PHYSICIAN-ASSISTED DYING
The case for palliative care and patient choice
Timothy E. Quill and Margaret P. Battin (Eds)
Johns Hopkins University Press, 2004
342 pp
ISBN 0-8018-8070-X
RRP US$26.95, £19.50
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This book was compiled in response to the volume edited by Kathleen Foley and Herbert Hendin (The Case Against Assisted Suicide; For the Right to End-of-Life Care, Johns Hopkins University Press, 2002; see review) and to stress what the authors see as the positive aspects of Physician-Assisted Dying.
The tone is set in the introduction. Those in favor of Physician-Assisted Dying champion the causes of patient autonomy, mercy (the relief of pain and suffering), and patient non-abandonment (all very positive), whilst those who oppose it are worried about the wrongness of killing, diminished integrity of physicians, and the risk of abuse (all very negative).
The book is divided into four parts. The first examines the critical values of autonomy and mercy. The second explores the clinical, philosophical, and religious issues that underlie end-of-life practices. Part three examines practice in Oregon and the Netherlands . The last section deals with some of the legal and political turmoil that has surrounded the debate on Physician-Assisted Dying in the United States.
The opening chapter by Marcia Angell in an impassioned statement, based around the tragic circumstances of her father’s suicide, that Physician-Assisted Dying should be legalized and that “many people would choose [it]”. But in Chapter 11, where Linda Ganzini reviews the Oregon data, it is seen that only between one-third and one-half of one percent of patients dying of cancer in Oregon have availed themselves of the State’s legalized Physician-Assisted Dying.
The chapter on patient autonomy deals with just that, and does not adequately address what effect legalizing Physician-Assisted Dying might have on the autonomy and rights of other people in society.
There are several chapters that discuss the Dutch practices, focusing particularly on the one thousand patients a year who are euthanased without specific request. [The fact that, according to the figures published by the Dutch, the incidence of non-voluntary euthanasia is a multiple of that number is not discussed]. But back to the one thousand. We are told that these patients had either expressed a wish for euthanasia at some time in the past (current wishes were not important) or they were incompetent. That’s not what the published data says. We are also told “In a number of cases [in which patients were euthanased without explicit request] the decision had been discussed with the patient.” That’s a new twist.
Mention is made in several chapters that, as a result of the open and honest system they have, the incidence of non-voluntary euthanasia is lower in The Netherlands than in other less advanced countries, including Australia . These studies (e.g. Kuhse et al) are based on deliberately ambiguous questions that have been publicly discredited. I received a questionnaire last year, based on the Dutch format, for the International Collaborative Study on End-of-Life Decisions in Medical Practice. It asked the question regarding a patient in pain “Would you intensify the alleviation of symptoms by using drugs, taking into account the possibility or certainty that this could hasten the end of the patient’s life?” So a good doctor, practicing good medicine, carefully titrating drugs to improve patient comfort, could or would be recorded as taking active steps to hasten death. So much for all those reports.
This is a worthwhile book and, given that any discussion has more than one side, I would recommend it to anybody with an interest in the debate about Euthanasia and Physician-Assisted Dying. But it did nothing to change my views, particularly about the Dutch practices. There are repeated references throughout the book that, if you just think about it properly, there is really no difference between hastening death and letting die. Death is a natural end to a life and will come to us all. Killing is something else. Or that’s what I think.
Roger Woodruff
Director of Palliative Care, Austin Health, Melbourne , Australia .
(May 2005)
Author Information
Timothy E. Quill is Professor of Medicine, Psychiatry, and Medical Humanities and Director, Center for Palliative Care and Clinical Ethics, University of Rochester School of Medicine and Dentistry, Rochester , New York , USA .
Margaret P. Battin is Distinguished Professor of Philosophy and Adjunct Professor of Internal Medicine, Division of Medical Ethics, University of Utah , Salt Lake City , Utah , USA .
Table of Contents
Introduction: False Dichotomy vs. Genuine Choice: the argument over Physician-Assisted Dying
Battin and Quill
I. Perspectives on Mercy, Non-abandonment, Autonomy and Choice
1, The quality of Mercy
Angell
2. Non-abandonment: A central obligation for Physicians
Quill and Cassel
3. The role of autonomy in choosing Physican aid in dying
Preston , Gundison and Mayo
4. Disability and Physician-Assisted Dying
Batavia
5. When suffering patients seek death
Cassel
II Clinical, Philosophical, and Religious issues about the ending of life.
6. Why do people seek Physician-Assisted Death
Pearlman and Starks
7. Doctor communication about Physician-Assisted Suicide
Back
8. When hastened death is neither killing or letting die
Beauchamp
9. Physician-Assisted Suicide as a last-resort option at the end of life
Brock
10. Death: A friend to be welcomed, not an enemy to be defeated.
Spong
III Open Practice in a Legally Tolerant Environment
11. The Oregon experience
Ganzini
12. The distortion of cases in Oregon
Goodwin
13. A model that integrates assisted dying with excellent end-of-life care
Lee
14. Thirty years experience with euthanasia in The Netherlands: Focusing on the patient as a person
Van Delden, Visser, Borst-Eilers
15. The Death of my Father
Kloot Meijburg
16. Assisted Death in The Netherlands: Physicians at the bedside when help is requested
Kimsma and van Leeuwen
IV Political and Legal Ferment
17. Political strategy and legal change
Stutsman
18. Legal advocacy to improve care and expand options at the end-of-life
Tucker
19. Physician-Assisted Suicide: Shifting the focus from means to ends
Meisel
20. Choice in Dying: A political and constitutional context
Law
21. Hastening Death: The seven deadly sins of the status quo
Baron
Conclusion: Excellent Palliative Carer as the standard, Physician-Assisted Dying as the last resort
Quill and Battin
Index.
