorial service playlist featuring the Beatles’ “Eleanor Rigby.” 

Ultimately, Achieving a Good Death is a stimulating must-read for mortals that will leave you equipped for a more peaceful, dignified, and meaningful end. 

Achieving a Good Death: A Practical Guide to the End of Life
Chris Palmer
Rowman & Littlefield, 2024

[1] Gawande, Atul. Being Mortal: Medicine and What Matters in the End. Metropolitan Books, 2014. 
[2] Substance Abuse and Mental Health Services Administration. The Opioid Crisis and the Black/African American Population: An Urgent Issue. Publication No. PEP20-05-02-001, Department of Health and Human Services, Office of Behavioral Health Equity, 17 Mar. 2020, samhsa.gov/sites/default/files/meeting/documents/csap-nac-presentation-03172020.pdf.  
[3] Harrington, Samuel. At Peace: Choosing a Good Death After a Long Life. Hatchette, 2018. 

Web image by Medhum.org.