The Case against Assisted Suicide: For the Right to End-of-Life Care [Paperback]

Kathleen M. Foley (Editor), Herbert Hendin (Editor)

Book Description

Publication Date: March 25, 2004

In The Case against Assisted Suicide: For the Right to End-of-Life Care, Dr. Kathleen Foley and Dr. Herbert Hendin uncover why pleas for patient autonomy and compassion, often used in favor of legalizing euthanasia, do not advance or protect the rights of terminally ill patients. Incisive essays by authorities in the fields of medicine, law, and bioethics draw on studies done in the Netherlands, Oregon, and Australia by the editors and contributors that show the dangers that legalization of assisted suicide would pose to the most vulnerable patients. Thoughtful and persuasive, this book urges the medical profession to improve palliative care and develop a more humane response to the complex issues facing those who are terminally ill.

Editorial Reviews

From The New England Journal of Medicine

Few medical issues arouse such strongly passionate opinions among health care professionals and laypersons alike as the debate about physician-assisted suicide. This valuable and intentionally provocative book will add much light -- and undoubtedly some heat -- to the debate. Foley and Hendin have assembled contributions from leading experts in diverse disciplines, all for the explicit purpose of making the "case against assisted suicide." The editors are well qualified in their own right. Foley, a neurologist, is an attending physician on the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center, and Hendin, a psychiatrist, is medical director of the American Foundation for Suicide Prevention. The writing is of uniformly high quality, and the book achieves stylistic consistency while still reflecting an individual voice in each chapter. In addition, the clustering of chapters into sections, the appropriate use of cross-referencing among chapters, and introductory and concluding statements by the editors result in a well-organized, cohesive statement -- a rarity for a multiauthored book. In brief, this book's carefully reasoned and carefully written arguments flow as follows. The first section considers the ethical and legal arguments against assisted suicide. A major focus is the fundamental ethical argument used by proponents of assisted suicide -- namely, respect for the principles of compassion and patient autonomy. Among the best in the book, these chapters posit that proper application of the principles of compassion and autonomy, within the context of the medical as well as legal professions, actually argues against assisted suicide. One point made repeatedly is the "slippery slope" argument. The application of compassion and autonomy as demanded by proponents of assisted suicide must inevitably lead to the sanction of assisted suicide, not merely for the terminally ill but also for patients with chronic suffering from any cause, life-threatening or not. This section then segues to an examination of legalized assisted suicide in Oregon and of legalized assisted suicide or euthanasia in the Netherlands and (briefly) in the Northern Territory of Australia. The conclusions are that legalization does indeed result in physician-caused deaths beyond the narrow confines of purported safeguards and that, together with social and financial pressures, it actually limits the development or availability of proper palliative care for the dying. Parts of this section depend on reinterpretation of the published data, an approach that leads to different conclusions from those made by the original authors. The reinterpretations are well presented, but some readers will differ and pose counterarguments. Much of this section also depends on vignettes involving particular patients or particular clinicians' practices. These stories are well told and are highly disturbing in precisely the manner intended. With any such vignettes, one wonders about information that is left out or shaped by the bias of the storyteller. Of course, concern about distortion is also paramount in interpreting the vignettes presented elsewhere by proponents of assisted suicide. The next section offers several "reasons to be concerned" that condoning assisted suicide will adversely affect vulnerable populations. One chapter focuses on the rights of the disabled, noting how the public debate is (too often invisibly) influenced by society's prejudices against them. Another provides a thoughtful review of the role of depression and the will to live. There is also a chapter that usefully summarizes and rebuts key arguments made by proponents of assisted suicide. The final section introduces "a better way" -- that is, hospice and palliative care. The editors conclude with their opinion that assisted suicide and euthanasia must be opposed, noting that the central objective must be to "stimulate the medical community . . . into accepting the challenge to provide better care at the end of life." Some detractors will criticize this work for not being what it is not. It is not a detailed explication of the principles and practice of palliative care. It does not present wholly new arguments against assisted suicide but, rather, collects these perspectives in well-organized and well-articulated form. It is not a scientific treatise on the shades of our uncertainty; rather, it only obliquely critiques the still scant empirical data on which to base discussions and implies, rather than sets, a research agenda to address the huge gaps in the literature. In addition, it is certainly not a balanced discussion among those with divergent views but, rather, a highly charged polemic. Do we need such a polemic, however comprehensive and clear? I recall a recent case conference for medical students. The patient was an elderly nursing home resident who had been debilitated by strokes and other conditions. She had become acutely suicidal, a state of mind indisputably caused by the recurrence of severe depression. As with previous episodes of depression, she responded well to treatment and subsequently returned to a pleasurable life at the nursing home. I was dismayed to see many of the students' reactions to this case. Surely, they said, we should have respected this patient's "autonomy" and shown her "compassion" by allowing her to die as she initially (though no longer) wished, rather than treat her depression. Here was an instance of the "expendable elder" dynamic -- one that I believe was strongly affected by the distorted public debate about assisted suicide. I purposely reveal my own biases here, since each reader's views will exert a dominant influence over his or her responses to this book. Having said that, I believe that this book is sorely needed. Many will argue against its details, but it will be of tremendous interest to a wide audience both within and outside of medicine. Jeffrey M. Lyness, M.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to the Hardcover edition.

