Medically Assisted Death [Paperback]

Robert Young (Author)

Book Description

Publication Date: November 26, 2007

Does a competent person suffering from a terminal illness or enduring an otherwise burdensome existence, who considers his life no longer of value but is incapable of ending it, have a right to be helped to die? Should someone for whom further medical treatment would be futile be allowed to die regardless of expressing a preference to be given all possible treatment? These are some of the questions that are asked and answered in this wide-ranging discussion of both the morality of medically assisted death and the justifiability of making certain instances legal. A case is offered in support of the moral and legal permissibility of specified instances of medically assisted death, along with responses to the main objections that have been levelled against it. The philosophical argument is bolstered by empirical evidence from The Netherlands and Oregon where voluntary euthanasia and physician-assisted suicide are already legal.

Editorial Reviews

Review

"...engagingly and clearly written, and contains a number of interesting observations on a range of issues central to the euthanasia debate."
-John Keown, Georgetown University, Notre Dame Philosophical Reviews

"...a carefully and rigorously argued book that is an elegant paradigm of the precise, succinct style of analytical applied ethics...Young's book is an excellent elaboration and critique of arguments on both sides of the issue...Highly recommended"
-R. Werner, Hamilton College, Choice

Book Description

Does a competent person with a terminal illness who considers their life no longer of value, have a right to be helped to die? This book offers a case in support of specified instances of medically assisted death and responses to the main objections to it.

See all Editorial Reviews

Product Details

• Paperback: 260 pages
• Publisher: Cambridge University Press; 1 edition (November 26, 2007)
• Language: English
• ISBN-10: 0521706165
• ISBN-13: 978-0521706162
• Product Dimensions: 9 x 6.4 x 0.6 inches
• Shipping Weight: 15.5 ounces (View shipping rates and policies)
• Average Customer Review: 5.0 out of 5 stars  See all reviews (1 customer review)
• Amazon Best Sellers Rank: #2,180,931 in Books (See Top 100 in Books)
  • #48 in Books > Law > Family & Health Law > Right to Die
  • #51 in Books > Medical Books > Medicine > Euthanasia

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1 of 1 people found the following review helpful:

5.0 out of 5 stars Medically Assisted Death, February 18, 2008

By 

Mr. Ralph Blunden (Australia) - See all my reviews
(REAL NAME)   

This review is from: Medically Assisted Death (Paperback)

Robert Young (2007) Medically Assisted Death, Cambridge University Press, Cambridge, UK.

Ralph Blunden

The author of this book, Dr Robert Young, is a former Reader in philosophy at La Trobe University, Australia.

In this review I will outline the form and content of Dr Young's wonderful book, but I will not be challenging any of his arguments or conclusions since I find myself largely in agreement with them. Yet, a characteristic of the book is that Dr Young draws attention to further literature that discusses issues in opposition to his own preferred position. Even those who disagree with Dr Young's conclusions will find guidance in this book to sources more congenial to their own philosophic leanings. Dr Young has a disquieting ability to both be gentle in the way he deploys arguments and to be uncompromising in the relentlessness of his logic.

Philosophy is notoriously difficult in its professional guise. Medically Assisted Death is unusual in its sensitivity to the reader. Dr Young takes enormous care to at all times inform the reader of what he is doing, why he is deploying certain arguments or discussing certain propositions and consistently throughout the book he summarises what he has done. The topic demands the reader's concentration, but there is nowhere the non-professional philosopher will find a more accessible account of the topic. This is not to say the book is without rigour as it certainly has that. It is to say that Dr Young has reflected on the topic of voluntary medically assisted death for many years and brings his meticulous analytic mind to bear on it in such a way as not only to provide lucidity, but to give the book a certain aesthetic dimension through the use of language that is elegant, succinct and precise. There is not a word out of place in Dr Young's book and none that need to be added.

Medically Assisted Death is, in effect, a connected series of essays on the central issues relevant to the topic of physician-assisted dying. Yet the book is entirely coherent and each chapter or essay forms a necessary part of the case that Dr Young argues. It will be useful here to provide a list the book's chapters:

* Chapter One: Introduction.
* Chapter Two: A case for the legalisation of medically assisted death.
* Chapter Three: Medical futility.
* Chapter Four: Physician-assisted suicide.
* Chapter Five: The sanctity of human life.
* Chapter Six: Killing versus letting die, the doctrine of double effect, and palliative care for the dying.
* Chapter Seven: Professional integrity and voluntary medically assisted death.
* Chapter Eight: Competence and end-of-life decision making.
* Chapter Nine: Advance Directives.
* Chapter Ten: Voluntary medically assisted death and slippery slope arguments.
* Chapter Eleven: Non-voluntary euthanasia.
* Chapter Twelve: Concluding remarks.

There is an extensive list of references and the volume is well indexed.

