20. David Lamb

Therapy Abatement, Autonomy and Futility:
Ethical Decisions at the Edge of Life

(Aldershot: Avebury, 1995)       146 pages
(ISBN: 1-85972-202-4; hardcover)
(LC call number: not given in book)
(Medical call number: WB310L218t 1995)

    David Lamb is a professor of philosophy in the United Kingdom.
He has read all of the relevant literature and created a good summary.
This book is an opportunity to visit or re-visit
all of the major issues concerning decision-making at the end of life:
advance directives; right-to-die; do-not-resuscitate orders;
futile medical care; food and water; health-care costs;
patient autonomy; & deciding for others.

21. Derek Humphry 

Lawful Exit:
The Limits of Freedom for Help in Dying

(Junction City, OR: Norris Lane Press, 1993)       166 pages
(Library of Congress call number: R726.H847 1993)

    Derek Humphry—champion of the right-to-die—
explores several legal details in the process of winning the right-to-die.  
Many provisions have been proposed for various right-to-die laws. 
Some are more workable than others.
Some deal with very unlikely possibilities.
Humphry presents his own Model Death-with-Dignity Act
as an appendix to this book. 

    History has moved on in the years since this book was published.
But some of the same issues are still discussed.
And reading this book could provide a background
for the debate about the right-to-die
that will continue in the 21st century. 

    Here are some of the legal issues discussed: 

1. How shall we define and use our technical terms?
2. How can we make tacit 'decisions' more open and honest?
3. Should doctors be involved in the process of ending life? 
4. When doctors are involved, should they be especially qualified
        in the disease or other condition of the patient? 
5. How can be make sure that a second professional opinion
        is really independent?
6. Must patients choosing death be competent?
7. Must patients choosing death be terminal?
8. How should we decide for infants and children?
9. Must patients choosing death have a physical illness
        or could mental suffering ever by a sufficient reason? 
10. Should a psychological evaluation of the patient be required? 
11. Should a medical trial of pain-control be required?
12. Should we have special protections for disabled people?
13. What documentation of voluntary deaths
        or merciful deaths should be required?
14. Should voluntary deaths and merciful deaths
        be certified by judges?
15. Residency requirements:
        Should only local people be granted the right-to-die?
16. How can we avoid the right-to-die becoming the duty-to-die? 
17. Should we prohibit or regulate 'suicide clinics'?
18. How should we protect health-care personnel
        from criminal, civil, & administrative sanctions
        if they follow the guidelines?
19. How should we handle people with Alzheimer's disease? 
20. Should there be special safeguards for nursing-home residents?
21. What sense does it make to report the fulfilling of safeguards
        after the death has already occurred?
22. Should the laws be changed by a direct vote of the people?
23. Are legislators usually too timid to vote for the right-to-die?
24. What about patients who wish to choose death
        who lack the physical capacity to kill themselves? 
25. How long should the patient have to wait
        between a request for death and when relief is finally granted?
26. How do we prevent coerced death?  
27. What kind of documentation or witnesses should be required
        to certify a request for death?
28. Must all family members be notified of a request for death? 

    One chapter in Lawful Exit
reviews the efforts in three states to change the law:
Washington, California, & Oregon.
Much of the opposition focused around lack of safeguards.

    This book offers a good opportunity to review and re-consider
many of the details of any proposed laws concerning the right-to-die.

22. Timothy E. Quill, MD & Margaret P. Battin, PhD., editors

Physician-Assisted Suicide:
The Case for Palliative Care and Patient Choice

(Baltimore, MD: Johns Hopkins University Press: www.press.jhu.edu, 2004)       342 pages
(ISBN: 0-8018-8069-9; hardcover)
(ISBN: 0-8018-8070-X; paperback)
(Library of Congress call number: R726.P485 2004)
(Medical call number: W50P5781 2004)

    This book is a collection of articles written by various people
in support of the right-to-die generally
and more specifically in support of
life-ending drugs prescribed by a physician
as a means of voluntarily ending one's life under careful safeguards.
The Oregon Death with Dignity Act is the background model
for so-called "physician-assisted suicide".

    Doctors should not abandon their patients as they near death.
Each patient needs special caring,
even when such services cannot be billed as medical care.
Patient autonomy should be respected.

