Author Tom Preston, MD, and his terminally ill patients and their families often face the controversial predicament of how to die when suffering has been medically extended. Through their conversations, they demonstrate how dying is a process, how physicians alter when and how we die, and why "natural" death is a misnomer after medical interventions prolong the process. Their cases also explain why patients-not physicians or others-should be able to make their own decisions about when and how to die. Dr. Preston gives compelling reasons as to why aid-in-dying is not suicide when used by terminally ill patients, and why physicians who help them die are not assisting suicide. He shows us the ethical aspects of aid-in-dying and how they are consistent with other current and legal medical practices that help patients end their suffering. He debunks claims that legalized aid-in-dying would be abused for financial, social, or political reasons. Dr. Preston also shows how outdated cultural attitudes impede society's understanding of how we die, why many physicians withdraw from their dying patients, and how the sanctity-of-life principle has become distorted to obstruct physician assisted deaths. "Patient-Directed Dying" is a powerful manifesto calling for mercy and reason in helping terminally ill patients die a peaceful death.