Assisted Death: A Study in Ethics and Law

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Ethical and legal issues concerning physician-assisted suicide and euthanasia are very much on the public agenda in many jurisdictions. In this timely book L.W. Sumner addresses these issues within the wider context of palliative care for patients in the dying process. His ethical conclusion is that a bright line between assisted death and other widely accepted end-of-life practices, including the withdrawal of life-sustaining treatment, pain control through high-dose opioids, and terminal sedation, cannot be justified. In the course of the ethical argument many familiar themes are given careful and thorough treatment: conceptions of death, the badness of death, the wrongness of killing, informed consent and refusal, the ethics of suicide, cause of death, the double effect, the sanctity of life, the "active/passive" distinction, advance directives, and nonvoluntary euthanasia. The legal discussion opens with a survey of some prominent prohibitionist and regulatory regimes and then outlines a model regulatory policy for assisted death. Sumner concludes by defending this policy against a wide range of common objections, including those which appeal to slippery slopes or the possibility of abuse, and by asking how the transition to a regulatory regime might be managed in three common law prohibitionist jurisdictions.

Assisted Death: A Study in Ethics and Law Review

L. W. Sumner

Assisted Death:
A Study in Ethics and Law

(New York: Oxford Unitersity Press, 2011) 236 pages
(ISBN: 978-0-19-960798-3; hardcover)
(Library of Congress call number: K5178.S86 2011)
(Medical call number: WB33.1S955a 2011)

A careful philosophical exploration of end-of-life medical choices,
which are intended or forseen to shorten the process of dying:
1. 'euthansia' and 'physician-assisted suicide';
2. using pain-killers with the knowledge that vital functions will probably be suppressed;
3. terminal sedation--keeping the patient continuously unconscious until death;
4. terminal dehydration--giving up all food and water, however provided.

Specific chapters discuss these important themes:
(2) patient consent and/or refusal of medical treatments.
(3) using pain-relieving drugs with the purpose of reducing suffering
and/or the intention of bringing death;
(4) evaluating and responding to patient requests for death;
(5) deciding death for others.

Part II deals with the attempts to control end-of-life choices
using various laws and regulations.

Almost all laws dealing with life-ending decisions
focus just on two high-profile methods of choosing death:
(1) 'euthanasia'--the doctor gives a lethal injection;
(2) 'physician-assisted suicide'--the doctor prescribes a gentle poison.
But even in jurisdictions where both of these life-ending options
have been available for many years,
less than 2% of all deaths are achieved by these methods.

Many more deaths are achieved by other methods,
which have the same result--death--but have not been controversial:
(1) ending all curative treatment and life-support systems;
(2) increasing pain-killing drugs to relief suffering
with the knowledge that the process of dying will also be shortened;
(3) choosing terminal sedation
--keeping the patient continuously unconscious until natural death; &
(4) giving up all food and water
--which will result in death by dehydration within a few days.

Because these four additional methods of choosing death
have not been thoroly discussed or studied,
we do not have precise data about how often they occur.
Also, these additional methods of dying are often combined.
In fact, it would be possible to use all four at once.

Even in locations where the controversial methods are banned,
doctors are already recommending these methods of choosing death
when the patient faces the last few days in the hospital.
When we ourselves are on our death-beds,
we already do have these possible methods of dying.

This book supports the right-to-die
and proposes some common-sense methods of preventing abuses and mistakes.
It should be read by careful students of choices at the end of life.

James Leonard Park, advocate of the right-to-die with careful safeguards
and author of How to Die: Safeguards for Life-Ending Decisions

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