How to Die - NYTimes.com ONE morning last month, Anthony Gilbey awakened from anesthesia in a hospital in the east of England. At his bedside were his daughter and an attending physician. The surgery had been unsuccessful, the doctor informed him. There was nothing more that could be done. "So I'm dying?" the patient asked. The doctor hesitated. "Yes," he said. "You're dying, Dad," his daughter affirmed. "So," the patient mused, "no more whoop-de-doo." "On the other side, there'll be loads," his daughter - my wife - promised. The patient laughed. He was dead six days later, a few months shy of his 80th birthday. When they told my father-in-law the hospital had done all it could, that was not, in the strictest sense, true. There was nothing the doctors could do about the large, inoperable tumor colonizing his insides. But they could have maintained his failing kidneys by putting him on dialysis. They could have continued pumping insulin to control his diabetes. He wore a pacemaker that kept his heart beating regardless of what else was happening to him, so with aggressive treatment they could - and many hospitals would - have sustained a kind of life for a while. But the hospital that treated him offers a protocol called the Liverpool Care Pathway for the Dying Patient, which was conceived in the 90s at a Liverpool cancer facility as a more humane alternative to the frantic end-of-life assault of desperate measures. "The Hippocratic oath just drives clinicians toward constantly treating the patient, right until the moment they die," said Sir Thomas Hughes-Hallett, who was until recently the chief executive of the center where the protocol was designed. English doctors, he said, tell a joke about this imperative: "Why in Ireland do they put screws in coffins? To keep the doctors out. The Liverpool Pathway brings many of the practices of hospice care into a hospital setting, where it can reach many more patients approaching death. "It's not about hastening death," Sir Thomas told me. It's about recognizing that someone is dying, and giving them choices. Do you want an oxygen mask over your face? Or would you like to kiss your wife? Anthony Gilbey's doctors concluded that it was pointless to prolong a life that was very near the end, and that had been increasingly consumed by pain, immobility, incontinence, depression and creeping dementia. The patient and his family concurred. And so the hospital unplugged his insulin and antibiotics, disconnected his intravenous nourishment and hydration, leaving only a drip to keep pain and nausea at bay. The earlier bustle of oxygen masks and thermometers and blood-pressure sleeves and pulse-taking ceased. Nurses wheeled him away from the wheezing, beeping machinery of intensive care to a quiet room to await his move to "the other side." Here in the United States, nothing bedevils our discussion of health care like the question of when and how to withhold it. The Liverpool Pathway or variations of it are now standard in most British hospitals and in several other countries - but not ours. When I asked one American end-of-life specialist what chance he saw that something of the kind could be replicated here, the answer was immediate: "Zero." There is an obvious reason for that, and a less obvious reason. The obvious reason, of course, is that advocates of such programs have been demonized. They have been criticized by the Catholic Church in the name of "life," and vilified by Sarah Palin and Michele Bachmann in the pursuit of cheap political gain. "Anything that looks like an official protocol, or guideline - you're going to get death-paneled," said Dr. Ezekiel Emanuel, the bioethicist and expert on end-of-life care who has been a target of the rabble-rousers. He is also a contributing opinion writer for The Times. Humane end-of-life practices have quietly found their way into cancer treatment, but other specialties lag behind. The British advocates of the Liverpool approach have endured similar attacks, mainly from "pro-life" lobbyists who portray it as a back-door form of euthanasia. They also get it from euthanasia advocates who say it isn't euthanasia-like enough. Surveys of families that use this protocol report overwhelming satisfaction, but inevitably in a field that touches families at their most emotionally raw, and that requires trained coordination of several medical disciplines, nursing and family counseling, the end is not always as smooth as my father-in-law's.