Final exit. The end of argument

The November defeat of Initiative 119 in Washington state promises only a pause in the public efforts to legalize physician-assisted suicide and active euthanasia. The news reports, while analyzing the eight-point margin by which voters rejected the measure, noted that a hefty 46 percent did approve, and that efforts are already underway to try again in California and Oregon. [1] Meanwhile, measures have been introduced in Canada and a number of European countries. [2] Assisted suicide and euthanasia are "hot"--high on the agenda of a public seemingly poised for action. Derek Humphry's publication of Final Exit, [3] billed as a suicide manual for the terminally ill, has played no small part in fueling the current swirl of activity. Concern about whether physicians should assist suicide or deliberately kill their patients is ancient. But the recent reawakening of public attention has been marked by the Journal of the American Medical Association's "It's Over, Debbie," Dr. Timothy Quill's piece in the New England Journal of Medicine, Dr. Jack Kevorkian's dispatch of Janet Adkins and more recently two others in Michigan, and now Final Exit. [4] This last holds a special place in the roster. The others are individual cases (though some have claimed "Debbie" to be fictional)--traditional catalysts to analysis and discussion. However, outrageous one might find the actions of these physicians, each seems to have intended to spur debate. Final Exit is something else altogether, though few have noticed the discontinuity. Commentators have been content to accept the book's self-description on its jacket--that it provides guidance for the "mature adult who is suffering from a terminal illness and is considering . . . rational suicide." The book's persistence at the top of the New York Times best-sellers list for nonfiction has thus been seen as further proof of widespread fear of suffering, anxiety about loss of control near death, and discontent with the way physicians handle terminal illness. And so it is. Those are the obvious lessons of Final Exit. But there are other lessons, less obvious and equally important. For Final Exit inaugurates a new stage in the debate--the end. At least that is evidently how Humphry would have it. The book rejects the very idea of considered argument. Instead, it urges doctors and nurses to begin assisting suicide and performing euthanasia now, without engaging in discussion, seeking consensus, or awaiting changes in law. The book meanwhile encourage patients to commit suicide, with misstatements making the alternatives seem exceedingly difficult. Wherever you stand in the debate, this book is thus profoundly disturbing. It is nearly certain to close minds, to lead caregivers to irresponsible acts, and to contribute to unwarranted deaths. It is hard to imagine a question more significant than whether certain citizens, particularly physicians, should be permitted at their discretion to kill others. Yet this ultimate question is here reduced to propaganda and diatribe. There are profound lessons in Final Exit, especially for those in bioethics. Against Argument, for Suicide Final Exit barely discusses the weighty question of whether physician-assisted suicide and active euthanasia should be legalized in America. Instead, it basically assumes the current state of affairs, with physician-assisted suicide and active euthanasia condemned by law and by the ethical pronouncements of the organized medical profession. Final Exit offers no real argument to change that. The New York Times Book Review is simply wrong in its squib--this is not "the case for suicide." [5] There is no "case" offered here at all. Final Exit is in fact profoundly dismissive of argument. Its message, to quote a popular advertisement, is in effect, "Just do it." To that end, it discusses method in considerable detail: how to rig the hose to your car exhaust, how to tie the plastic bag around your neck, the pros and cons of swallowing household cleansers. …