    The authors from the Netherlands defend their practice
of assisting dying under their current safeguards.
And they offer telling criticisms of the critics
who claim wide-spread abuse within the Dutch system.
These chapters include first-person accounts of doctors' feelings
as they help their patients to end their lives.

    In the opinion of this reviewer,
the Dutch system spends too much time and energy
reviewing cases of voluntary death
after the death has already been achieved.
If abuses and mistakes are to be avoided,
such reviews should take place before death.

    Some chapters address political strategy
for changing laws to permit the right-to-die.
Advocates of the right-to-die should take the opposition into account.
How they are likely to manipulate legislators and the public
as they attempt to prevent any changes in the laws of the various states?

    From this reviewer's perspective,
this book seems to have been put together
in a hurry by people who are very busy with other things.
The usual authors were asked to contribute.
And they form a united front in favor of life-ending chemicals
as the only means of voluntary death.
We might even say that these authors
are the establishment of the right-to-die movement.
They did not consider the impact of their code words
on readers from the general public
who do not deal with right-to-die issues every day.
The outstanding example of this oversight is embodied in the title
and several of the articles: "physician-assisted suicide".
We are not really recommending
that people commit irrational suicide with the help of a doctor.
Was the expression "physician-assisted suicide"
invented by the opposition?

    (Instead of "suicide", we should say "voluntary death".
The present reviewer has created an on-line essay on this theme:
Will this Death be an "Irrational Suicide" or a "Voluntary Death"? .)

    The authors of the articles collected here
represent various professional perspectives
rather than the thoughts and feelings of people facing their own deaths.
But it is nevertheless useful to know what doctors and lawyers
think about the process of choosing wise pathways towards death.
No authors share their own plans for achieving an ideal death.

    In general this is a good book, 
but unfortunately it does not break any new ground.  
Nevertheless this book will stand as a broad-based representation
of the state of right-to-die thinking at the beginning of the 21st century.
What will such books say 50 or 100 years from now?

23. Loretta M. Kopelman & Kenneth A. DeVille, editors

Physician-Assisted Suicide:
What Are the Issues?

(Dordrecht, Netherlands: Kluwer Academic Publishers, 2001)       235 pages
(ISBN: 0-7923-7142-9; hardcover)
(Medical call number: W50P578 2001)

    Collected papers from a conference in March 1998. 
The doctors and professors invited to speak were already well-known
for their views on the question of physician participation
in the decision to bring life to an end.  
Most favor allowing physicians to assist a voluntary death.

    The issues are explored deeply
as they were understood at the end of the 20th century.
But no new ground was broken by these contributors.

24. Lisa Yount, editor 

Euthanasia

(San Diego, CA: Greenhaven Press, 2002)       174 pages
(ISBN: 0-7377-0828-X; paperback)
(Library of Congress call number: R726.E782 2002)

     This is a collection of short articles from a wide variety of view-points,
dealing with many end-of-life issues:
right-to-die, euthanasia, physician-assisted suicide, personhood,
public opinion, medical ethics, doctors' role, Oregon and Netherlands,
terminal illness as a safeguard, religious perspectives,
& active and passive help in dying.

    One major benefit of this book is that it collects in one short volume
articles that would take many hours to locate in their original sources.
And the editor has selected only the best articles.
They are short and to the point.
These are not offered as extremes on any issue—pro & con.
But they do offer very different perspectives on the same issues.  

    The only extreme views seem to be the right-wing religious views
—authors who fear that terrible things will happen
if euthanasia is even considered.
Somehow at least the most rational of these fears should be addressed.

    I found this a good collection, but no article breaks new ground.
I wonder when and how new thinking will enter the debate. 

25. Lisa Yount

Physician-Assisted Suicide and Euthanasia

(New York: Facts On File: www.factsonfile.com, 2000)
(ISBN: 0-8160-4021-4; hardcover)
(Library of Congress call number: R726.Y673 2000)

    This is a reference book focusing on
the most important court cases related to the right-to-die.
Chronology of important events; 
glossary of terms used in the debate;
important persons;
annotated bibliography;
listing of organizations.

    This book is a research tool rather than opening new ideas.
But it could be a good place to begin reading
about the past efforts to win the right-to-die.

26. Sue Woodman

Last Rights:
The Struggle over the Right to Die

(New York: Plenum, 1998)       293 pages
(ISBN: 0-306-45995-7; hardcover)
(Library of Congress call number: R726.W655 1998)

    Sue Woodman is a journalist,
who has read deeply in the history of the right-to-die movement.
She summarizes the well-known cases that attracted media attention.
And she illustrates the need for the right-to-die
in the lives of several people who were forced to live too long.  

    When this book was written, Dr. Jack Kevorkian
was the most famous person in the right-to-die movement.
Serious doubts were raised about some of the deaths he assisted.

    Should physicians help their patients to die?  
Doctors come down on both sides of this question.

    Disabled people usually reject any talk of the right-to-die
because they fear that they will be forced into death
because able-bodied people think their lives are not worth living.

    Opponents of the right-to-die can cite many cases
in which people died before their time.
Mistakes and abuses can and do occur in the name of 'the right-to-die'.

    The Roman Catholic Church is one of the best-organized
and best-funded opponents of the right-to-die.  
And yet, even Roman Catholic morality allows withdrawing life-supports.

    This book is mostly of historical interest now.
There have been several important developments since the middle 1990s.
But Sue Woodman tells us the stories and introduces some of the people
from the early years of the right-to-die movement.

27. Ian Dowbiggin

A Merciful End:
The Euthanasia Movement in Modern America

(New York: Oxford University Press: www.oup.com, 2003)       250 pages
(ISBN: 0-19-515443-6; hardcover)
(Library of Congress call number: R726.D69 2002)

    The author is an historian who has read deeply in the documents
of the right-to-die movement, mainly in 20th century America.
He reviews the most important organizations and personalities,
including these best-known characters:
Joseph Fletcher, Derek Humphry, Robert Ingersoll, Jack Kevorkian,
Donald McKinney, Ralph Mero, Hugh Moore, Charles Francis Potter,
Timothy Quill, Sidney Rosoff, Olive Ruth Russell, & Ruth Proskauer Smith.

(New York: Human Sciences Press, 1975) 

     The author makes no new arguments
but masterfully summarizes the arguments advanced thru the years.
A good historical survey of the right-to-die movement up to 1975.

32. A.B. Downing, editor 

Euthanasia and the Right to Die

(London: Peter Owen, 1969)
(Los Angeles: Nast, 1970)
(New York: Humanities Press, 1971)

     A very well-written collection of essays
on merciful death and voluntary death as debated in England.
Summarizes in a small volume all the major issues.
A Basic source.

33. Louis Shattuck Baer, MD

Let the Patient Decide:
A Doctor's Advice to Older Patients

(Philadelphia: Westminster Press, 1978)

     An excellent short book illustrating the many hazards
and complications created by ordinary medical science.
Dr. Baer, a family doctor in his 60s when he wrote this book,
explains his own decision to refuse resuscitation and
life-prolonging drugs if he has been brain-damaged or becomes senile.
He presents the documents he has executed to prevent
the routine 'life-saving' treatments he does not want.

34. Jo Roman 

Exit House:
Suicide as an Alternative

(New York: Seaview Press, 1980)

     One woman, suffering from terminal cancer,
explains her reasons and plans for a "rational suicide".
This very personal book encourages readers to think deeply
about what they would do in similar circumstances.
A very forthright and outspoken book by someone who actually
carried out her careful practical and interpersonal plans
to die at the right time and by the best means.

35.  Doris Portwood 

Common Sense Suicide:
The Final Right

(New York: Dodd, Mead & Co., 1978)

     This is a courageous argument favoring voluntary death for the elderly.
A peaceful, orderly death is much preferred
over the common distasteful death in hospital or nursing home.
Mrs. Portwood's photograph suggests
that she was over 70 when she published this book.
And she has probably at least tried to die according to her plan by now.
We can only hope that she found a peaceful and meaningful end
—and was not prevented by well-meaning 'helpers'.

36. Ernan McMullen, editor 

Death and Decision

(Boulder, CO: Westview Press, 1978)

     A symposium sponsored by
the American Association for the Advancement of Science.
The two best contributions:

    (1) "Definitions of Death" by H. Tristram Engelhardt, Jr.
He argues for the death of the person
rather than the death of the biological organism
or the death of the whole brain
(which is now almost universally accepted as a definition of death).
Human death should be defined by neo-cortical or cerebral death
because once the higher parts of our brains are dead,
we will never functions as persons again.

    (2) "What is the Function of Medicine?" by Eric J. Cassell argues
that medicine should work to preserve
the autonomy and independence of patients
—not merely to preserve their biological lives.
Sometimes allowing patients to refuse treatment
and hence shorten the process of dying
helps them to preserve their dignity as human persons.

    The other 6 contributors deal with
familiar themes in the right-to-die debate.

37. Jonathan D. Moreno, PhD, editor 

Arguing Euthanasia:
The Controversy over Mercy Killing,
Assisted Suicide, and the "Right to Die"

(New York: Simon & Schuster, 1995)       251 pages

     A collection of 19 articles by well-known authors such as Timothy Quill,
Nat Hentoff, Betty Rollin, Ronald Dworkin, Sidney Hook, Daniel Callahan,
H. Tristram Engelhardt, Jr., Margaret Pabst Battin, Dan Brock, & Leon Kass.
Both sides of the debate are well represented.
And this format—presenting complete articles—
gives more space to each thinker than other 'both-sides' collections,
which usually give each author only 2 or 3 pages.
This book could be a good introduction to the issues,
but it does not break any new ground.

38. Robert L. Risley 

Death with Dignity:
A New Law Permitting Physician Aid-in-Dying

(Eugene, OR: Hemlock Society, 1989)    109 pages

     A presentation and explanation of a law
to allow physicians to assist a voluntary death.
Basically the law calls for the patient
to make a written request for death.
After the doctor has made sure that it is a valid request
and that all the other options have been considered,
the doctor may assist the patient in dying.

     The basic safeguard of this law is the doctor's participation,
following the patients fully-informed, repeated request.
The doctor may grant a merciful death
to someone who has previously requested death
—while fully capable of making medical decisions.
Only doctors may assist with a voluntary death.
Anyone else who helps, commits a crime—and should be punished.

     This book lists all the objections to such a law
—and gives good replies:

     1. Doctors will use this new right to cover their mistakes.
They can already do this by withdrawing treatments and life-supports.

     2. Doctors will murder their patients
under the guise of "physician aid-in-dying".
Doctors who kill without proper requests will be guilty of murder.
And proper safeguards will make this kind of murder easy to detect.

     3. Mistakes in diagnosis will lead to premature death.
A second, independent medical opinion is required.
Both doctors must certify in writing that the patient is terminal.

     4. The right to die would become the duty to die.
The physician is there to counter-balance any undue influence
from greedy relatives who want to inherit sooner rather than later.

     5. Physician-aid-in-dying would harm the doctor-patient relationship.
Doctors have the best interests of their patients at heart.
And knowing the full range of help available (including aid-in-dying)
should help some doctor-patient relationships.

     6. Doctors will be feared as "executioners".
The rhetoric is inflammatory.
Real executioners kill only condemned criminals,
who are being punished by society
(following due process with many safeguards)
for capital crimes they have committed.
Usually such criminals do not want to die.
And they are not terminally ill.

     7. Better pain control will eliminate the wish to die.
Not all pain can be controlled.
And sometimes the pain-medication so depresses consciousness
that such a life becomes meaningless to all concerned.

     8. Holland.

     9. Oath of Hipocrates prohibits physician aid-in-dying.
It has been changed before (eg abortion, surgery for kidney stones).
And it can be changed again if there are good reasons.

     10. Physician-aid-in-dying would kill the useless and elderly.
The safeguards proposed would never permit this.
And if some mistakes occur, the safeguards should be improved.

     11. The Nazis used physicians to kill "useless eaters".
Good safeguards would prevent any such abuses.

     This book is an excellent example of a good-faith attempt
to write a law permitting physician-aid-in-dying.
Everyone else who is trying to change the law
to permit the right-to-die should read this book.
This approach was finally accepted by Oregon.
And it has operated for many years without problems.

39. James Rachels 

The End of Life: Euthanasia and Morality

(Oxford, UK: Oxford University Press, 1986)       204 pages
(ISBN: 0-19-217746-X; hardcover)
(ISBN: 0-19-286070-4; paperback)
(Library of Congress call number: R726.R32 1986)

    See related bibliographies:

Books on the Right-to-Die

Books Opposing the Right-to-Die