Review

The writing is of uniformly high quality, and the book achieves stylistic consistency while still reflecting an individual voice in each chapter. The book is sorely needed.

(Jeffrey M. Lyness New England Journal of Medicine 2004)

The methods of palliative care, or comfort care, have in the past few decades reached a level of effectiveness such that suffering thought at first to be intractable can almost always be relieved. And this is the ultimate message of this vastly important book that now makes its timely appearance.

(Sherwin B. Nuland, M.D. New Republic 2003)

A major contribution to our understanding of the practice, theory, and limitations of assisted suicide and euthanasia in seriously ill patients. The book is superbly written and intellectually challenging. I am convinced that it will become standard reading for all—whether advocates or opponents of assisted suicide—who want to think more deeply and learn more about what we need to do to improve end-of-life care.

(The Lancet 2005)

The book is timely and important in the life and death debate that is of personal relevance to us all.

(Review of Disability Studies 2006)

This excellent book will be a valuable resource for anybody interested in the delivery of better end-of-life care, whether they are clinicians, ethicists, or health care policymakerrs.

(International Association for Hospice and Palliative Care )

Foley, Hendin, and their contributors have produced a truly outstanding resource.

(Cambridge Law Journal )

Brings together some well known and respected players in the debate, whose contributions lend considerable weight to the case... A thought-provoking and comprehensive look at the case against assisted suicide.

(Bulletin of Medical Ethics )

Provides a comprehensive, persuasively argued case against assisted suicide.

(Tony O'Brien Metapsychology )

See all Editorial Reviews

Product Details

• Paperback: 384 pages
• Publisher: The Johns Hopkins University Press; 1 edition (March 25, 2004)
• Language: English
• ISBN-10: 0801879019
• ISBN-13: 978-0801879012
• Product Dimensions: 9.1 x 6.1 x 1 inches
• Shipping Weight: 1.2 pounds (View shipping rates and policies)
• Average Customer Review: 4.0 out of 5 stars  See all reviews (2 customer reviews)
• Amazon Best Sellers Rank: #1,564,227 in Books (See Top 100 in Books)
  • #37 in Books > Medical Books > Medicine > Euthanasia

Customer Reviews

Most Helpful Customer Reviews

3 of 3 people found the following review helpful:

5.0 out of 5 stars Cogent and Authoritative, May 31, 2004

By 

Gerald J. Nora - See all my reviews
(REAL NAME)   

This review is from: The Case against Assisted Suicide: For the Right to End-of-Life Care (Hardcover)

Editors Kathleen Foley and Herbert Hendin note in their preface to The Case Against Assisted Suicide that much of the dialogue on physician-assisted suicide (PAS) involved one side invoking religious principles against assisted suicide, while the other proponents of PAS invoked feelings compassion and talk about autonomy. This book is a welcome change to that deadlock by investigating in non-sectarian language the very problematic nature of physician-assisted suicide. Even better, the primary contributions are from physicians in end-of-life care or disability advocates and hospice workers, giving the reader an intimate view of the realities of end-of-life care.

The book is divided into four sections:

The first section has an impressive line-up. Bioethicist Dan Callahan's essay on compassion and its limits undercuts some of the strongest arguments that PAS proponents make. He is joined by Yale Kamisar's legal critique of PAS, and also an essay on the patient-doctor relationship by Leon Kass, the head of the Presidential Committee of Bioethics.

The second section is the most disturbing as it examines the reality of physician assisted suicide in Oregon, the Netherlands, and during a period of time in the Northwest Territory of Australia. Every essay is written by one or two physicians who practice medicine in the country or state affected by assisted suicide. Running as a theme through all these accounts is the silence surrounding suicides, the squelching of meaningful discussion of suicide alternatives, and the lack of any real oversight.

Upon reading the second section, a PAS proponent may retort, "oh fine, the Dutch and the Oregonians have messed it up, so we'll just improve it in the future." The third part of the book, however, has several articles that show that the problems in Oregon and elsewhere are symptomatic of inherent vulnerabilities in the disabled population. Diane Coleman, a disabled lawyer and founder of the disability organization Not Dead Yet, has a particularly good piece on the struggles of the disabled in America to obtain proper care and the threats posed to them by institutionalized suicide.

The fourth section has a brief history on the first modern hospice in London, and how its mission has involved, often from the experiences of their first patients. The last piece is by editor Kathleen Foley, who summarizes some of the current American initiatives on improving end of life care, and also how both physicians' and the public's views on death and its psychology have evolved, and where they need to improve.

The Case Against Assisted Suicide is a well-organized volume that brings together a very complicated issue and develops a powerful argument for how we need to practice medicine and care for some of society's most vulnerable members.

0 of 1 people found the following review helpful:

3.0 out of 5 stars RAISING DOUBTS ABOUT THE RIGHT-TO-DIE, September 12, 2010

By 

James L. Park "James Leonard Park" (Minneapolis, MN USA) - See all my reviews
(REAL NAME)   

This review is from: The Case against Assisted Suicide: For the Right to End-of-Life Care (Paperback)

Kathleen Foley, MD & Herbert Hendin, MD, editors
The Case Against Assisted Suicide:
For the Right to End-of-Life Care

(Baltimore, MD: Johns Hopkins UP: [....], 2002) 371 pages
(ISBN: 0-8018-7901-9; paperback)
(Library of Congress call number: R726.C355 2002)
(Medical call number: W32.5AA1C337)

This is a collection of articles and essays by several different authors,
all pointing out problems with the right-to-die
such as the physician aid-in-dying now available in Oregon and Washington.
Johns Hopkins University Press also published a similar collection
that took the opposite point of view:
Physician-Assisted Suicide:
The Case for Palliative Care and Patient Choice
edited by Timothy E. Quill, MD & Margaret P. Battin, PhD.
This book is reviewed in the companion bibliography:
"Best Books on the Right-to-Die".
Search the Internet for that exact expression.

