Dr. Tom Preston, a Compassion & Choices leader in Seattle, chose these poignant words for the title of his new book. They are powerful words, gripping even on paper. Imagine them emerging from the lips of a patient, perhaps one whom the doctor has treated over decades, who is now dying of cancer. They strike right at the core of a physician’s identity, training and moral compass.

Preston knows well that each person, each healer and each caregiver responds to such a request from patient or loved one from the deepest parts of their own authentic being. He begins his book quoting Dumbledore, who in the last Harry Potter book pleaded with Snape to cut his dying short. “You alone know whether it will harm your soul to help an old man avoid pain and humiliation,” the wizard tells his reluctant friend. So it is with every doctor In America.

I recall hearing Dr. Peter Goodwin, Compassion & Choices’ leader and dear friend who died last March, describe how his “blood ran cold” the first time he heard these words. He responded to his patient he could not, but spent the remainder of his life regretting that answer.

Last month Dr. Eric Kress testified to the Montana legislature that when he refused the first patient who asked for his help in dying, the patient reacted in disgust and called him a coward. Thus began his own soulful rumination and his decision not to abandon subsequent patients who asked for his help. “What kind of man am I?” he asked himself. “What kind of doctor am I?”

Preston writes from his long and passionate interest in how doctors respond to this plea. By extension, he is also vitally interested in the historic and potential relationship between the field of Medicine and patients who yearn for choice and control in their dying. Today, it’s mostly a dysfunctional relationship. But it has not always been so, and this book may well help heal the dysfunction.

Preston is a fine writer, and a splendid historian. I greatly enjoy his reaches into ancient Greece and Medicine’s dawn as a profession. In one enlightening chapter he traces the transformation of medical oaths, “From Hippocrates to Lasagna,” to demonstrate how politics, religions and accidents of history influence the words and meanings that endure, even when at odds with ancient precepts or practices. Personally, I’ve always been fascinated to observe that sometime in the course of history the caduceus, symbol of Mercury, god of thieves and business, came to replace the staff of Asclepius, son of Apollo and the first mortal healer, as the symbol of Medicine. (That’s right, the patron god of financial gain stands as the profession’s symbol in modern times.)

Another of Preston’s great contributions is his concentration on “patient-centeredness” as the mark of excellent care. Preston acknowledges that his colleagues may pay lip service to the term, while actually delivering “physician-centered” service. Therefore he takes care to advocate a “meaningful” patient-centered approach. One of the speakers at this year’s TEDMED conference noted that even “patient-centered care” can mean that professionals circle the patient and impose a one-way dialogue.

Non-physician readers will find in Preston’s words the reassurance, courage and tools to approach their doctors with legitimate requests arising from their experience in health and in decline. Physician readers will find compassion and gentle guidance in adopting an open and responsive attitude toward the needs of their dying patients. Physicians across the nation are examining their position on intention and assistance in dying, and this book is bound to help.

“In the end of February, it was discovered I had kidney cancer,” said hospice care worker Dorothy Haden, who has stage four cancer.

“I tried to live my life with dignity, and I do want to end my life with dignity,” said former lawmaker Earnest Juggie Heen, who has liver and pancreatic cancer.

Both said they want to choose how and when they end their lives.

“It’s our position that aid in dying is legal and it can be incorporated into medical practice legitimately here in Hawaii,” said Barbara Coombs Lee, who is the president of Compassion & Choices, a national nonprofit organization that supports aid in dying. She returned to Hawaii in early November, one year after a small group of Hawaii doctors first prescribed life-ending medication to a terminally ill patient.

“Hawaii has a constellation of laws that have never really criminalized aid in dying,” she said.

She said in the past year, 31 people have inquired about aid in dying, seven qualified to receive medication, and four were actually prescribed it, but she said all four died of natural causes before taking that prescription.

“People just want the comfort. They just want peace of mind,” she told KITV4 reporter Lara Yamada.

