Medicine And Multimedia

Regulating How We Die: The Ethical, Medical and Legal Issues Surrounding Physician-Assisted Suicide

BMJ 1998; 317 doi: (Published 17 October 1998) Cite this as: BMJ 1998;317:1088
  1. Ariel Rosita King, doctoral student
  1. Department of Public Health and Policy, London School of Hygiene and Tropical Medicine

    Ed Linda L Emanuel

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    Harvard University Press, 11$.95, pp 315

    ISBN 0 674 66654 2

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    All physicians are confronted with dying, which is difficult emotionally when dealing with patients and their relatives, and professionally when the question of “helping” a patient to die is raised. Associations that come to mind are compassion, alleviation of pain, autonomy, dying with dignity, and withdrawing treatment—but, above all else, “Do no harm.” These terms conjure up intense emotions, opinions, expectations, and, for some, memories. As the book notes, “Physician-assisted suicide and euthanasia may appear to be a hot new topic. But the questions have been debated since before Hippocrates. Some arguments change, but mostly they do not. And yet questions are urgent, and answers must be rendered anew for society's current context.”

    Regulating How We Die is divided into three parts: considerations for, considerations against, and empirical, historical, and legal perspectives. The book “aims to clarify and balance the arguments concerning physician-assisted suicide and euthanasia and to direct attentionto the root issues that motivate calls for their use in our own time.” The list of the 10 contributors is a Who's Whofor bioethics and health law, and they cover the breadth of ethical, moral, and legal issues that surround physician assisted suicide and euthanasia. Of special interest are chapters on “Facing assisted suicide and euthanasia in children and adolescents” and “Religious viewpoints.” Although the legislative focus is on the Netherlands and United States, other countries, like Britain, are fully considered.

    Medical and nursing staff, patients, and families are at some time confronted with death. Physicians guide us throughout our lives in living with the best possible health. When death is near, the role of the physician as helper is still expected by some, even if it means the ending of pain,suffering, humiliation, fear, and life. “What bothers the physicians is the claim that patients have a right—a right against' the physician—for performance of an obligation to help patients kill themselves. Actual clinical situations in the real world are often not simple, and the relevance of ideas such as self determination and mercy are far from clear. Even among physicians who recognise a moral obligation to assist dying patients with suicide, putting that policy into practice in actual situations is often problematic.”

    This is a big step from legalising euthanasia. Widely accepted is the view that “legalising euthanasia would degrade physicians to the position of executioners.”

    Regulating How We Die is a valuable source of balanced information for those who are faced with these questions. Written with grace and clarity, the book comprehensively explores the arguments for and against—cross cultural, religious, moral, and ethical aspects are considered. It will “help to guide those who must make very difficult decisions, whether at a level of public policy, in the personal practice, or among their own family members.” As a reference and resource, it will be valuable and relevant for a long time to come.

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