This review is actually a review of some chapters from the book.
Only the most insightful and original chapters are reviewed.

~~~~~~~~

Chapter 1: "I Will Give No Deadly Drug":
Why Doctors Must Not Kill
by Leon R. Kass, MD, PhD.

People who are old and sick can sometimes be persuaded
that death is the best option for them.
It relieves them of any further suffering.
And their families are also relieved
of the further stress of their disease and dying.
Kass wonders whether we have gone too far
in the direction of patient autonomy.
Just because a patient 'wants to die'
does not mean that death is the best choice.

The answer to this worry is to make sure
that more people than just the doctor and the patient
are involved in every life-ending decision.
If several open-minded and thoughtful persons
are involved in examining all of the options,
then the best decision is more likely to emerge.
But society should not go so far as
to prohibit all voluntary deaths and all merciful deaths
because of the worry that some chosen deaths
might be coerced and/or manipulated.
We need wise ways to separate the harmful deaths from the helpful deaths.
Here are more than 30 safeguards,
many of which call for the opinions of other persons.

Kass points out that the doctors already have overwhelming power
and authority in making medical decisions.
Often the doctor has a strong recommendation,
based on past experience with similar cases.
And many patients simply follow the recommendations of their doctors,
even if they do not fully understand
their medical problems and the options available.
Thus if the doctors could legally recommend
a voluntary death or a merciful death,
how many patients and families would resist
and ask for a second medical opinion?
How many suffering patients and/or their proxies
can really make independent choices at the end of life?

One way to counter-balance this great power of doctors
is to make sure that other knowledgeable persons
are involved in the decision-making process.
When only one doctor and one patient are involved,
and if the doctor can recommend death as the best option,
how many dying patients will have the courage to resist?
We should not automatically assume
that doctors are always acting in the best interests of their patients.
Sometimes they make recommendations that would be simpler for themselves.
Sometimes they want to get rid of difficult patients.
And rarely doctors do commit murder under the guise of medical care.
But the correct way to restrain this overwhelming power of doctors
is not to prohibit any discussion of the option of death
but to make sure that other wise persons are also involved
in the process of making thoughtful medical decisions,
which should also include the option of a voluntary death or a merciful death
if the patient cannot be cured.

Leon Kass argues against allowing anyone to choose a voluntary death
because of the spill-over effect this would have on less obvious cases.
In other words, once voluntary death and/or merciful death
become available, legal options for every patient to choose,
then some people who should not be helped to die
will be encouraged to commit irrational suicide
because they know about others
who have chosen a voluntary death or a merciful death.
Kass thinks that even the obvious cases involving a wise choice of death
should be prohibited because some less-wise cases will follow.
If we allow the voluntary choice of death by the patient and/or the proxies,
how much longer will it be before involuntary choices of death
are imposed on patients and families
who have little power to resist medical authority?

This reviewer is not convinced.
By the use of careful and comprehensive safeguards,
we can say "yes" to wise and compassionate choices of death
and we can say "no" to foolish and ill-considered choices of death.
We need safeguards to prevent manipulated-death,
not a blanket ban on all forms of chosen death.
Here is a list of possible forms of abuses and mistakes,
linked to the specific safeguards
to avoid those distortions of the right-to-die.

One of the most basic and comprehensive of Kass's objections
to doctors helping people to die
is that this will fundamentally change the doctor-patient relationship.
Even doctors who never participate in life-ending decisions
will have their role tainted by the fact that
some doctors are involved in the process of helping their patients to die.
Especially when patients do not know their doctors very well,
there is a serious worry that their doctors might too easily recommend death.
When patients put their lives into the hands of doctors,
they do not want the additional worry
that their doctors might be considering recommending
voluntary death or merciful death instead of continued medical treatment.

There are valid worries about the proper role of doctors.
Some potential patients already have irrational fears of doctors and hospitals.
And if it became part of the doctor's standard role to recommend death,
then such irrational fears might become worse.
Perhaps the proper response to this worry is to keep regular doctors
far away from any practice of advising about death.
We do not want to confuse patients about what medical care includes.
When the patient has exhausted standard medical care,
and when death is being considered as a valid option,
then specialists who deal only with life-ending decisions could be called in
to help explore the various options at the end of life.
This would allow society to follow the dictum in the title of this chapter:
"Doctors must not kill."
Most doctors would be confined to their healing roles.
They would recommend various options for treating the disease or condition.
Ending all treatments would still be an option
that could be considered by ordinary doctors.
But even the option of discontinuing treatment
needs to be protected from mistakes and abuses.

Kass argues that death can never be a benefit to the patient
because once death has come, there is no person remaining to benefit.

This reviewer would suggest reframing this question another way:
We are not confronted with the question: to die or not to die?
What we face is dying now or dying later.
When is the best time to die?
What are the best circumstances?
Which is the best pathway towards death?
There is no pathway that avoids death.
We must all die one way or another, at one time or another.
When we reframe the question this way,
some of the experiences we might have to undergo
between now and death might better be avoided.
Each of us can ask: What is the ideal way for me to die?

I, for one, do not want to be kept 'alive'
if there is no meaning for my continued life.
Meaningless existence should be shortened in my case.
I wonder if Leon Kass really wants his existence as a former person
extended as long as possible.

(This reviewer has written a book encouraging everyone
to create an Advance Directive for Medical Care:
Your Last Year:
Creating Your Own Advance Directive for Medical Care
Eight Questions in PART III deal with life-ending decisions.
These would be the ideal places for anyone
to express his or her wishes with respect to end-of-life medical care.)

I think Leon Kass began to write this article
with the established principle that doctors must not kill.
Then he proceeded to defend it to the best of his ability.
In my opinion, he has not met the arguments
of those who favor allowing (at lease some) doctors
to have some role in helping their patients to die.
He does not offer a better approach to dying.
He merely says that the doctor should always strive
to keep their patients alive.

~~~~~~~~~~

In Chapter 3 Daniel Callahan also argues against
allowing doctors to recommend death.
Allowing physicians to participate in death
(even when there is obvious benefit to the patient)
will inevitably lead to practices we all regard as evil.
Even if we create... Read more ›