THE CASE AGAINST ASSISTED SUICIDE
For the Right to End-of-Life Care
Kathleen Foley and Herbert Hendin (Eds)
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| Johns Hopkins University Press, 2002
ISBN 0-80186792-4
371 pp
RRP $US49.95 £33.50
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This book cogently sets out the medical, ethical, philosophical and legal arguments against the legalization of physician-assisted suicide
and, just as importantly, describes how palliative care needs to be developed so that we can uphold the right of the terminally ill not to suffer. The contributors are distinguished experts in
medical ethics, palliative care, and law.
The book is divided into four sections. In the first - Autonomy, Compassion and Rational Suicide - Kass, Pellegrino, Callahan and Kamisar
provide ethical, philosophical and legal arguments that neither of the major justifications for assisted suicide, autonomy and compassion, provides an adequate basis for legalizing the practice.
And, in the words of the ethicist Sissela Bok, if you do legalize it "no country has yet worked out the hardest questions of how to help those patients who desire to die, without endangering
others who do not".
The second section - Practice versus Theory - includes chapters on the practice of assisted suicide and euthanasia in the Netherlands, Oregon
and the Australian Northern Territory. Hendin’s extensive knowledge and insight is evident in his review of the Dutch practices and includes the remarkable statement by one of the authors of
the 1995 Dutch report "that the person responsible for avoiding involuntary termination of life is the patient". Ben Zylicz describes working in palliative care in the Netherlands,
where its development has been severely hampered by the easy availability of euthanasia; one feels a tug as he describes being prevented from seeing terminally ill patients with treatable symptoms,
and patients for whom palliative care might offer so much being taken away to hospital for euthanasia. Foley and Hendin review the Oregon experiment and catalogue the lack of legal safeguards
and the paucity of information that has been made available. The Northern Territory deaths are described and discussed by David Kissane.
The third section - Reason to be Concerned - discusses assisted suicide and palliative care in relation to patients who are disabled, vulnerable
(minority groups, the elderly and the financially disadvantaged), or depressed. The chapter by Cohn and Lynn clearly and categorically refutes the claims seen almost constantly in the lay press
and should be required reading for any journalist contemplating writing anything about assisted suicide.
The last section - A Better Way - includes chapters by Dame Cicely Saunders and Kathleen Foley, examining the state of palliative care and
what needs to be done to improve it so that it provides better end-of-life care, for all those people who need it.
This book adequately accomplishes its goal of providing an open and tolerant discussion of both the case against assisted suicide and the
case for palliative care. The book also provides some powerful insights into the shortcomings of the palliative care system and how it might be improved. The discussions are well written and
are practical and clinically relevant. This excellent book will be a valuable resource for anybody interested in the delivery of better end-of-life care, whether they are clinicians, ethicists,
or health care policymakers.
Roger Woodruff
Past Chairman, International Association for Hospice and Palliative Care (IAHPC)
Director of Palliative Care, Austin & Repatriation Medical Centre, Melbourne, Australia
AUTHOR INFORMATION
Kathleen Foley is Professor, Department of Neurology, Weill Medical College, Cornell University; Attending Neurologist, Pain and Palliative
Care Service, Memorial Sloan-Kettering Cancer Center; and Director, Project on Death in America, Open Society Institute, Soros Foundation, New York, USA
Herbert Hendin is Professor, Department of Psychiatry and Behavioral Sciences, New York Medical College and Medical Director, American Foundation
for Suicide Prevention, New York, USA
TABLE OF CONTENTS
Introduction: A Medical, Ethical, Legal and Psychosocial Perspective 1
Foley and Hendin
Autonomy, Compassion and Rational Suicide
1. "I Will Give No Deadly Drug": Why Doctors Must Not Kill 17
Kass
2. Compassion Is Not Enough 41
Pellegrino
3. Reason, Self-determination, and Physician Assisted Suicide 52
Callahan
4. The Rise and Fall of the "Right" to Assisted Suicide 69
Kamisar
Practice vs. Theory
5. The Dutch Experience 97
Hendin
6. Palliative Care and Euthanasia in the Netherlands 122
Zylicz
7. The Oregon Experiment 144
Foley and Hendin
8. Oregon’s Culture of Silence 175
Hamilton
9. Deadly Days in Darwin 192
Kissane
Reason to be Concerned
10. Not Dead Yet 213
Coleman
11. Vulnerable People: Practical Rejoinders to Claims in Favor of Assisted Suicide 238
Cohn and Lynn
12. Depression and the Will to Live in the Psychological Landscape of Terminally Ill Patients 261
Chochinov and Schwartz
A Better Way
13. A Hospice Perspective 281
Saunders
14. Compassionate Care, Not Assisted Suicide 293
Foley
Conclusion: Changing the Culture 311
Foley and Hendin
Notes 333
Index
365
