Selected and reviewed by James Park,
philosopher of the right-to-die.
Organized in the
order of quality, beginning with the best.
Summaries of the contents are presented in black.
Comments and responses by this reviewer are presented in red.
Herbert Hendin, MD
Seduced by Death:
Patients, and the Dutch Cure
(New York: Norton,
(ISBN: 0-393-04003-8; hardcover)
(Library of Congress call number: R726.H46
psychiatrist turns a critical eye
on the Dutch experience of voluntary death
with the assistance of a physician
and merciful death chosen for patients
no longer capable of giving consent.
Hendin believed that too many abuses and
were taking place in the Netherlands
—and that the U.S. should not
copy the pattern
created by the Dutch.
Rather, we should provide better pain control,
so that patients will not request death.
several cases of physician-assisted death
in which serious doubts could be raised:
In one case a woman was suffering because
of the loss of two sons to death
and the loss of her husband by divorce.
She had no further reasons to go on living.
When, after many attempts at psychological
all agreed that nothing was going to change
her wish to be dead,
she was granted her wish to die merely because
of her mental suffering.
On the basis of such
cases and other controversial reports,
Hendin claims that the Dutch guidelines for
with the assistance of a physician were routinely
Doctors were often doing what they thought best
—including shortening the process of dying—
without explicitly asking the patient or
if death is the best choice.
The best response
to the worries
and doubts raised in this book
is not to ban all voluntary death and merciful
but to create safeguards
that are more reasonable
than those originally used in the Netherlands.
For example, reporting
cases in which a physician assisted a death
to the prosecuting authority
after the death
had already taken place
made no sense.
The Dutch police and prosecutors could not bring
anyone back to life.
They could only punish the doctor for doing
(What incentive does a doctor have to report
if no good can come
of such reporting
and the doctor might even be prosecuted?)
Furthermore, law-enforcement officials
have no training or expertise
in the complex issues of making end-of-life medical choices at the
Any such reviews
by the prosecutor should
be completed before
the voluntary death or merciful death takes
Then everyone involved can proceed with the
that no prosecutions will result from their
in favor of a voluntary death or a merciful
(Since this book was published,
the Dutch system has been changed a few times.
Now instead of reporting to the police or the public prosecutor,
doctors are supposed to report their cases of chosen death
to Regional Review Committees
each of which has a lawyer, a doctor, & an ethicist.
Only a few cases each year are forwarded to prosecutors.)
Hendin points out
that the second doctor's professional opinion
is often routine and superficial,
based more on the first doctor's reputation
than on an independent assessment
condition of the patient.
A better system could be created
that the second
is truly independent and designed
in the diagnosis and
waiting periods should be required.
Often patients ask for assistance in dying
immediately after learning that they have
a terminal disease.
But many who were prevented
immediately after they were told about
have gone on to live for a number of additional
Should a long-married
couple be permitted to die together?
This would save either spouse having to grieve the
loss of the other.
But sometimes the dominant partner (often
is forcing the other partner to go along
with a 'suicide pact'.
including the option of dying
But the physical condition of the
should also be taken into account.
Another problem of
the Dutch system is the requirement
that the patient
conscious and capable
up until the moment of death.
This leads to some premature
because of the dying patients
that they will not be sufficiently
lucid or rational
to be able to consent to
The solution to this
dilemma is for the patient
to draw up a written request
—created when the patient was clearly in
of his or her mental capacities.
This plan for death would specify what should happen
if and when the patient becomes unconscious
or otherwise loses the capacity to make medical decisions.
Such prior documented requests for
should be honored everywhere in
Proper safeguards would make sure
prior request for death
was made while the patient was
of making a wise decision about
and means of death.
A well-documented advance request
once a certain point in mental
would remove most doubts in the
doctors and proxies
who now must make decisions for
who have progressed
beyond the point of being able to
own life-ending decisions.
This would solve the problem in
sometimes called "assisted death
Some Dutch doctors
(as doctors everywhere)
Hendin usually considers
the worst possible interpretation
provide slight assistance in the dying process,
such as increasing
in order to avoid going thru the formal process
of applying for an approved voluntary death.
Such life-ending decisions produce a slower
And such deaths are always reported as resulting
from natural causes,
rather than cases of voluntary death with
A more user-friendly system of
would work better in such cases,
thereby avoiding some premature
from secretive—often unarticulated—
to shorten the dying process.
of each of the cases and
situations he considers.
But such maximum skepticism must
by all advocates of the
We must be able to address problems
that will be raised by rather rare
Wise safeguards are needed for the
about which reasonable persons of
When we are in doubt about the
we need a deeper investigation of
and a fuller exploration of all
other than death.
Opponents of the right-to-die will
to support their position that all chosen death
must be outlawed
because of the
of mistakes and abuse.
No one wants people to be put to
death for the convenience of others.
Some disabled people
fear this the
Can we create wise safeguards that are so comprehensive
that even (open-minded) disabled people
will endorse them?
The title of Hendin's
points to a danger he fears if a society
too easily affirms the 'right-to-die'.
If we create a 'culture of death', irrational suicides are
likely to increase,
because people who have foolish 'reasons'
for killing themselves
will get the mistaken impression that the
of their 'decision' to commit irrational
Because Dr. Hendin has devoted his professional
to preventing irrational suicide,
he is acutely aware of the dangers created
by glib talk about the 'right-to-die'.
our right-to-die, we
Voluntary death and merciful death
not be the first option
people consider when faced with
problems in life.
Rather, a wise and rational ending
should be the last resort.
2. Wesley J.
The Slippery Slope from Assisted Suicide to Legalized Murder
(New York: Random House:
www.randomhouse.com, 1997) 291 pages
(ISBN: 0-8129-2790-7; hardcover)
(Library of Congress call number: R726.S576 1997)
Wesley Smith was at the time of this book
the attorney for the International
Anti-Euthanasia Task Force,
one of the strongest opponents of the right-to-die in the United
Like any good lawyer, Smith builds his case
by giving the details of cases
in which people took their own lives prematurely
—people who were assisted in dying
before it was necessary
& former persons whose lives were ended by others
before they would have died from natural causes.
Smith wants us to stand against
the worst abuses of
the so-called "right-to-die"
by banning all life-ending
If society turns against the media-promoted cult of
then a few more premature deaths could be prevented.
Loud talk about the "right-to-die" encourages some people
who have very poor 'reasons' for ending their lives
to kill themselves prematurely.
Smith presents a very low threshold for continuing
If the patient is still a living human being,
then no one should 'pull the plug'.
In other words, on most (perhaps all) of the famous right-to-die cases,
he would have argued to keep the former person 'alive'
even tho he or she was in a persistent vegetative state.
Human life should be granted sanctity no matter what its quality.
All human life should be preserved as long as technologically possible.
'Anti-euthanasia' advocates such as Smith
realize that one of the most common ways
for life to be mercifully terminated is to remove life-support systems.
This method of drawing life to a close is well-established in law and
The last-ditch resistance focuses on food and water:
If nutrition and hydration are provided by means of tubes,
then it looks like a medical
treatment or a
As medical treatments or
procedures, such tubes can be withdrawn.
But if they are defined as comfort
care (like keeping the patient warm),
then they cannot be withdrawn or withheld.
'anti-euthanasia' advocates had their way,
food and water could never
be withdrawn or withheld
—as long as the body is still
But it does not seem likely that
such views will prevail.
Just as fully-capable persons can
to end their lives by refusing
food and water,
so similar choices can be taken
for former persons
who can no longer decide for
As least this means of merciful
death can be used
when the patient has left a
According to the 'anti-euthanasia' advocates,
all efforts to expand the 'right-to-die' must be resisted
because of the slippery slope:
If we allow relatives of former persons
in persistent vegetative state to 'pull the plug',
we will not be able to stop the rampage of killing.
The next people killed without their consent will be the disabled
and others who can no longer contribute anything to society.
Every disabled person will be at risk
if we allow further advances of the right-to-die.
Lest this reviewer be suspected of exaggerating
here is a quote from the bottom of page 50:
"Yet virtually every day, fellow humans are being deprived
of the basics required for life just because they are disabled."
Lawyers tend to
over-state their cases
because it has some persuasive
power for the listeners.
Smith wants to classify Nancy
Cruzan as "cognitively disabled",
even tho she was in a persistent
Few people want to discriminate
against the disabled.
But if a former person will never
have another thought or another
why keep that body 'alive' on
Smith does correctly warn against hasty diagnoses:
One patient who was thought to be permanently unconscious
woke up a week later and made a complete recovery.
Death-by-dehydration is another important theme
in the anti-euthanasia movement.
Smith claims that death by means of withdrawing fluids is terrible.
He quotes one doctor who told him so in a private interview.
No further evidence is offered.
Death-by-dehydration will have to
and documented much more fully
before the position
taken by the anti-euthanasia
advocates will be sustained.
This reviewer thinks the opposite
will be shown:
is a good way to end of one's life.
Here is a website supporting Voluntary Death
Smith points out that we would not cause
the deaths of dogs or horses by dehydration.
Why cause additional days of suffering?
When we decide that the end has come for animals,
we easily give them a lethal injection.
Smith warns that we will do the same for human
If we allow death-by-dehydration,
why not shorten
the process of dying by giving the patient a lethal injection?
To avoid sliding down the icy sidewalk on a hill,
we should avoid even getting close to that hill.
This means no
Another common argument used by the anti-euthanasia
invokes the specter of Nazi Germany,
which also used the concept "euthanasia" for a time.
'Undesirable' people were put to death in concentration camps.
These included Jehovah's Witnesses and labor union leaders.
But most of the victims of the Nazi Holocaust
were killed merely because they were Jews.
Part of the Nazi program also sought to get rid of
If the disabled and the dying could no longer contribute,
then they should be sent to the gas chambers.
The Nazi crimes
committed under the name of
should never be associated with
victims of the Nazi killings had no choice.
They were killed for economic,
political, & racist 'reasons'.
Smith thinks that we should learn from the Nazi
that we should never permit doctors to assist people in dying:
Just see what happened in Germany during the Nazi period.
have a strong emotional appeal.
And there are probably some
lessons we can learn from Nazi atrocities.
Safeguards are needed to prevent
even vaguely similar to the
from ever happening again.
should never be in charge of who lives
and who dies.
Keep strangers out of the loop.
As we claim the right-to-die for
this should always be a very
personal, individual decision.
And when we are no longer capable
of deciding for ourselves,
our prior wishes (best expressed
in writing) should be honored.
When choosing proxies for
ourselves, we should choose
people we trust,
who are very familiar with our
and who will protect our best
opponents of the right-to-die often refer to the Nazi Holocaust,
we who believe in the right-to-die
should be ready to answer
the questions raised by the Nazi
atrocities during the Second World War.
to prevent any premature killing for economic, political, or racist
The next chapter deals with the Dutch experience
In the Netherlands, doctors are supposed to follow guidelines
in helping their patients to die.
But frequently they perform euthanasia
without going thru all the prescribed procedures.
For example, they sometimes ignore the requirements
for repeated requests for death from the patient
because the patient is already too far gone
to be able to make a rational request for death.
reviewer's mind, this illustrates the need
that can take such situations into
When the patient has become incapable of making medical
then specific proxies should be
empowered to make such choices,
including the decisions that will
end that patient's life.
These proxy decision-makers should
be selected by the patient
before he or she becomes incapable
of making wise end-of-life choices.
Smith cites some foolish reasons for wanting death:
a scar on one's face, fear of overeating,
fear of future health problems caused by AIDS,
& untreated psychological problems.
When doctors are given all the power to decide life and death,
such mistakes will take place.
Also under Dutch law and practice,
parents of defective newborns can request death for them.
If they can find a doctor who agrees, death will be the result.
Smith does not think it should be that easy.
And he cites disabled people who are glad
that they were not killed in infancy.
In several chapters, Smith warns against the
as a form of oppression
against the most vulnerable in any society.
The poor, the homeless, those who cannot express their wishes well,
the most difficult patients who have no one to speak for them,
racial minorities, illegal aliens, criminals, etc.
are all in danger of being put to death
if we allow the 'death culture' to advance.
Sometimes doctors might be tempted toward euthanasia
in order to prevent malpractice suits.
The doctor might hope to cover
up a mistake.
And if the patient is dead,
any economic award won in court will be much less
than if the patient will need life-long care.
Disabled people are among the strongest opponents
of the so-called "right-to-die".
They fear that people who can no longer contribute to the society
will be killed first whenever any "right-to-die" is allowed.
So they think that the best way to protect themselves
in to resist all advances toward a 'death culture'.
All forms of chosen death should be prohibited
because of the
danger to vulnerable people.
agrees that these worries should be
taken very seriously.
We do have the historical
of Nazi Germany,
where disabled people were put to
death as "useless eaters".
Such things are not likely to
But good safeguards will make it
that disabled people
will not be
coerced or manipulated into death.
right-to-die movement should seek to create
that will be approved even by
Here is one example of a
safeguard especially for disabled
When a disabled person is
selecting a Medical Care Decisions Committee,
he or she could make sure to have
many disabled persons on that MCDC.
Or an ethics committee of a
hospital or nursing home
could be sure to include disabled
persons on that committee.
Where medical decisions are routinely made for disabled persons,
there could be a regular committee
entirely of other disabled persons.
Of course, these would have to be
open-minded disabled people,
who are capable of going either
way on questions of life or death.
If a committee of disabled persons
always said "no"
to all proposed life-ending
then, of course, there would be no
point in having such a committee.
When able-bodied people try to make decisions for
they often bring their own preconceptions to the process.
For example, if they could not imagine themselves
wanting to live with such severe limitations,
they might suggest death as an alternative to life-with-disability.
But people who have already adjusted to disability
realize that it is entirely possible to have a meaningful life
even with a disabled body and/or mind.
Disabled persons might not be the only victims of a
Sometimes a spouse wants to be free of responsibility
for a husband or wife who has become more a burden
than someone who is loved and cherished.
If too-easy choices for death were permitted,
spouses might use the "right-to-die"
as a means of relieving themselves of relationships they no longer
In Chapter 8, Smith attempts to answer
several arguments for the right-to-die.
After each argument favoring the right-to-die is rebutted by Smith,
this reviewer offers a reply from
the perspective of the right-to-die.
Opposition to the right-to-die is primarily religious.
Therefore the separation of
church and state
should permit those who choose
death to have the right-to-die.
Smith cites examples of non-religious people
who also oppose the right-to-die.
People who object of choosing
death on religious grounds
should following their own
But they should not attempt to
impose their morality
on the whole society by means of
Safeguards will prevent abuses and mistakes.
Smith cites the Netherlands and Nazi Germany
as places where safeguards have been circumvented.
He believes that safeguards will never work.
The question of safeguards will be
to the next decades of debate
about the right-to-die.
Thoughtful advocates of the right-to-die
safeguards that will work so
that even some of the opponents of
will eventually embrace such
At least many people in the middle
that such safeguards are workable.
(Here are the Fifteen
for Life-Ending Decisions
created by this reviewer.
And here is a website devoted to safeguards for life-ending decisions:
Voluntary death and merciful death will only be used as a last resort.
Smith says that it is never
necessary to hasten death.
Better hospice care and pain-control will eliminate all requests for
Yes, all appropriate medical care
should always be tried first.
should never be suggested as
a substitute for medical
But there might come a
turning-point in many slow deaths
when shortening the process of
would be better in the eyes of all
than keeping the body 'alive' as
long as technologically possible.
Good safeguards will eliminate
even the suspicion
that someone is being rushed into
instead of being offered
appropriate medical care.
Prohibiting the right-to-die is
not the best way to
improve end-of-life care.
Voluntary death and merciful death should only be considered
after all appropriate medical
options have been tried.
And safeguards should be created
that all relevant
have been explored.
In extreme cases, when cure is no longer possible,
Smith does endorse terminal
which will keep the patient unconscious until natural death.
In his view, being unconscious for the last few days
is better than being poisoned.
animals are terminally ill or hopelessly injured,
we have no problem "putting
them to sleep".
Why do we lack similar
compassion for suffering human beings?
Smith points out that we have always separated
killing animals from killing people.
We should not use veterinary ethics for persons.
Yes, we should certainly give up
No human person wants to be
treated like an animal.
What we want is wise and
as we bring our
distinctively-human lives to a close.
advocates of choices at the end of life
are also advocates of choices
at the beginning of life:
They approve of the right to
have an abortion.
Yes, again, reproductive freedom should be separated from the
Quite different values are being
protected in these very
majority of the population favors the right-to-die.
Smith disputes this claim by pointing out
that such poling can easily be distorted by the way the question is
The majority of people do not
favor doctors helping patients to die.
And Smith points out the many failures of referenda on the right-to-die
when they were put to a yes/no vote of the people.
Public opinion is moving slowly in
the direction of the right-to-die.
More high-profile cases of former
persons kept 'alive' by machines
will convince more people to favor
choices to end 'life' voluntarily.
And the people who will never
agree to any form of chosen death
will not be forced to participate.
For the foreseeable future,
'natural death' will always be an
right-to-die is needed because
too many people are being kept
alive on machines
for too many months before they
Smith says that the appropriate answer to this problem
is better Advance Directives and better implementation of them.
An Advance Directive should specify
when life-support is appropriate and when it is not.
Smith argues that Advance Directives should not be rigid.
Unforeseen circumstances might call for a different response
than imagined in the Advance Directive for Medical Care.
Yes, better use of Advance
Directives will help all end-of-life
And a very important part of any
is appointing the best proxies to
when the patient is not capable
And comprehensive Advance
should include discussion of the
who want the right-to-die
should say so.
And people who want the maximum
permitted medical care
should express that wish just as
completely and explicitly.
conservatives oppose the right-to-die.
Smith disputes this claim by citing many people
who are very liberal on other issues
who nevertheless oppose any so-called "right-to-die".
Liberals also can fear the abuses that might follow
any liberalizing of the laws surrounding the process of dying.
It does not matter who is lined up
on either side.
We want wise policy achieved by democratic means and based on reason.
is no difference between pain-control and choosing death.
These advocates of the
right-to-die appeal to the principle of double effect:
Pain-control measures may be
used to maximum effect
as long as the primary intention is to relieve pain and not to
even if shortening the process
is a foreseeable consequence of
Only some advocates of the
right-to-die use this form of thinking.
More forthright advocates say that
we should clearly separate
decisions that are intended to
(with an eye to returning the
patient to a normal life)
from decisions that are intended to
end the patient's life.
Even 'terminal sedation' should be
correctly called a life-ending decision.
And when life-ending decisions are
all of the safeguards should come
If we play mind-games ("We are
only relieving suffering."),
the value of safeguards for
life-ending decisions is lost.
If it is only a medication
who will raise the question of
safeguards for life-ending
Does it seem
to readers of this book-review
that Smith discusses only very
weak arguments for the right-to-die?
Perhaps this is his lawyer's
Think only for one side.
Never acknowledge that your
opponent has any valid ideas.
Attempt to make the other side
Present and reply only to the
weakest arguments of your
If you have discussed 9 arguments, the reader might get the
that you have looked at the whole
case for the right-to-die.
Perhaps Smith has selected only
these 9 arguments
because they give him occasions to
support his own point of view.
Why has Smith not confronted the very best arguments for the right-to-die?
For example, where does Smith
discuss personal autonomy?
A more balanced
book would allow each side
to present its very best arguments,
to which the other side would be
invited to reply.
Smith's preferred mode of death is a natural death
in a hospice.
We do not need to drink the hemlock.
Rather, we can get proper pain-control in a home-like setting.
And then we will never be interested in the right-to-die.
will probably never change.
But some of the less committed
might have their minds changed
by reading some books
In any case, the issues Smith
raises all need to be addressed,
because they do in fact appear in
the minds of many people.
3. Wesley J. Smith
Culture of Death:
The Assault on Medical Ethics in America
(San Francisco, CA: Encounter
Books: www.encounterbooks.com, 2000) 285 pages
(ISBN: 1-893554-06-6; hardcover)
(Library of Congress call number: R724.S57 2000)
(Since this is the same author as the book just
this review will be somewhat
because the author makes many of
the same points again.)
A lawyer raises doubts about what he perceives as
a trend in modern medical ethics to decide in favor of death
rather than keeping patients
as long as possible.
The major issues include:
giving up medical care 'too soon',
making value-choices regarding the quality of life,
mercy-killing and assisted suicide,
& pressuring people into dying so they can 'donate' their organs.
Smith has no
special expertise in the
field of medical ethics,
but he wants to preserve or go
what he conceives to be
traditional medical ethics.
Most of the
review that follows will consist of
replies to Smith.
People who believe in the
right-to-die (as I do)
should take the critics seriously,
especially those who base their
arguments on reason
rather than mere ideology.
Smith does give the best arguments
he can construct
for each of the points he wants to
When Wesley J.
Smith criticizes a case of premature
he usually frames the choice in
These cases of 'mercy-killing' or
'euthanasia' should not have
We should always choose life over
But as mortals, we do not have
Rather, we must select death now or death later.
And we should ask how much better
a later death would be.
consider a former person
who has been in a persistent
vegetative state for a number of years:
When there is no chance of
options are not life
but death this year or death in
some future year.
What would be the best
year-of-death for this former person?
Smith has entitled this book Culture
because he fears that medical ethics is now becoming ideological.
And that new ideology will always favor death over life.
Or to put it more accurately, the new culture of death
will always favor death now over death later.
He gives examples to prove his case.
And some of these examples do seem
to be premature deaths.
However, we do not hear the other
side of any of these cases.
As a lawyer, Smith presents only
In a court of law, the other side
would be given equal time.
And even if
there were a number of cases of
this does not mean that we should
outlaw all chosen death.
Rather, it means that we need wise
and careful safeguards
that have the potential to prevent premature deaths.
Under any system of safeguards,
there will always be mistakes:
Some lives will be ended too soon.
But under any system that
prohibits all chosen deaths,
there will also be mistakes:
Some individuals will be forced to
suffer too long before
And if these patients are no
longer suffering because they are
those who care about them might be
forced to endure
seeing them imprisoned by machines that are keeping them
All colors of
medical ethics should be permitted in
a free society.
Some patients and proxies will
choose a later death.
And other patients and proxies
will choose an earlier death.
Within reason, both options should
Smith fears that a new elite of medical ethicists is
who have an ideology that says:
"When in doubt, always choose death now rather than death
I do not see
Ethical views of all colors are
heard and heeded.
Do conservatives or liberals have the upper hand?
A case for either claim can easily
by selecting only examples that
support the chosen claim.
Smith deplores the fact that medical ethics
longer based on religious belief.
When the 'sanctify of life' prevailed, then all life
(no matter what its quality) was preserved as long as possible.
Smith fears that if we 'devalue' some forms of life,
we will not know when to stop.
If we allow some forms of voluntary death or merciful death,
then other individuals with
a low quality of life are in danger.
This is simply
a foolish and absurd claim.
Even ordinary people who have no
training in medical ethics
can make quality-of-life choices
—and for the former persons they
does not mean that we will always
'pull the plug'.
As a matter of
everyday medical practice,
religious views are taken into account.
And religious beliefs about life
should always be honored whenever
But religious beliefs should not
Some religious people
believe that prayer
will bring a
If they pray hard enough, God will
perform a miracle.
Nothing in medical practice should
But there should be some practical
limit on how long to wait for a
Hospitals should not be required
to keep hopeless bodies on
while waiting for a miracle.
Let religious practices be
parallel to medical practices.
But do not let one dictate to the
Smith worries that bioethics sometimes
makes wrong decisions:
Some doctors recommend non-treatment for defective newborns.
Late-term abortions should not be permitted.
Sometimes medical experiments are performed on human subjects
without those subjects fully understanding the dangers.
the right-to-die would reply:
Each example of a questionable
decision in medical ethics
could have been handled by better
—and a more thoro application of
safeguards already in place.
The problems Smith cites call for better
rather than for prohibiting
the practices he discusses.
Has the principle of autonomy gone too far?
Sometimes people wish to die when they get a terminal diagnosis.
But if doctors refuse to cooperate with irrational suicidal urges,
some of these patients change their minds about dying.
A little paternalism is justified by the good results sometimes
For example, sometimes the patient
might be hurried into choosing death mainly to benefit the family,
who will be freed
of the burden of caring for the patient
and who might inherit
large sums of money.
Careful safeguards surrounding all
should be able to prevent almost
all mistakes and abuses.
Smith has performed a valuable
for everyone considering the
option of choosing death:
He has gathered doubtful cases
—situations in which valid
questions can be raised
about the wisdom of choosing death
at the time it was chosen.
Another chapter explicitly addresses the possibility
that discussing the 'right-to-die' will create a duty-to-die.
Medical ethics uses the concepts of futile medical care and rationing.
Sometimes patients and their loved ones demand medical
that have little or no chance of being effective.
Medical ethics does
consider the cost and benefit of each procedure.
Smith does not think that money should ever be considered.
The state of
Oregon has created a
priority list of
Public funds go only for
the procedures higher on the list.
Treatments lower on the
list are not offered to people who
Each year the cut-off point is
adjusted to fit the money available.
This system of rationing assures
less-expensive treatments are available to everyone on
But it does exclude complex and
Thus, some people do die sooner
because the public will not pay for
But many more people are saved
from simple causes of death
because in Oregon basic medical
care is available to all.
Smith worries that the duty-to-die mentality
will be reinforced by the need for 'donated' organs for transplant.
Especially disabled people might be rushed into 'choosing' death
because it will benefit others who need their organs.
Because of the possibility of
abuses and mistakes,
is Smith suggesting that we terminate
But a more
to apply the safeguards already in
place more carefully.
The public needs to be convinced
that the donors really were dead
before any organs were taken.
Science fiction and sensational
journalism like to focus
on the possibility of stealing organs from the living.
Public willingness to
donate organs after death is very
A few reports of questionable
(or cases that were not correctly
can cause some people to revise
their plans for donating organs
—either their own organs after
or the organs of their loved ones
after they are finished with them.
The public needs to understand brain-death more
Smith cites some cases when the diagnosis of brain-death was wrong:
The patient did recover and returned to normal life.
independent doctors must
repeat the tests
make sure that the patient
before any question of
organ-donation is raised.
Understand the cause of the death
of the brain
and following the safeguards for
proper waiting periods
can make the diagnosis of
brain-death more certain.
Some ethicists favor PVS being an optional
definition of death.
Smith does not agree: Persistent vegetative state is not death.
The public will rightly resist
such a re-definition of death.
When the patient seems to be awake
part of the time,
has reflex movements and breathes
without mechanical assistance,
people without medical training
often have great difficulty
understanding that this former
person will never recover.
Another proposed new definition of death
that Smith resists is permanent unconsciousness.
infants is another possible source of
for other infants who will
otherwise also die.
Especially when infants are born
with their upper brains missing,
these could be defined as born permanently unconscious.
Because anencephalic infants lack
the thinking and emoting parts of the human brain,
they will never have a thought or
But if the rest of their bodies
are working well,
they make ideal organ-donors
for other infants who were born
with defective hearts, for example.
Smith is also against any form of organ selling.
He worries that the poor will be exploited:
Instead of being offered full medical care,
their relatives will be offered cash for their organs.
This is not
likely to happen,
but even the fact that people can conceive of such a practice
shows the need to have strong
safeguards to prevent
Organ selling does present real
opportunities for abuse.
So any organ-market should be
Smith also points out the dangers of surgically
before the donor has been officially declared dead.
Even if the
donor has approved of
such a practice in advance,
it would never be good public
to allow harvesting organs needed
for survival from living bodies.
No one associated with the present
system of organ-donation
has approved such a practice.
And it would be counter-productive
because it would feed
worries about stealing organs from the
This is called the dead-donor
Another element of modern medical ethics
that Smith disagrees with is the effort to limit 'futile' care.
Smith worries that it is too easy for doctors to declare
that further medical treatment would be useless.
According to Smith, economic and quality-of-life factors
should not be
considered in making medical decisions.
Ethics committees should be subject to review and reversal,
just as courts now are.
And this would mean making their deliberations
Smith worries that 'medical dehydration'
will be used inappropriately against disabled people.
And defective infants should not be refused treatment
merely because they will have lives of low quality.
In summary, Smith has constructed the best arguments
he can think of
to prevent medical ethics from devaluing human life.
All human life is equally valuable and should be
In the first
few decades of the
the most likely arena of this
will be patients who are in
persistent vegetative state.
Smith always wants to keep such
Everyone who affirms the right-to-die
will have to confront the
arguments presented in Culture
4. Kathleen Foley, MD
& Herbert Hendin, MD, editors
The Case Against Assisted Suicide:
For the Right to End-of-Life Care
MD: Johns Hopkins UP: www.press.jhu.edu,
2002) 371 pages
(ISBN: 0-8018-7901-9; paperback)
(Library of Congress call number: R726.C355 2002)
(Medical call number: W32.5AA1C337)
This is a
collection of articles and essays by several different authors,
all pointing out problems with the
such as the physician aid-in-dying now
available in Oregon and Washington.
Johns Hopkins University Press also
published a similar collection
that took the opposite point of view:
The Case for
Palliative Care and Patient Choice
edited by Timothy E Quill, MD &
Margaret P. Battin, PhD.
This book is reviewed in the companion
Best Books on the Right to Die:
The review of The Case Against Assisted Suicide
grew so long that it was given its own room in this on-line
5. Mary & Robert Schindler
Schindler Vitadamo and Bobby Schindler
A Life that Matters:
The Legacy of Terri Schiavo—a
Lesson for Us All
York: Warner Books: www.twbg.com, 2006) 251
(ISBN-10: 0-446-57987-4; hardcover)
(ISBN-13: 978-0-446-57987-2; hardcover)
(Library of Congress call number: R726.S34 2006)
This book is written
mainly in the voice of Mary Schindler,
mother of Terri Schiavo.
But Terri's father Bob, sister Suzanne, & brother Bobby
all have major comments included.
These four people make up Terri Schiavo's family of origin.
And they were united in their opposition of allowing Terri Schiavo to
Terri Schiavo's husband, Michael Schiavo, has
written another book
—Terri: The Truth—which
takes a very different perspective
on the facts and opinions surrounding the Terri Schiavo case.
Michael Schiavo's book is reviewed
in the bibliography Supporting
This reviewer will leave it to careful readers to
just where the objective truth lives between these two different
Even tho each book tries to spin
the 'facts' to favor a particular perspective,
Michael Schiavo's book is probably
closer to what really happened.
And after many years of battling in courts,
the husband's perspective finally prevailed:
Terri Schiavo had her feeding-tube removed after 15 years in PVS.
The Schindler family members consistently 'see'
more responses from Terri Schiavo than observed by most medical
And they found their own experts to support their observations.
The Schindlers always wanted to keep Terri alive
and to seek rehabilitation for her
so that at least some moments of awareness would be possible.
And after Terri's final death in 2005,
the Schindlers established a foundation
to support patients who have lost many mental capacities.
They hope that the tragic case of Terri Schiavo
will make it possible for other patients like Terri to be kept alive,
who would otherwise be declared "vegetative" and allowed to die.
The rhetoric of this book displays its point-of-view.
Disconnecting Terri's feeding-tube is consisting called
"starving and dehydrating" Terri.
The judge and the husband who chose this course of action
after it was determined to be what Terri would have chosen for herself
are called "murderers".
The most extreme statements by the Schindlers
say that they should both be in jail.
The Schindlers were able to find their own Roman
to support their position that life-support should always remain in
until natural death occurs despite
(In his book, Michael Schiavo notes that Mary
did authorize the removal of her
own mother from life-supports
at the end her mother's life.
But the experience of dealing with
her daughter's death
might have changed Mary
Schindler's mind about life-supports.)
As the media began to pay attention to
many right-to-life groups came to side of the Schindlers.
In many ways Terri Schiavo became their poster-child.
The demonstrators and public opinion
were largely on the side of keeping Terri 'alive'.
The Florida legislature passed 'Terri's Law',
which allowed governor Jeb Bush to re-insert the feeding-tube,
even tho the courts had already decided she did not want it.
was set to last only 15 days—
was ruled unconstitutional because the
does not have the power to change rulings of the courts.
The U.S. Congress similarly tried to intervene
and the President signed a special bill, but it also was
One take-home lesson from the Schiavo case
is that families can easily be divided about end-of-life choices.
No matter what evidence was collected by the courts,
even including the autopsy report,
the Schindlers continued to believe that Terri was alive and conscious
until she finally died in 2005 when her feeding-tube was removed.
This shows the
power of metaphysical belief.
The same people who believe that
an embryo has a soul
believe that all remnants of life
must be preserved
as human beings approach the end
of their lives.
The same difference of opinion will happen in other families:
Some family members will believe their dying relative is still a person.
And other family members will believe
that the patient has become
Such possible conflicts should be avoided
by each person creating an Advance Directive for Medical Care,
stating exactly what he or she wants
if he or she is ever in a persistent vegetative state
or some similar condition from which he or she is not likely to recover.
The Schindlers will create one kind of 'living will',
which will keep them 'alive' as long as possible.
The Schiavos will create another kind of 'living will',
authorizing the withdrawal of life-supports
when there is no hope of recovery.
In the wake of the Terri Schiavo case,
many opponents of the right-to-die attempted to create state laws
that would mandate food and
water for all patients in PVS
unless there is clear and convincing evidence to the contrary.
For more information about this effort in Minnesota, go to:
Starvation and Dehydration
or Persons with Disabilities Prevention Act
This reviewer also read Michael Schiavo's book
in parallel—chapter-by-chapter with this book.
Michael Schiavo's book-—Terri:
is reviewed in the bibliography on Books on the
Both reviews end with the following paragraph:
Whatever we want, if ever we are
in a condition similar to Terri Schiavo,
we should state our wishes clearly
in our Advance
Directives for Medical Care.
To keep abreast of the thinking represented in this
go to the website of the Terri Schiavo Life & Hope Network:
A Concise History of Euthanasia:
Life, Death, God, and Medicine
MD: Rowman & Littlefield, 2005)
(ISBN: 0-7425-3110-4; hardback)
(Library of Congress call number: R726.D688 2005)
A good summary of
the historical background of the right-to-die debate,
beginning in ancient times and brought
up to the present.
This book is definitely against
An historian favoring the right-to-die
would have selected different facts
to include and would have presented it
all with an opposite tone of voice.
Dowbiggin frequently notes that people who favor the right-to-die
are also in favor of such godless
things as evolutionary theory and abortion.
Also, Nazi atrocities are associated
with the "euthanasia" movement.
One reason God appears in the title is
believes that traditional religions
will always oppose the right-to-die.
people in the right-to-die movement should read this book
to catch a good
dose of the
assumptions operating in the minds of the opposition.
Please suggest additional
books that should be included
in this bibliography of books opposing the right to die.
Send your suggestions to James Park: e-mail:
The reviews above
make up about 16 pages of the bibliographies for
How to Die:
Safeguards for Life-Ending Decisions.
These are several of the books
4-22-2009; 9-13-2010; 2-9-2012; 4-1-2012; 4-18-2013
Best Books on the Right-to-Die
Books on Voluntary Death
Books on Preparing for Death
on Terminal Care
Books on Helping Patients to Die
Go to the Book
to discover 350 other reviews
organized into 60 bibliographies.
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