Copyright © 2013 by James Leonard Park
Selected and reviewed by James Park,
existential philosopher and advocate of the right-to-die.
Organized in the order of quality, beginning with the best.
Comments in red are the opinions of this reviewer.
A note to authors
of books supporting the right-to-die:
Please avoid the following four misleading words:
euthanasia, suicide, hasten, medication.
1. James M. Hoefler
(Boulder, CO: Westview
(ISBN: 0-8133-2816-0; hardcover)
(Library of Congress call number: R726.H564 1997)
a broad consensus among almost all groups
(doctors, nurses, hospitals, religious organizations)
that have taken official positions
concerning how to manage the process of dying:
1. Forgoing medical
treatment and life-supports
is not suicide.
2. Withholding and withdrawing life-supports are ethically the same.
3. Family members can decide for incapacitated patients.
4. Terminal illness is not required
as a precondition for making life-ending decisions.
5. Food and water need not always be provided.
7. Severe dementia
is a condition in which
the patient is no longer able
to make any meaningful decisions about life or death.
The number of such patients is measured in the millions at any given time.
But common sense and public opinion are slowly moving toward consensus
that the severely demented need not be kept alive by artificial means.
In other advanced countries, they are not routinely put on life-supports
—as is quite common in the United States.
But America as a society does not yet have a consensus
about how to treat former persons who have permanently lost
such capacities as consciousness, memory, language, & autonomy.
artificial nutrition and
hydration at end of life.
Dying from lack of water is much quicker and easier than starvation.
Two months is a typical time to die from lack of food
—if there are no other physical diseases or problems.
A week or 10 days is all it takes to die
if all water and other fluids are given up.
According to all objective reports, this is a quick and easy death,
often without the need for pain medication.
following points about voluntary death by dehydration (VDD)
come from this reviewer rather than from James Hoefler:
Giving up water and
other fluids has some additional advantages
over other methods of bringing life to an end:
The patient can always change
his or her mind.
Since it takes at least a week to die using this method,
the patient might see life quite differently
after a few days without food and water.
People tempted to commit irrational suicide
will probably recover from their suicidal urge before they die.
Then they will resume eating and drinking
—and continue to live indefinitely.
Other people will probably know about this decision to die
—which gives them ample opportunity to intervene
if they do not believe that death at this time is the best option.
Doctors do not need
to be involved in the
dying process at all.
Thus, there are no moral or legal questions
about doctors aiding in the process of dying.
Death by dehydration can be conducted completely at home,
without the need for any special equipment or drugs,
and without the involvement of any health-care institutions.
Giving up food and
water is completely legal.
There are no laws against choosing this method of dying.
This eliminates all the secrecy involved in underground means of death.
Families can be
informed ahead of time
about the planned death,
so they can gather for the last days of their loved one if they please.
Death by dehydration
a preferred method for voluntary death
in the first few decades of the 21st century,
because it does not involve the state
or health-care institutions or personnel.
Patient autonomy is certainly preserved
because the decision to die must be affirmed over and over again
during the last week or 10 days of life.
And when the patient slips into unconsciousness,
the proxies and medical personnel can continue to withhold fluids.
No new legislation
is required to permit this method of choosing death.
We already have the power to end our lives in this way.
The danger of irrational suicide is sharply diminished.
(Irrational suicide is a danger in all methods that bring death suddenly.)
The patient will go to sleep at night and wake up again in the morning
several times during the period of dying from dehydration
which will give new perspectives on problems
that might otherwise lead to an irrational suicide.
If this plan for achieving a voluntary death is announced to others,
they might decide to provide new support or better medical care,
which might postpone dying until some later time.
reviewer has written two essays on this subject:
And he has begun a website on
the same subject:
Voluntary Death by Dehydration---Questions and Answers.)
hopes that death will be better managed in the future.
He suggests the following ways to improve the process of dying:
1. New standards of
care will be developed
for mortally-ill patients.
Then they will no longer suffer the default decision,
which is always to provide maximum aggressive medical care:
Because it can be done, it will be done
—until someone decides otherwise.
