Based on over 5 years of research in many countries this book asks some of the most difficult questions in the assisted dying debate:

Who should be eligible for an assisted death? Who decides? On what grounds?
What safeguards, if any, are necessary? Who needs protection? Protection from what?

Engelhart explores this terrain by following several difficult personal stories in depth. The stories are interspersed with in depth background about the wider arguments and the legal situations in various countries where a form of assisted dying is legal (USA, Canada, Netherlands, Belgium, Switzerland). She has managed to interview an impressive range of people in her research, in some cases forming trusted relationships with the subjects of her case studies before they end their life. Engelhart also gives a more rounded understanding of each case study by interviewing relatives, friends, medics and campaigners. 

The case studies chosen cover a range of situations where the current laws, or lack of laws, fail people who would like to be helped, such as a lady who was elderly with various ailments but who was not terminally ill who considered that her life was complete and a young man suffering from incurable mental illness. She shows why some people feel forced to take action to end their own lives without assistance. The stories show the lengths people go to and the difficulties they overcome to reach what, for them, is the most dignified end of life they can obtain.

Engelhart has interviewed many leading campaigners in the field, both proponents and to a lesser extent, those opposed. In many cases she has sought out those arguing for the most wide reaching assisted dying positions (including the founder of MDMD).

The book does not suggest a solution. Is the Canadian approach an improvement on that used in the USA? Does the legalised euthanasia in the Netherlands go too far? Or not far enough? For the author, the jury is still out, though it is clear from the situations she describes, and the way she describes them, that she believes that the Oregon model, where assisted dying is limited to those with six months or less to live, is inadequate and problematic. But how readily available should assisted dying be? Her investigations into Exit International suggest that giving the ability to peacefully end one’s life to anyone without question is going too far. Without saying as much, she hints at a position close to that campaigned for by MDMD.

At the end of the book Engelhart reflects on the fact that virtually all the people she talked to were seeking “dignity”. But what did they mean by that? She suggests that what they were seeking was a form of authenticity. People wanted to live “as themselves” until their final moment – even if that meant ending their life early. From conversations I’ve had over the years, that rings true of many MDMD supporters.

The book makes an important contribution to the worldwide debate about Assisted Dying by examining some of the most difficult issues, combining ethical arguments with the practical complexities of real-life situations.

A long extract from the book was published in The Guardian on 10th March 2021.


Review by Phil Cheatle, My Death, My Decision’s Lead Campaign Commentator. For any more information please contact Keiron McCabe, My Death, My Decision’s Campaigns and Communications Manager at or phone 07396694470

My Death, My Decision is a grassroots non-profit organisation that campaigns for a balanced and compassionate approach to assisted dying in England and Wales. As a growing movement, we are at the forefront of social change: nearly 90% of the public now favours a change in the law to allow adults of sound mind, who are either terminally ill or facing incurable suffering, the option of a peaceful, painless, and dignified death.

Read more about My Death, My Decision’s campaign for an inclusive change in the law: