In the Arms of Others: A Cultural History of the Right-To-Die in America [Paperback]

Peter G. Filene (Author)

Book Description

ISBN-10: 1566632684 | ISBN-13: 978-1566632683 | Publication Date: August 20, 1999 | Edition: 1

When, if ever, is life no longer worth living? When, if ever, is it right to withdraw life-support or hasten death? These questions—which confront physicians, bioethicists, social workers, the children of aging parents, and sooner or later almost everyone—now receive increasingly urgent attention in American society. Peter Filene’s In the Arms of Others is the first book to set this dilemma into broad historical and cultural context. It is, in other words, a history of the “right to die” as viewed in the United States. With the narrative skills he has displayed in his fiction, Mr. Filene takes the reader into the lives and feelings of people who have struggled with the predicament of modern dying. Beginning with the nineteenth-century background and the rise of medical technology, he moves quickly to the landmark case of Karen Ann Quinlan, who became in the 1970s the macabre protagonist of a melodrama that crystallized the nation's consciousness and produced a legal benchmark. Mr. Filene explores the maze of bioethical arguments surrounding this and succeeding cases, and guides readers through complex questions with remarkable lucidity. Ultimately, he argues, we must acknowledge that traditional American self-determination is not sufficient to resolve terrible questions of life and death; what we need is an ethic of relatedness.

Editorial Reviews

Amazon.com Review

"As we think about how we hope to die," writes Peter Filene, "we need to take into account the perspectives of history and culture. They will help us understand the ambiguities that await us and the choices we want to make or to have made for us, so that each of us can give his or her life the kind of ending it deserves."

Filene begins by introducing his reader to the 19th-century tradition of the "good death" (the literal translation of the word "euthanasia"). At a time when disease was usually incurable, he explains, a gentle death, often involving drugs in "as large a dose as needed for a peaceful passing," was the best an ill person could hope for. Using the Karen Ann Quinlan case as a benchmark, the author then sifts through the late-20th-century issues around dying, drawing in the reader with stories of people who have themselves faced modern dying's dilemmas.

"Modern medicine," says the author, "produced modern dying"; no longer always a single event, but a "prolonged process," requiring deliberation and decision-making for doctors, families, judges, and the dying themselves. Faced with this process, the author and his subjects ask: "How can we die with dignity?" This intelligent, compassionate, finely written book is Filene's contribution towards an answer. --Maria Dolan --This text refers to an out of print or unavailable edition of this title.

From The New England Journal of Medicine

Commenting on the narrow defeat of referendums to legalize physician-assisted suicide in Washington and California in the early 1990s, Peter Filene writes, "Fifteen years earlier -- no more than a minute or two of cultural-historical time -- Americans had been hesitant to legalize living wills. Now 46 percent voted to legalize not simply passive euthanasia but active euthanasia by doctors." In the Arms of Others is a terrifically well written narrative of how we got from there to here. ("Here," of course, now includes Oregon's statute on physician-assisted suicide, which has already been invoked in the suicides of several Oregonians.) Filene structures his narrative around the major court cases that have defined Americans' expanding legal right to refuse or terminate life-sustaining medical treatments, with the most detailed attention paid to the case of Karen Ann Quinlan. But In the Arms of Others is far more (and far more readable) than a recitation and analysis of medical facts and court opinions. Filene has a gift for bringing legal and ethical arguments vividly to life. He situates the Quinlan case, as well as the cases of Joseph Saikewicz, Infant Doe and Baby Jane Doe, Claire Conroy, and Nancy Cruzan, in their richly detailed, psychologically nuanced human contexts. And he places these family dramas in the still broader context of the political and cultural wars that swept over the United States in the 1970s and 1980s and that continue today.

Filene emphasizes in particular how the "right to die" became entwined with the abortion debate and how both issues "translated [patients' and families' private choices] into the ideologies of warring social movements. The dilemma of dying became political, absorbing the passions and anxieties of modern America." Though he does not make this point explicitly, his account is a cautionary tale for bioethicists and palliative care advocates (including me) who aspire -- in the words of the mission statement of the Project on Death in America -- "to transform the culture of dying" in the United States. It would be naive, Filene warns, to assume that this task is simply a matter of convincing ethical arguments, evocative personal narratives, or savvy public relations. Each of these elements has an important role, as In the Arms of Others illustrates. Yet Filene also demonstrates that they are all played out in a highly contested cultural terrain, making the process of transformation complicated and unpredictable.

Certain trends do seem clear, however. For one thing, it is unlikely, according to Filene's history, that American society will hold the line much longer against widespread acceptance of physician-assisted suicide. In Filene's words, which continue the passage I quoted in my introduction, "Attitudes [toward suicide and euthanasia] were shifting with astounding speed; informal or extralegal behavior was moving almost as fast; sooner or later, legislation would surely catch up." Oregonians have proved Filene right, though legalization came in the form of a referendum. Filene is ambivalent about this trend and, partly as a consequence, leaves the reader in something of a muddle. On the one hand, he enters the ethical debate on the side of those who deny a critical moral difference between passive and active euthanasia, or between withholding or withdrawing life-sustaining treatment and intentionally hastening death with a lethal injection. On the other hand, he worries that legalized physician-assisted suicide in the United States would not "function" as it does in the Netherlands (according to the benign interpretation) and could conceivably lead to the manipulation and coercion of vulnerable people, as "the direst opponents" of legalization fear. But if there is no substantial difference between what is now legal and what (except in Oregon) is not, why does Filene worry about manipulation and coercion only in the latter case? I think he should worry more about physician-assisted suicide than about withholding or withdrawing treatment and that they are morally different, but that is an argument for another occasion.

Finally, Filene makes a convincing case that Americans will continue to struggle over decisions at the end of life because our legal and ethical approach to the subject has been dominated by a preoccupation with autonomy and self-determination. In contrast, most people die from chronic, incurable diseases, and under these circumstances, decisions at the end of life require an emphasis on dependency and interrelatedness. To Filene it is ironic, but inevitable, that the "rights" propounded in the landmark cases involving Quinlan, Conroy, and Cruzan were justified on the basis of privacy and self-determination but had to be exercised on the patients' behalf by others on whom they had become utterly dependent. This, Filene reminds us, is the nature of frailty, decline, and death -- and perhaps the hardest thing of all to assimilate in American culture in the late 20th century.

Reviewed by David Barnard, Ph.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to an out of print or unavailable edition of this title.

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Product Details

• Paperback: 302 pages
• Publisher: Ivan R Dee; 1 edition (August 20, 1999)
• Language: English
• ISBN-10: 1566632684
• ISBN-13: 978-1566632683
• Product Dimensions: 8.8 x 5.8 x 0.9 inches
• Shipping Weight: 15.2 ounces (View shipping rates and policies)
• Average Customer Review: 5.0 out of 5 stars  See all reviews (2 customer reviews)
• Amazon Best Sellers Rank: #527,079 in Books (See Top 100 in Books)
  • #7 in Books > Medical Books > Medicine > Euthanasia
  • #9 in Books > Law > Family & Health Law > Right to Die

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Customer Reviews

Most Helpful Customer Reviews

2 of 2 people found the following review helpful:

5.0 out of 5 stars A moving, engrossing treatment of a subject that affects all, October 21, 1998

By A Customer

This review is from: In the Arms of Others: A Cultural History of the Right-to-Die in America (Hardcover)

A history of the right-to-die in America, Filene has achieved a remarkable balance of the specific and the general, the personal and the objective. His analysis of the interaction between the American focus on the individual and the basic human need to relate to others is fascinating. A book that deals with an experience which we all share and yet must all go through alone, I was brought to tears several times.

1 of 1 people found the following review helpful:

5.0 out of 5 stars Helps readers with hard decisions about a dying loved one., June 17, 1998

By A Customer

This review is from: In the Arms of Others: A Cultural History of the Right-to-Die in America (Hardcover)

In The Arms of Others is an extremely moving story of people, including the Quinlan family, who have faced agonizing decisions about whether to continue to maintain life support for a comatose loved one. The book gives a clear picture of the laws and medical practices that families deal with...and will provide readers information to help them make up their own minds. The story is gripping as a novel. I found it profoundly stirring, even though I don't have such a life-and-death decision before me now.