2. We will make better
use of hospice care.
Now it is often used just for the last week of life—or last few hours.
Taking advantage of hospice services
for several weeks or months
can greatly improve the process of dying.
3. We will develop a
clearer concept of medical
Research will show more clearly than ever before
which medical treatments are useful and which are useless
in the various situations in which such treatments might be used.
Not only the medical profession but also the general public
will reach a more reasonable consensus
about when to omit or withdraw high-tech medical care at the end of life.
decision-making will become
more open and rational.
Both health-care professionals and the general public
will be better educated in order to make wiser end-of-life decisions.
Death can be better managed rather than fought every step of the way.
5. We will reject the slippery-slope arguments
of those who oppose making any life-ending decisions.
By paying close attention to the particulars of each case
rather than trying to enforce rigid rules of morality,
wise decisions will emerge that can be embraced by everyone involved.
6. Advance Directives will
used more fully
so that we can choose our own pathways towards death,
rather than being handled according to the standard operating procedures
of the hospital or the medical profession.
Death is a basic and moderate
book about the process of dying.
Hoefler does not attempt to break new ground.
Rather he clarifies the consensus that we already have achieved
—and projects the elements of a new consensus
that is now beginning to emerge in our collective thinking.
Everyone concerned about the process of dying
should read Managing Death.
2. John Griffiths, Heleen Weyers, & Maurice Adams
Euthanasia and Law in Europe
(Oxford, UK & Portland, OR: Hart
2008) 595 pages
(ISBN: 978-1-84113-700-1; hardback)
(Library of Congress call number: KJC8357.E96G75x 2008)
Updating and expanding Euthanasia
and Law in
the Netherlands, 1998.
The authors present a comprehensive review and commentary
on the laws and practices concerning life-ending decisions
in the following countries:
Netherlands, Belgium, England and Wales,
France, Italy, Denmark, Norway, Sweden, Spain, & Switzerland.
All show increasingly acceptance of life-ending decisions,
but some countries have more advanced laws and controls.
Holland and Belgium have the most developed systems,
but the rates of making life-ending decisions in the other countries
are similar, even where 'euthanasia' is still not legally-recognized.
The first half of the book is devoted to the Netherlands.
In Holland, doctor-assisted death
includes both 'euthanasia' and 'physician-assisted suicide'.
Both kinds of help in dying fall under the same regulations.
The only difference is taking pills (physician-assisted suicide)
or receiving a lethal injection from the doctor (euthanasia proper).
The most surprising disclosures are the high frequency of
life-ending decisions as part of normal medical practice.
These include: (1) increasing pain-medication at the end of life;
(2) terminal sedation to keep the patient unconscious until natural death;
& (3) ending all medical treatments and life-supports
when it becomes clear that the patient will never recover.
Because all of these life-ending decisions take place in medical settings,
the doctors are the ones who recommend such changes in care,
which will result in the death of the patient.
Exact numbers for these end-of-life medical decisions
are very difficult to determine
because there are no systematic ways of identifying the cases
and putting them into discrete categories.
Death-certificates can be studied.
These will show deaths openly declared to be 'euthanasia'
or 'physician-assisted suicide'.
But the termination of medical treatments is seldom mentioned.
Doctors can be polled about how often they help their patients to die.
But (especially where aid-in-dying is not yet legal),
doctors do not want to incriminate themselves
by admitting that they have used methods of helping
that are not yet approved by the laws of their countries.
But doctors do routinely help their
patients to die.
And these practices are within normal medical care
and the medical ethics of their respective medical associations.
About half of all deaths
in some European countries
take place with a meaningful element of choice.
For contrast, the other deaths taking place within medical institutions
occur while doctors are still trying to save the patient from death.
The full range of medical treatments are still being applied
and all appropriate forms of life-support are still operating.
But the patient dies despite all such efforts to prevent death.
This reviewer calls such deaths being "treated-to-death".
Perhaps about 20-30% of all deaths fall into this category.
The Netherlands has the most elaborate laws and controls.
Specially-trained doctors are available as euthanasia consultants
for all doctors who might be called upon to help patients to die.
Whenever a doctor agrees to 'euthanasia' or 'assisted suicide',
the doctor must report such deaths to a Regional Review Committee.
About 3% of total deaths in Holland are so reported.
Since the new euthanasia law went into effect in 2002,
no one has been charged with violating the law.
And technical violations of consulting and reporting requirements
have not led to any prosecutions of doctors.
3. Stuart J. Youngner & Gerrit K. Kimsma, editors
Physician-Assisted Death in Perspective:
Assessing the Dutch Experience
(New York: Cambridge University Press:
www.cambridge.org, 2012) 403 pages
(ISBN: 978-1-107-00756-7; hardcover)
(Library of Congress call number: R726.P484 2011)
(Medical call number: WB65P578 2012)
23 academics and physicians with first-hand
with 'euthanasia' and 'physician-assisted suicide' in the Netherlands
offer their perspectives and analyses of how these life-ending decisions
are achieved and reported in Holland.
Several chapters at the beginning trace the unusual pathways
by which Holland has finally arrived at its present practices.
Usually court decisions have led to regulations that make exceptions
to the laws against helping patients to die.
Because "unbearable suffering" is required by Dutch law of 2002,
there has been considerable discussion about exactly what qualifies
as conscious suffering that cannot be relieved by any medical methods.
Some advocates of the right-to-die argue that the normal losses of old age
are sufficient losses of dignity to qualify as "unbearable suffering".
And because patients must be suffering,
they no longer qualify if they become comatose.
Also, Alzheimer's patients do not qualify for 'euthanasia' or 'physician-assisted suicide'
because it is questionable whether they are suffering unbearably.
And they can no longer give informed consent for a life-ending decision.
This is a peculiarity of Dutch law
that might be avoided by other countries.
Instead of requiring "unbearable suffering",
would it be sufficient to determine that meaningful life is over?
Reporting of 'euthanasia' and
continues to improve each year.
And as of 2011, about 2% of all deaths in Holland
were being achieved by these defined and reported methods.
Another 2% are achieved by patients who decide to forego food and
This method of choosing death does not fall under the Dutch law
and therefore does not require consultation and reporting.
Also, an even larger number of death are achieved as a normal part of
which would be found in any countries with advance medical care.
These include providing pain-medications at the end of life,
even with the knowledge that the pain-killers might shorten the process of dying.
Terminal sedation is becoming more popular:
The doctor decides to keep the patient continuously unconscious
until death comes as a part of the natural process of dying.
And, of course, whenever life-supports are in use,
it is completely within normal medical practice
to disconnect or discontinue all forms of medical treatment and life-supports.
Such life-ending medical decisions often include
discontinuing artificial nutrition and hydration,
but these doctor-initiated decisions are not counted
in the 2% of Dutch deaths (mentioned above)
caused when patients themselves decide to give up food and water.
Richard N. Côté
In Search of Gentle Death:
The Fight for Your Right to Die with Dignity
A Social History of the Right-to-Die: The
End of the Beginning?
Historian and journalist, Richard Côté, here profiles
the major movers in the right-to-die up to 2012.
Readers will recognize these names: Derek Humphry, Jack Kevorkian,
Sue Rodriguez, Philip Nitschke, Rodney Syme, Faye Girsh,
Richard MacDonald, Pieter Admiraal, Boudewijn Chabot,
Stanley Terman, Ludwig Minelli, Michael Irwin, & Russel Ogden.
Dozens of lesser-known characters also grace these pages.
Almost 100 pictures are included.
Some chapters are
devoted to a single leader of the right-to-die movement.
Other chapters deal with major themes such as new methods of dying.
Ch. 2 Good-bye, My Love
(Derek Humphry starts a revolution)
Ch. 3 Euthanasia's Lightening Rod
(Jack Kevorkian is the Lone Ranger of doctor-assisted dying)
Ch. 4 The Twilight Zone
(famous cases of the right-to-die)
Ch. 5 Who Owns My Life?
(Sue Rodriguez and the Canadian scene)
Ch. 6 Robbing Death of Its Sting
(new technology for voluntary death)
Ch. 7 Grandma Martens Makes Her Rounds
(voluntary death in Canada)
Ch. 8 The Search for the Peaceful Pill
(Philip Nitschke and Australia)
Ch. 9 Death Down Under
(more about Australia and New Zealand)
Ch. 10 Caring Friends and Hemlock's
(strife and evolution in right-to-die organizations)
Ch. 11 Going Dutch
(the right-to-die in the Netherlands)
Ch. 12 The Battleground States
(some states change their laws)
Ch. 13 Esta Es Mi Volundad
(the right-to-die in Latin America)
Ch. 14 One-Way Tickets to Zurich
(voluntary dying at Dignitas)
Ch. 15 The Disunited Kingdom
(struggling for the right-to-die in Great Britain)
Ch. 16 Those Feisty Scots
(leaders of the right-to-die in Scotland)
Ch. 17 A Rising Tide Lifts All Ships
(the right-to-die in other lands)
Ch. 18 Seeker of the Grail Secrets
(Russel Odgen in British Columbia)
Ch. 19 The Big Sting
(the Final Exit Network and law enforcement)
Ch. 20 Seamless Care for a Gentle
(reasonable choices at the end-of-life)
Who will read In Search of
First, the approximately 425 living people listed in the Index.
Perhaps only Derek Humphry knows more people
in the right-to-die movement than Dick Côté.
(And, yes, this reviewer is also mentioned.)
Everyone concerned about the right-to-die should read this book.
It is an interesting and pleasant review
of the first bumpy years of the right-to-die movement.
Because this book
what has happened
in the last several years leading up to publication,
it looks backward more than it looks forward.
"Gentle Death" is
certainly a good replacement for "euthanasia".
Who could be opposed to having a gentle death?
"Assisted dying" would have been better than "physician-assisted suicide".
"Timely death" would have been better than "hastened death".
And "gentle poison" would have been better than "medication".
See my extensive recommendations for new expressions on the Internet:
Search using this exact phrase:
"EUTHANASIA, ASSISTED SUICIDE---Let's find better expressions".
These traditional expressions appear dozens
Readers familiar with the history of the right-to-die
will read right over these code words,
but people who are exploring the right-to-die for the very first time
will be pulled into the past when they come across
"euthanasia" and "assisted suicide".
Even the expression
"death with dignity"
does not correctly describe choosing gentle death.
Do all other deaths lack dignity?
The basic reason I have
entitled this review:
"The End of the Beginning"
is because everything in this history fails to notice
that thousands of life-ending decisions
are already taking place in modern hospitals
as a part of normal medical practice.
When the readers of this book come to the end of their own lives,
they have greater than a 50% chance
that meaningful life-ending choices will be made for them.
To what degree do we already have the right-to-die?
Doctors, patients, &
are already making the following four kinds of choices,
which bring human life to a peaceful and timely end:
(1) increasing pain-medication, (2) terminal sedation,
(3) ending curative treatments and disconnecting life-supports,
and (4) medical dehydration.
Perhaps the organized right-to-die movement
has helped this quiet revolution in medical care to advance.
Maybe all we need now is better communication
with the doctors who will be taking care of us at the end.
More discussion of this
quiet, behind-the-scenes revolution
will be found in my on-line essay with the following title:
"Four Legal Methods of Choosing Death".
If In Search of Gentle Death
marks the end of the beginning,
then the next phase will be better cooperation between
the advocates of the right-to-die and the medical profession.
We might see a shift from the 'suicide-model right-to-die'
to the 'medical-model right-to-die'.
Hospital deaths will usually include a meaningful element of choice.
And hospice care will include all the legal methods of choosing death.
Nevertheless, Richard Côté has
done us a great service
by putting all of this interesting and useful information into one book.