What opponents call assisted suicide is legal in three states: Oregon, Washington and Montana. Massachusetts included it on the ballot in 2012, but voters shot it down. Hawaii’s attorney general said he considers it manslaughter, but has yet to prosecute any physicians in the state.

“There has never been in the history of the United States a physician who has been successfully prosecuted for providing a terminally ill, mentally competent person with medication that they could take to die,” said Coombs Lee.

Affirmation, she says, that this movement will continue to grow.

“At some point I may have to make that choice,” said Haden.

At 82, Merla Zellerbach has been reborn as a mystery writer. Her earlier novels paint psychological portraits. The Hallie Marsh Mystery Series, however, reflects the Bay Area author’s present concern: the injustices of death.

“I’m just getting started; I feel fit and fabulous. I can never lie about my age,” she says with a laugh. “I was born here, educated here and still see too many of my old school chums from Stanford.”

Zellerbach’s Marsh—the heroine of three novels so far—becomes an accidental detective after breast cancer changes the course of her life. Surrounded by medical expertise and malfeasance, she evolves novel by novel, as the mystery within begins to reflect the mystery without. Zellerbach, ’52, writes with wry wit and a breezy style. She sets her plots in the Bay Area and keeps the reader absorbed with recognizable character types and local color.

Mystery of the Mermaid, The Missing Mother and Love to Die For appeared to warm trade reviews, with Publishers Weekly comparing the series to the early works of Mary Higgins Clark. A fourth book, Dying to Dance, will be out later this year.

Zellerbach has a full past with a wealth of material to draw on. At the center of San Francisco’s social swirl for 12 years as editor of the Nob Hill Gazette, a lifestyle and philanthropy magazine, she’s well acquainted with life at the top. An active contributor of time and money to charitable causes, she’s passionate about health and euthanasia issues. She counts Sen. Dianne Feinstein, ’55, among her close friends. During the late ’60s, Zellerbach was a panelist (with actress June Lockhart) on ABC-TV’s game show Oh, My Word! She wrote the San Francisco Chronicle column “My Fair City” from 1962 to 1985.

The daughter of a conservative rabbi, Zellerbach (née Burstein) considers herself “an agnostic who believes in God.” At the end of her sophomore year at Stanford, where she studied psychology, she married Stephen Zellerbach, whose family business was the Zellerbach Paper Company (later Crown-Zellerbach). They had one son, Gary, and a friendly divorce after 18 years.

Zellerbach relates how her first book, Love in a Dark House, came about. “We had a psychiatrist living next door,” she remembers. “He and I used to take walks together. I’d pour out all my woes, he’d offer insights, and I’d come home and type them up.

“One night at a dinner party, I sat next to a Doubleday editor, mentioned my notes, and he asked to see them. I said I wasn’t a novelist, but he persisted until I sent them. He read them and agreed that I wasn’t a novelist, but ‘had promise.’” With his editorial help, Doubleday published the novel about a socialite who seeks purpose in 1961. In 1968, Zellerbach wed CBS newsman Fred Goerner, author of the bestseller The Search for Amelia Earhart.

Zellerbach’s allergy problems inspired her to write five books on that subject, followed by four novels for Ballantine. In 1990, Rittenhouse Square (Random House) landed her on the Recommended Reading list of the New York Times.

Personal experience also led the way to her latest genre. “I saw my beloved father die a terrible death from pancreatic cancer,” Zellerbach explains, “and I also saw my late husband Fred die pain-free and peacefully, with physician help. After those two experiences, I began delving into the mysteries of life and death.”

Her culprits always get their just deserts, but her “main concern is with the needless suffering of those who don’t know they have choices, don’t want to know for religious or other reasons, or who don’t have access to aid in dying.”

In 2010, C&C gave Zellerbach its Hugh Gallagher Award “with great appreciation for her courage and dedication to choice and human liberty at the end of life.”

How does she explain all those romances in her books? “Hard-core mystery buffs and purists of the genre want me to choose between romance and mystery. But then I would ask: What is death without life? And what is life or death without love?”