Given that my own post graduate research concerned professional ethics I was particularly interested in Dr Young's essay chapter `professional integrity and voluntary medically assisted death'. This is a short piece of writing that should be read by all medical personnel and should be prescribed reading in medical and nursing courses. Dr Young, as in many of his chapter-essays, is at pains to begin with a conceptual analysis of the topic, in this case professional integrity. He writes:

Professional integrity differs from each of personal and moral integrity in that its focus is not on the personal, or even on the moral, nature of the values, standards or principles that the professional is committed to, but on the relationship between those values, standards or principles and the fulfilment of a particular professional role. (p. 114)

Dr Young, in this chapter, (Professional Integrity), argues that physician assisted death is not necessarily in conflict with the values and standards that apply to professional medical ethics, but in many cases is entirely consistent with them. He argues this because,

There has been so much social change since, for example, the formulation of the Hippocratic Oath, that medicine has had to re-conceive itself. It now incorporates the relief of suffering as well as healing, and hence should accommodate physician-assisted suicide. (p. 121, `professional integrity')

He gives here an account of the tension between the autonomy and the self-determination (of the patient) and the professional integrity of the doctor and specialists involved. In this chapter (`professional integrity') Dr Young provides an especially nuanced argument. It may be useful if readers mostly concerned with the content of this chapter also to refer to Dr Young's earlier book (1986) Personal Autonomy: Beyond Negative and Positive Liberty, Croom Helm, London. This is acknowledged as one of the best books written on the subject of personal autonomy.

Dr Young writes in the introduction to Medically Assisted Dying that:

My central thesis is that there is a strong case for legalising physician-assisted suicide and voluntary euthanasia but that it is neither justifiable nor necessary to do so for non-voluntary euthanasia. (p. 1)

The first chapter of the book looks at landmark legal cases and their outcomes and the precedents that they set. Chapter two, `A Case for the legislation of voluntary medically assisted death', provides a compelling case for the legislation of voluntary medically assisted death as the most appropriate public policy for today's circumstances. Here Dr Young outlines the sort of restraints and protections that are needed to protect the vulnerable.

The threat to the vulnerable is often appealed to by those who oppose medically assisted death. They argue that once we legalise a restricted form of voluntary euthanasia it will not be long before we advance to bumping off the vulnerable (ageing parents, or the disabled, for example). Dr Young devotes a chapter to refuting this slippery slope argument (and slippery slope arguments in general) as well as addressing the problem of medical futility - where further medical intervention in the sickness of a patient will not be curative, but will only needlessly prolong life for those with no reason to live. Related to this theme he also addresses the concept of a reverence for life, or a claim that human life is sacred. Here the arguments are quite devastatingly in support of his thesis.

There are many potential problems involved in legislation that makes it legal for physicians to assist their patients to die. Dr Young writes in his chapter on physician-assisted suicide:

Among the more important concerns specifically raised about physician-assisted suicide are the following: whether it is appropriate to place potentially lethal doses of barbiturates, opioids, and other medication in the hands of the terminally ill; whether medical practitioners may with propriety agree not to play a supervising role at the time when a patient chooses to take a lethal dose of such drugs; whether physician-assisted suicide is of any use to sufferers from severely disabling conditions like multiple sclerosis or motor neurone disease (who would be unable to suicide in the way envisaged in physician-assisted suicide); whether (as opponents of physician-assisted suicide claim) there are available equally efficacious but less contentious strategies - like the refusal of food and fluids - which would enable competent terminally ill persons to end their lives; whether legalising physician-assisted suicide would pose any serious risks to others, especially those who constitute the more vulnerable members of society; and, whether requests for assistance with dying made in the advance of the onset of incompetence by, for example, victims of Alzheimer's disease, may legitimately by honoured through physician-assisted suicide. (p. 44)

Dr Young considers these problems consecutively and I found his discussion of the supervision of the use of lethal drugs especially pertinent. An important chapter deals with the doctrine of double effect, of the moral differences, if any, between acts and omissions (what we do and what we fail, or choose, to do or not to do). Although this is a good chapter it reworks well trodden ground. Nevertheless, it is a useful addition to the book for the sake of completeness especially given that many people who should read this book will not be familiar with philosophical analysis of acts and omissions.

There is much more to say about this book though I suspect that, given Dr Young's thoroughness, there will be little of consequence advanced against him. This book is an exercise in practical ethics and, in my view it is an exemplary instance of this genre. No one will come away from reading even a chapter of this book without feeling that light has been cast on the topic. In the best traditions of philosophy Dr Young illuminates his subject. He has done a public service in publishing this book which should be influential in developing public policy.

Dr Young concludes his book with the following:

[T]here is nothing in medical morality or the goals of medicine that precludes offering medical assistance with dying to those intolerably burdened patients who competently request it; that the imminence of death does not inevitably undermine competence; that directives made in advance of death have probative value in relation to a patient's end-of-life care; and, that the evidence from the couple of jurisdictions where voluntary medically assisted death has been legalised gives cause for confidence that its legalisation... Read more ›