Medicine and books: Physician-assisted suicide
Authors: Johannes Jm van Delden
Journal: BMJ (1998)

Ed Robert F Weir 

Indiana University Press, £24.95, pp 266 

ISBN 0 253 33282 6 

During the first Dutch study into euthanasia and other end-of-life decisions (for the Remmelink committee in 1991), we asked doctors involved in euthanasia cases why they chose euthanasia instead of assisted suicide and vice versa. 

Most respondents had strong opinions about how they complied (if at all) with patients’ requests to end their life. Doctors who performed euthanasia regarded asking patients to take the deadly drugs themselves, as in assisted suicide, as abandoning them at the “moment supreme.” On the other hand, doctors who assisted patients to commit suicide thought that, by having to take the drugs themselves, patients were put to a test—did they really want to die? Interestingly, the choice between assisted suicide and euthanasia was usually made by the doctor. 

Despite these apparent differences, most doctors, ethicists, and lawyers in the Netherlands do not believe that assisted suicide differs morally from euthanasia (understood as voluntary, active euthanasia). In the United States, however, many people seem to believe that doctors should never end their patients’ lives, while assisting suicide may be acceptable under some circumstances. The reason is that physician assisted suicide endows patients with greater levels of control over when and how their lives end. This might explain why the referenda in the states of Washington and California, which sought to decriminalise both euthanasia and physician assisted suicide, failed, whereas the proposal to legalise only physician assisted suicide in Oregon was accepted. 

In his very enriching historical contribution, Harold Vanderpool argues that both euthanasia and physician assisted suicide can be understood as reactions to ideas that were prevalent in the 1950s to ’70s. During this time, prolonging life seemed to take absolute priority over easing suffering. This was accompanied by an unwillingness to talk openly about the process of dying. Since the 1970s medicine has focused progressively on the patient as a person, strongly influenced by the movement for patients’ rights and the rising importance of the ideal of patient autonomy. And this ideal has fuelled the debates about refusing medical treatment and choosing death. 

Accepting physician assisted suicide (or euthanasia for that matter) in an individual case is one thing, to accept it as public policy level is something quite different. While Dan Brock very cautiously defends physician assisted suicide in individual cases, William Winslade proposes changing US law to allow physician assisted suicide. Steven Miles and colleagues argue that proposals to legalise physician assisted suicide can never contain adequate safeguards. 

The only problem with this interesting, well written, and informative book is that it is one of many. Recently, we have seen similar books by Timothy Quill, John Keown, and Margaret Battin to name a few. Any doctor who is interested in the subject (and who is not?) should certainly read some of these books, but won’t need to read many to be exposed to the main issues of this debate.