Palliative Care Book of the Month and another Review
Palliative Care Book of the Month
END OF LIFE CHOICES
Consensus and Controversy
Fiona Randall and R. S. Downie
Oxford University Press, 2009
220 pp
published on euthanasia and physician-assisted suicide.
The first part of the book is about choices and argues that the best interests of patient are promoted by means of the traditional aims of medicine: to prolong life, to alleviate suffering, and to restore or maintain function, but they draw a clear distinction between patient choice and what might happen if patients are simply regarded as consumers with end-of-life services run on consumerist lines. In their no nonsense way, they state that to understand decision-making in end-of-life care requires us to distinguish between intended and foreseen consequences, between acts and omissions, and between killing and letting die. And the arguments of Mary Warnock and others are chopped up despatched.
Part two of the book is about issues in end-of-life care that are controversial. Is advanced care planning, as we know it today, the right way to go? Does it promote unrealistic patient expectations, does it cause avoidable emotional distress? They asked whether we should be asking a different question regarding the preferred place of care and death. The chapter on physician-assisted suicide and euthanasia debunks the arguments that some morally acceptable practices are equivalent to euthanasia and confronts the ‘dignity’ and ‘right to die’ arguments head-on. The ‘human rights’ issue casts a shadow, but one can argue that it has been taken too far in many fields besides end-of-life care.
A substantial appendix on ethical theories and terms is available on-line.
The material in this book is well-presented and articulate. If you are going to delve into these matters only once this year, this should be the book.
Other Reviews
ASSISTED DEATH IN EUROPE AND AMERICA
Four Regimes and Their GLessons
Gunter Lewy
Oxford University Press, 2011
250 pp
ISBN 978-0-19-974641-5
RRP £26.00, $US49.95
This review is written by an octogenarian emeritus professor of political science who states ‘I have arrived at a stage in my life when the issue of dignified and compassionate end-of-life care is of more than theoretical interest.’ The focus is on how the systems are working rather than the pros and cons of euthanasia and physician-assisted suicide.
Lewy seems satisfied with everything in the Netherlands. He doesn’t confront the issue of intent. When the Dutch were challenged about whether intent mattered, they stopped reporting it. He mentions euthanasia without request or consent, but seems to gloss over it. Reading the journals, it would seem that the recent reduction in euthanasia in the Netherlands has been balanced by an increase in ‘terminal sedation’, and in the majority of cases it was the doctors’ intention to hasten death. The difference is that terminal sedation is not subject to the same stringent reporting criteria that apply to euthanasia. In short, it’s pretty much all tulips in the Netherlands.
I was startled by the statement that ‘among European physicians, Dutch doctors are now considered the best trained in [palliative care]’. I thought a few people from across the Channel might have something to say about that.
Lewy’s view of euthanasia in Belgium is up-beat, with few criticisms. What happens in Switzerland is anybody’s business, with Exit and Dignitas coming into conflict with government recommendations. The discussion of physician-assisted suicide in Oregon touches on some of the problems, but does not provide any arguments to counter the criticisms leveled by Kathleen Foley, Herbert Hendin, John Keown and others. I am afraid his last chapter, ‘Assisted Death as a Last Resort’ did not hold much water.
I don’t doubt Lewy’s scholarship or sincerity for one moment, but I found the conclusions he reached were curious. I am uncertain whether this relates to non-medical eyes or to the focus being on the regimes rather than the practices. I would recommend this book to anyone involved in the euthanasia debate as an example of how an intelligent but non-medical person can interpret the data that is out there.
NO GOOD DEED
A Story of Medicine, Murder Accusations, and the Debate over How We Die
Lewis Cohen
Harper Collins, 2010
255 pp
ISBN 978-0-06-1172176-2
RRP $US25.99, £16.05
Here is a story about the terminally ill and nursing staff accused of murder. Written by a psychiatrist, it delves into many of the issues involved in end-of-life care. Described as a ‘compelling page-turner’, it was a touch over-dramatic for me, but perhaps that is just what is needed to get people out there thinking and openly discussing issues related to end-of-life care.
Roger Woodruff
August 2011
Below please find some of the previously reviewed books on assisted suicide and euthanasia that were published in this Newsletter.
EUTHANASIA, ETHICS AND PUBLIC POLICY.
An Argument Against Legalisation . Keown (2002) Review
PHYSICIAN-ASSISTED DYING. The case for palliative care and patient choice .
Quill & Battin (2004) Review
TO DIE WELL. Your right to comfort, calm, and choice in the last days of life.
Wanzer & Glenmullen (2007) Review
EASEFUL DEATH. Is There A Case For Assisted Dying?
Warnock and Macdonald (2008) Review
Dr. Roger Woodruff is a Lifetime member of the IAHPC Board and past Chair. He lives in Heidelberg, Victoria, Australia and his biography may be found at
http://www.hospicecare.com/Bio/r_woodruff.htm
View over 100+ IAHPC hospice & palliative care book reviews
www.hospicecare.com/bookshop/hospice-palliative-care-book-reviews
Note for authors: If you wish to have your book reviewed, please send to:
Dr Roger Woodruff
IAHPC Bookshop Editor
210 Burgundy St, Suite 9
Heidelberg, Victoria 3084
AUSTRALIA
Note: Review copies become property of IAHPC and are not returned to the author. Only palliative care related books which are previously approved will be reviewed. Due to the large number of requests, we can't provide exact dates of when books will be reviewed.
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