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Product details

File Size: 29462 KB

Print Length: 180 pages

Publisher: OUP Oxford; 1 edition (March 6, 2008)

Publication Date: March 6, 2008

Sold by: Amazon Digital Services LLC

Language: English

ASIN: B003N2P43U

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Mary Warnock & Elizabeth MacdonaldEaseful Death:Is There a Case for Assisted Dying?(Oxford, UK: Oxford University Press, 2008) 155 pages(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 philosophical principlesbehind the discussion of allowing physicians to help their patients to die. They draw especially on right-to-die caseswidely discussed in the media in Great Britain. Perhaps because they begin with media discussion of the right-to-die,the main means of choosing a voluntary death they consideris 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 sufferingcauses them to lose perspective on the choices that lie before them? The solution suggested by this revieweris the careful selection of a Medical Care Decisions Committee,which will be empowered to make medical decisions for the patientwhenever 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 personswho are known to have the patient's best interests at heartwho 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 convincethe close family members and friends who make up the MCDCof the wisdom of the patient's chosen pathway towards death. This approach to the right-to-die puts the emphasis on the individual patient.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 chosen deathis not left to a group of strangers,who will apply abstract guidelines to life-ending decisions. As an 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 deadand she could find no futher 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 otherwiseshows some problems with the right-to-die in the Netherlands.Those who help others to die do not always knowhow they will be treated by the law and the courts. In this case, the application of additional safeguardswould 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 womanto re-examine her reasons for wanting to die several timesduring the process of dying.And she might have changed her mind.Friends, previously-distant relatives, and even neighborsmight 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 timechanges 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 wasmerely to determine whether she really wanted to die. Mary Warnoch and Elizabeth Macdonald also discuss neonateswho are born with serious birth defects.Sometimes governments have set standardsthat 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 patients,but they are sometimes open to allowing death to come. Another chapter 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 lawsto 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 readersand they do not break any new ground.But Easeful Death could be a good place to begin reading about the right-to-die.To discover other books on improving dying, search the Internet for:"Books on the Right-to-Die".James Leonard Park, advocate of the right-to-die with careful safeguards.

This is a careful discussion of ideas that are often hard to write about. Ideas that it is time to consider. The author's exploration is comprehensive, well annotated, and the language clear.I have two comments to add.While I agree that the strident objections from part of the disability community about helping death along are from the edges, I want also to acknowledge how often people with disabilities are not given full preventive medical care, how often aches and lumps are dismissed as secondary to the presenting disability, and how that leads to a concern that any social acceptance of hastening death will also mean less good interventions for people with disabilities who do not think of themselves as dying, less attempts to keep babies alive who have been born with disabilities, as were many of the objecting advocates.Depression is also a disability, and excluding it out of hand as a motivation for wanting to die, which the authors do without exploration (p 121), assuming that it can be `fixed', is to discount the pain of living with depression, to ignore the other effects of medications and the sometimes lack of efficacy, to dismiss the autonomy of some who know there hard life has been lived enough. The hopelessness and lack of dignity of ongoing depression is no less severe than other conditions, and assuming this can be fixed, is for some, as fantastic as assuming one can recover from pvs.

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