Michael Schiavo with Michael Hirsh
Terri: The Truth
(New York: Dutton,
2006) 360 pages
(ISBN-10: 0-525-94946-1; hardback)
(ISBN-13: 978-0-525-94946-6; hardback)
(Library of Congress call number: R726.S35 2006)
Terri Schiavo—the author's wife—
became a major name in the right-to-die debate
as she reached the end of her life in 2005,
after 15 years in a persistent vegetative state.
book is a personal account in which Michael Schiavo
tells the story of her life and death as known to him,
the person who was closest to her
and to the events that led to her collapse in 1990
and to her being disconnected from life-supports in 2005.
Michael Schiavo is well aware
that there are other accounts of the same events,
which is the reason he has sub-titled his book The Truth.
reviewer also read the book by the Schindler family
in parallel with reading this book,
following the two accounts of the events year-by-year in both books.
It is quite remarkable that a family that was originally very close
could be so dramatically split by this right-to-die controversy.
The same events are often given diametrically-opposite interpretations
by the two sides of this family dispute
about what should be done for Terri Schiavo.
The Schindlers' book—called A Life that Matters—
is reviewed in the bibliography of Books Opposing the Right-to-Die.
Immediately after her collapse,
Michael was completely devoted to helping his wife recover.
He spent many days by her bedside
watching for the slightest sign that she was conscious again.
But after several months and many failed attempts to rehabilitate her,
Michael had to agree with the doctors that his wife would never recover.
jury in the 1992 malpractice trial determined that Terri herself
was 70% responsible for her own collapse,
which was most likely due to an eating disorder,
which ultimately caused her heart to go into fibrillation,
which deprived her brain of oxygen,
causing a persistent vegetative state that lasted for 15 years
—until she was ultimately disconnected from her life-supports.
The other 30% responsibility was assigned to her doctors,
who failed to diagnose her eating disorder,
which could have been treated, preventing her death.
long, complex legal wrangling over Terri's guardianship and fate
is discussed in full in both books, but that will not be reviewed here.
the year 2000, Michael was first empowered by the court
to remove Terri's feeding-tube.
It took 5 more years of appeals,
intervention by the Florida legislature and governor,
and ultimately the U.S. Congress and the President
before the court cases were ultimately settled
—ordering the removal of Terri's feeding tube.
secret video-tape was made by the Schlinder family,
which was widely shown on television.
It was convincing enough to many viewers
that most public opinion favored keeping Terri 'alive'.
A number of neurologists diagnosed Terri from this tape
as being in a "minimally conscious state"
rather than being in a persistent vegetative state.
when the court ordered 5 experts to examine Terri,
the majority determined that she was in PVS,
which was confirmed by autopsy after her final death.
(The two experts selected by the Schindler family
did not agree that Terri was in PVS.)
The autopsy showed that her brain had shrunk to half normal size,
that she could not see, and that there was never any hope of recovery.
Terri's brain was even more gone than most patients in PVS.
The apparent 'responses' seen on the video-tape
were random events originating in Terri's brain-stem,
not actual responses to anything in her environment.
Pope John Paul II got involved indirectly.
He declared the tube-feeding of patients in PVS
is not medical treatment but a normal means of caring for the sick.
Actually, Roman Catholic priests
were lined up on both side of the Schiavo case,
some saying that she should be kept on life-supports
and others saying that she should be allowed to die.
Such religious opinions affected the public's responses to the case,
but they did not affect the legal rulings,
which ultimately led to removing Terri's feeding-tube in 2005.
Michael reminds us at the end of his book
that Terri Schiavo would not have become a 'household name'
if she had had an Advance Directive for Medical Care,
which would have been immediate "clear and convincing" proof
that Terri did not want to be kept 'alive' by a feeding tube
if she was never going to recover.
Whatever we want, if
ever we are in a condition similar to Terri
we should state our wishes clearly and unambiguously
in our Advance Directives for Medical Care.
you would like to see possible language to put into your 'living will'
so that you will not be kept 'alive' indefinitely on life-supports,
go to the following website created specifically
to help others avoid Terri Schiavo's fate:
The Modern Art of Dying:
A History of Euthanasia in the United States
(Princeton, NJ: Princeton University
Press: www.pup.princeton.edu, 2005)
(ISBN: 0-691-10263-5; hardcover)
(Library of Congress call number: R726.L3797 2005)
The process of dying in the United States
In the early years of the USA, dying was more an art,
often with deep religious dimensions.
But in more recent times, regular medical techniques
have shaped the process of dying.
This history of aid in dying goes up to the 1960s,
altho an epilogue mentions more recent developments.
One chapter examines palliative care as a new pathway towards death:
Chapter 5: "Lethal Dosing: Technique beyond the Law".
This reviewer discusses these methods of choosing death as
increasing pain-medication and terminal sedation.
Pain-killers have become standard in most managed deaths.
And instead of on-and-off pain-relief, the standard practice has become
to provide a continuous stream of drugs to prevent suffering.
The use of sedatives at the end of life
has not been included in the discussion of "euthanasia"
because the primary, direct purpose for using the drugs
has not been to cause the patient to die.
Rather, such palliative care eases the process of dying
without explicitly shortening the time between
the beginning of this medical treatment
and the date of the patient's death.
Hundreds of books debate
'euthanasia' pro and con,
but only a few books acknowledge that many more patients
are meeting death with the help of palliative drugs.
These medical practices at the deathbed
have become standard health-care without any of the public debate
that surrounds the use of gentle poison to bring death.
Originally palliative drugs came into use under the principle of double effect:
Doctors may prescribe pain-relief in reasonable amounts
as long as the purpose of giving the drugs is not to cause death.
Shortening the process of dying is likely to be foreseen but not intended.
A few states have modified their laws to allow such use of drugs.
But even without any change of law,
doctors everywhere in the USA are prescribing palliative drugs,
which often do (as a side effect) shorten the process of dying.
This pathway towards death has not aroused any public or legal debate.
While the right-to-die debate rages on and on
with respect to "euthanasia" and "physician-assisted suicide",
which might apply to 2 deaths in a thousand,
palliative drugs are being provided to 500 patients
of the next 1,000 who are on their deathbeds.
This book would have
achieved its purpose more directly
if the author had avoided the word "euthanasia" entirely.
The subject of this historical research was practices at the deathbed.
Death used to be accepted more openly and compassionately.
But now standardized medical techniques are applied to all deaths
that take place in hospitals, nursing homes, & hospices.
Steven W. Smith
End-of-Life Decisions in Medical Care:
Principles and Policies for Regulating the Dying Process
(Cambridge, UK: Cambridge University
Press: www.cambridge.org, 2012) 350
(ISBN: 978-1-107-00538-9; hardcover)
(Library of Congress call number: R726.S55 2012)
This book reviews the philosophical and
surrounding the process of making life-ending choices for patients
in the United Kingdom and the United States.
The author deals exclusively with those life-ending decisions
that this reviewer calls "voluntary death" and "merciful death".
These reasonable choices at the end of life
are usually initiated by the patient and/or the family.
In contrast, life-ending decisions initiated by doctors are hardly mentioned.
The book is based on
written materials published previously
rather than any original research into how particular patients have actually met death.
The latest developments
in law and practice are included.
But no original or creative insights appear.
Readers deeply interested in right-to-die issues
will be the main readers of this book.
An Internet search of
the title will disclose the specific contents.
(New York: Putnam, 1975)
The best book on
the right-to-die: comprehensive, with good examples,
well-documented, readable, insightful, forthright, well-argued.
Deals with: merciful death (for adults and defective infants),
refusing treatment, voluntary death, definitions of death,
organ transplants, & hospices.
11. Derek Humphry & Mary Clement
Freedom to Die:
People, Politics, and the Right to Die Movement
(New York: St. Martin's
(ISBN: 0-312-19415-3; hardback)
(Library of Congress call number: R726.H844 1998)
No single individual
is more central to the right-to-die movement
than Derek Humphry, who founded the Hemlock Society in 1980
and who has written several book on the subject.
(In 2003 the Hemlock Society renamed itself End-of-Life Choices.
And in 2004 it merged with Compassion in Dying,
taking the new name Compassion & Choices.)
This book is a summary of the history
of the right-to-die movement up to 1998.
The right-to-die emerged in response to modern medical technology,
which can keep bodies 'alive' longer than ever before imagined.
Humphry and Clement summarize the most famous right-to-die cases:
Quinlan, Cruzan, Kevorkian, Quill.
They summarize the then-current policies in the Netherlands,
which allow a physician to assist a patient to die
when specified safeguards are fulfilled.
are given to the efforts to win the right-to-die
on the West coast of the United States: California, Washington, Oregon.
These states have referendum laws,
allowing the people to create laws directly by a popular vote
—when the elected lawmakers are too timid to enact a particular law.
One drawback of this means of changing the laws
is that the debates tend to be reduced to 30-second television ads.
Oregon was the first state to allow physicians to aid a voluntary death
—by prescribing lethal drugs after careful safeguards were fulfilled.
(The complete text of the Oregon law is included as an appendix.
The Oregon law with annual reports is also available on the Internet:
The U.S. Supreme Court
found no right-to-die in the Constitution,
but the justices left the door open for states to write new laws.
Humphry and Clement even include a chapter on
the high cost of medical care at the end of life,
—an argument for the right-to-die that is open to easy attack by opponents,
who will suggest that some people will be put to death to save money.
Voluntarily-created 'living wills' or Advance Directives for Medical Care
can accomplish the same goal, but few people have written them.
And sometimes doctors do not know about 'living wills' or ignore them.
This book is an excellent
place to begin reading
about the right-to-die movement.
It is based on Derek Humphry's personal experiences and all published sources.
(New York: iUniverse:
www.iuniverse.com, 2006) 180 pages
(ISBN-10: 0-595-38144-8; paperback)
(ISBN-13: 978-0-595-38144-9; paperback)
Library of Congress call number: not given in book)
Samuel Greenberg, MD
Euthanasia and Assisted Suicide:
(Springfield, IL: Charles
C. Thomas, 1997) 164 pages
(ISBN: 0-398-06785-6; hardcover)
(Library of Congress call number: R726.G74 1997)
is an open-minded book on the right-to-die
written by a psychiatrist.
He does not break any new ground.
And he does not prejudge any of the difficult cases he discusses.
following summary of the contents shows the wide-range of this book:
Ch. 1 a good summary of the issues and the sides taken.
Ch. 2 a good summary of the high-profile cases of the previous 20 years.
Ch. 3 experiences in other countries: Netherlands, Great Britain, Germany.
Ch. 4 learning from the practices of veterinarians.
Ch. 5 physicians' attitudes are divided,
but moving in the direction of the right-to-die.
Ch. 6 legal aspects: definitions.
Ch. 7 religion, morals, & bioethics.
Ch. 8 the hospice movement.
Ch. 9 right-to-die societies.
Ch. 10 a case of a severely defective newborn.
Ch. 11 looking toward the future.
Mary Warnock & Elizabeth Macdonald
Is There a Case for Assisted Dying?
Oxford University Press, 2008) 155
(ISBN: 978-0-19-953990-1; hardcover)
(Library of Congress call number: R726.W36 2008)
(Medical call number: WB60W285e 2008)
Two British philosophers discuss the
behind the discussion of allowing physicians to help their patients to die.
especially on right-to-die cases
widely discussed in the media in Great Britain.
they begin with media discussion of the right-to-die,
the main means of choosing a voluntary death they consider
is using lethal drugs prescribed by a doctor.
But what about
patients who want to die because of mental, non-physical problems?
'Clinical depression' is widely assumed to be a major cause of irrational suicide.
Should we allow patients who are not thinking very clearly to choose death?
Or should they be protected from their own irrational urges toward self-destruction?
What should happen if their mental suffering
causes them to lose perspective on the choices that lie before them?
The solution suggested by
is the careful selection of a Medical Care Decisions Committee,
which will be empowered to make medical decisions for the patient
whenever the mental capacity or rationality of the patient is in question.
They will always listen to the immediate 'wishes' of the patient,
but they will not always agree to cooperate.
In other words, the patient selects wise persons
who are known to have the patient's best interests at heart
who will protect the patient from possibly-irrational suicidal decisions.
If and when the patient has good reasons for choosing a voluntary death,
then he or she should be able to convince
the close family members and friends who make up the MCDC
of the wisdom of the patient's chosen pathway towards death.
This approach to the right-to-die puts the emphasis on the individual
The life-ending decisions will be taken by the patient himself or herself,
possibly with the assistance of the people who are closest to the patient.
Whether of not to allow or approve a specific chosen death
is not left to a group of strangers,
who will apply abstract guidelines to life-ending decisions.
illustration of psychological reasons for wanting to die,
the authors discuss the Chabot case in the Netherlands:
A suicidal woman came to a psychiatrist, Dr. Chabot,
and explained her wish to die.
She had previously tried to kill herself, unsuccessfully.
And she wanted professional help to achieve a good death.
All of the members of her family were dead
and she could find no further reason to go on living.
Dr. Chabot felt that he could not prevent her suicide,
so he agreed to help.
The court ruled that he should have asked for the opinions of other physicians.
But no penalty was imposed.
However, the fact that the court could have ruled otherwise
shows some problems with the right-to-die in the Netherlands.
Those who help others to die do not always know
how they will be treated by the law and the courts.
In this case, the
application of additional
would have helped to clarify the options.
Perhaps other solutions beside death would have emerged.
Dr. Chabot now recommends voluntary death by dehydration.
This pathway towards death would have forced the woman
to re-examine her reasons for wanting to die several times
during the process of dying.
And she might have changed her mind.
Friends, previously-distant relatives, and even neighbors
might have helped her to adjust to her new situation of grief.
Many people have eventually found ways to recover from bereavement.
Sometimes just the passage of time
changes the early urge toward irrational suicide.
Dr. Chabot merely determined
that the woman was not clinically depressed.
It was a philosophical suicide:
She had decided to die—with or without his help.
And Dr. Chabot believed that his role was
merely to determine whether she really wanted to die.
Mary Warnoch and
Elizabeth Macdonald also discuss neonates
who are born with serious birth defects.
Sometimes governments have set standards
that go beyond what the parents want.
The authors also
present a chapter on adults who cannot decide for themselves.
Another chapter deals
with the question of the 'sanctity of human life'.
If we allow some wise
deaths to be chosen,
how will we prevent other, premature deaths?
Does the right-to-die create a slippery slope?
Most doctors do not
want to kill their
but they are sometimes open to allowing death to come.
discussed some specific methods of choosing an easeful death:
(1) giving up food and water;
(2) terminal sedation—keeping the patient unconscious until natural death;
Here increasing pain medication without causing coma is also discussed.
(3) lethal drugs prescribed by a doctor;
(4) back-up euthanasia in case other methods are impossible or if they fail.
But, in general, these authors favor only assisted dying, not directly causing death.
In their terms, they say yes to "assisted suicide" and no to "euthanasia".
The authors foresee
changes in laws
to allow doctors to give more direct assistance in dying.
This is a small, useful, supportive book,
which reviews the right-to-die issues as already present in media discussion.
They do not go beyond the depth of educated readers
and they do not break any new ground.
But Easeful Death could be a good place to begin reading about the right-to-die.
This room expanded into two rooms in 2009.
Please suggest additional
books that should be included
in this (two part) bibliography supporting the right-to-die.
Send your suggestions to James Park: e-mail: PARKx032@TC.UMN.EDU
Several reviews from this bibliography
are also included in the reviewer's book:
How to Die: Safeguards for Life-Ending Decisions.
Go to the Right-to-Die Portal.
Go to the Book
to discover 350 other reviews organized into 60 bibliographies.
Return to the DEATH page.
Go to the Medical Ethics index page.
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