Walking Toward a Good Death

A new book by Brandeis anthropologist Anita Hannig reveals how medical aid-in-dying can restore dignity and a sense of control to those facing terminal illness.

Illustration of a man with gray hair walking purposefully away from an outstretched hand into a landscape depicted with less-saturated, paler colors.
James Steinberg

Anita Hannig is an expert on how we die.

A medical and cultural anthropologist who studies life’s bookends — birth and death — she’s the author of “The Day I Die: The Untold Story of Assisted Dying in America” (Sourcebooks, 2022), a moving portrait of individuals who overcome formidable barriers to plan and carry out a medically assisted death.

In a style more journalistic than academic, Hannig takes readers inside bedrooms, living rooms and courtrooms to explore the complicated issue of medical aid-in-dying in the U.S., and observe the empowerment that can come as the terminally ill assume control of their death.

Over hundreds of hours, she shadowed patients, families, lawmakers, activists and physicians. She worked as a hospice volunteer and was a firsthand witness to several planned deaths in Oregon, which legalized medically assisted dying in 1997, the first state in the nation to do so.

Not surprisingly, Hannig became emotionally involved in her research. And though she didn’t start out as a committed advocate for assisted dying, she became one. “You can’t do this research and not be swayed one way or another,” she says. “I couldn’t attend these deaths and remain unmoved.”

For many Americans, medically assisted death remains shrouded in stigma, misunderstanding and taboo, despite the fact that nine states and Washington, D.C., have joined Oregon in enacting assisted-dying legislation over the past 25 years. Today, one in five Americans has legal access to an assisted death. Seven in 10 Americans say they support assisted dying, according to a 2020 Gallup Poll. “Yet we live in a death-phobic society,” says Hannig, who, at 40, is an associate professor of anthropology, a new mother and a serious athlete.

Her book never loses sight of the big questions: How do the dying gain agency over death? What is medicine’s role at the end of life? How do we restore dignity to death in our high-tech age, when the chasm between the living and the dying seems ever-widening?

Hannig believes easing restrictions on aid-in-dying laws is a good place to start. For example, U.S. laws, which are more restrictive than those in other parts of the world, require the dying person to self-administer a lethal pharmaceutical cocktail — an impossibility for many patients with terminal illnesses that make swallowing difficult, such as Lou Gehrig’s disease. Physicians should be allowed to administer lethal medications to those who otherwise meet the aid-in-dying criteria, Hannig says.

In addition, assisted-dying laws require that two physicians determine a patient is in the last six months of life — a narrow time frame that’s difficult to predict, and one that excludes terminally sick people who experience unbearable suffering earlier in their illness.

“An assisted death is not the easy way out,” Hannig writes in “The Day I Die.” “Hastening the end of your life is an act of will that demands improbable courage. It means accepting the hard truth of your mortality and walking toward death with clear, open eyes.”

In the book excerpt that follows (reprinted by permission of the publisher), Ken, a 90-year-old husband, father and grandfather, is suffering from congestive heart failure, aggressive prostate cancer and a leaky heart valve when he decides to end his life with the help of Oregon’s medical aid-in-dying law.

Hannig prepares to go to his home to witness his death.

The morning of Ken’s death, I stood in front of my closet, trying to figure out what to wear. I knew Ken didn’t want his death to be a somber affair. He was ready, giddy even. The drab librarian dress was definitely out. Jeans, on the other hand, seemed a little too casual. I wanted to look nice and give Ken’s death the gravity it deserved, while also honoring his wish to celebrate. As I thumbed through my hangers, I couldn’t help but feel the dissonance of choosing an outfit for someone’s final hours. Three years into my research on assisted dying, I still found myself in situations like this with no formal playbook. But if I didn’t decide promptly, I was going to be late. Finally, I opted for a pair of striped summer slacks, a sleeveless, navy blue satin blouse, and leather sandals. Then I grabbed my notebook and ran out the door.

Thirty blocks to the east, at the foot of one of Portland’s iconic city parks, Ken was also getting ready. Though he had spent much of his life flouting propriety, he had decided to dress up for his death. In the quiet light of the morning, he trimmed his white Van Dyke beard, slipped into a clean pair of khakis, buttoned his olive-colored dress shirt and threw on a charcoal vest. He dug out his red bandanna and tied it in a neat triangle knot around his neck. Then he traded his tired plaid house slippers for a pair of elegant, pointy leather brogues.

Ken’s breakfast that day was simple: a single hard-boiled egg and a cup of black coffee laced with Fireball whiskey. Not that it was his habit to drink alcohol with breakfast — it didn’t mix well with his heart medications — but today Ken felt festive. He had waited for this day for months.

At 10:30 a.m., I met Ken’s prescribing physician, Neil Martin, in the foyer of Ken’s retirement facility. Save for his medical bag, which could have passed for a plump briefcase, you wouldn’t have guessed Martin was a doctor — he wore a cornflower-blue dress shirt, black Levi’s and hiking sneakers. Martin had begun working with terminally ill patients interested in using Oregon’s Death with Dignity law in 2009. After his retirement from family medicine in 2015, he had kept his license so he could continue to volunteer as a physician.

Martin and I signed the facility’s guest log and made our way to Ken’s apartment in the far corner of the building. At the entrance to the dining hall, next to a roster of activity charts announcing bingo night and water aerobics, a cluster of walkers sat parked, waiting for their owners to return. We swung a left down a wide hallway lined with rustic watercolor paintings all depicting stone bridges reaching across gurgling creeks. The pictures conjured a pleasant but generic nostalgia. Ken couldn’t stand them.

When we entered his apartment, everyone else was already there: Ken and his two sons, Tony and Zack; Ken’s granddaughter, who had flown in from California; and Sophie, his beloved caregiver. Standing and chatting among the family was Derianna Mooney, a volunteer for End of Life Choices Oregon — a nonprofit that accompanies patients and families on their path to an assisted death. Derianna was here to ensure that everything went smoothly and that Ken felt supported in his wish to die.