Many of us think of death as the worst possible outcome for a terminally ill patient, but Judith Schwarz disagrees.

Schwarz, a patient supporter at the nonprofit Compassion & Choices, says prolonging death can be a far worse fate. For many patients, good palliative or hospice care can alleviate suffering, yet “a small but significant proportion of dying patients suffer intolerably,” Schwarz says.

Based in the New York area, Compassion & Choices is an organization that helps terminally ill patients and their families make informed and thoughtful end-of-life decisions to hasten a patient’s death. These decisions are not made impulsively, Schwarz tells Fresh Air‘s Terry Gross. “Nobody makes this choice unless the burdens of living have so consistently, day after day, outweighed all benefit.”

Schwarz notes that her organization does not help patients kill themselves, and their work should not be confused with assisted suicide. “They are dying,” she says. “They are on a dying trajectory. The only choice they have is the circumstances of their death and what kind of disability they will be suffering as they approach that time.”

Compassion & Choices supports the right to die but does not work outside the limits of the law, which varies from state to state. There are now three states — Washington, Oregon and Montana — where, in certain instances, it is legal for doctors to prescribe medication to hasten death.

As patients and their families make these excruciating decisions, they consult with doctors who evaluate their end-of-life options. Making decisions to hasten death “requires a tremendous act of love on the part of the family,” Schwarz says. “Because actually, what this patient is doing is leaving them, and leaving them perhaps sooner than their disease would require.”

Interview Highlights

On our conflicted feelings about hastening our own deaths

“People who think they want to be able to, for example, take a lethal amount of medication to end their life — they speculate that that’s how they are going to feel, but they actually don’t know how they are going to feel when they get to the point where their quality of life is so diminished that they really wish they were dead, that they would not wake up the next morning. But to take that step, to take that final step to cause your own death in one very … dramatic act is very, very hard, and most people don’t do that.”

On existential distress and medical prescriptions to hasten dying

“The Oregon Death with Dignity Act has been around for 14 years now, and the … primary reasons for patients asking their physician for this prescription have remained consistent over all of those years. It’s not about pain; pain can actually be managed … that’s not why people want to hasten their dying. They do [it] because they’re not able to do any of the things that they’ve always enjoyed doing — that give them any kind of pleasure. They can’t do those things anymore. And they have a complete loss of autonomy, they’re dependent upon other people to care for them, and they feel that they’ve lost all dignity. You have to understand, Terry, this doesn’t matter for everybody, but for those people that it does matter to, it matters profoundly. This is really what we really think of … as sort of existential distress — the meaningless of having to just wait for this death to occur.”

On the American Medical Association’s definition of physician-assisted dying as incompatible with the role of the physician as healer

“I suppose that’s a comforting position to take, but it doesn’t really speak to the nature of suffering, and it doesn’t speak to a patient’s wish to be treated with dignity and to be heard. We talk about ethical principles of beneficence and non-maleficence, that death is deemed the worst possible outcome that should be prevented at all costs. Well, I beg to differ. There are many people for whom death is not the worst thing that could happen to them. In fact, prolonging their dying is the worst thing that could happen to them, and the notion of healing in that environment strikes me as a bit of a one-sided understanding of the relationship.”

Listen to the entire program here.

Compassion & Choices Hawaii, a nonprofit organization working to improve care and expand choice at the end of life, received 31 local inquiries in its first year of service.

The figure comes from an annual report released by the Physician Advisory Council for Aid in Dying, or PACAID, a group of local doctors that collaborates with Compassion & Choices Hawaii and can prescribe life-ending medication if necessary.

PACAID has a rigorous eligibility process that applicants must go through, and of those 31 inquiries only seven qualified to consult with a PACAID doctor.

Of the seven, four received a prescription for medication “which they could ingest to end their life and suffering in peace and dignity, at the time of their choosing,” according to a Compassion & Choices press release.

As of Thursday, two of the four patients died from natural causes and none had taken the medication.