Physician-Assisted Dying: The Case for Palliative Care and Patient Choice

by Timothy E. Quill MD (Editor), Margaret P. Battin PhD (Editor)

Overview

Despite a growing consensus that effective palliative care should be a core element in the treatment of all terminally ill patients, challenging questions remain about the physician's role in helping suffering patients end their lives. Physician-assisted dying remains one of the most controversial issues facing doctors, lawmakers, and patients today, and the need for intelligent and informed opinion on both sides of the debate is greater than ever.

In this volume, a distinguished group of physicians, ethicists, lawyers, and activists come together to present the case for the legalization of physician-assisted dying, for terminally ill patients who voluntarily request it. To counter the arguments and assumptions of those opposed to legalization of assisted suicide, the contributors examine ethical arguments concerning self-determination and the relief of suffering; analyze empirical data from Oregon and the Netherlands; describe their personal experiences as physicians, family members, and patients; assess the legal and ethical responsibilities of the physician; and discuss the role of pain, depression, faith, and dignity in this decision. Together, the essays in this volume present strong arguments for the ethical acceptance and legal recognition of the practice of physician-assisted dying as a last resort—not as an alternative to excellent palliative care but as an important possibility for patients who seek it.

Contributors: Marcia Angell, Anthony L. Back, Charles H. Baron, Andrew I. Batavia, Tom L. Beauchamp, Els Borst-Eilers, Dan W. Brock, Christine K. Cassel, Eric J. Cassel, Barbara Coombs-Lee, Linda Ganzini, Peter Goodwin, Martin Gunderson, Gerrit K. Kimsma, Sylvia A. Law, David Mayo, Alan Meisel, Robert A. Pearlman, Thomas Preston, John Shelby Spong, Helene Starks, Eli D. Stutsman, Kathryn L. Tucker, Johannes J. M. Van Delden, Herman H. van der Kloot Meijburg, Evert van Leeuwen, Jaap J. F. Visser

Product Details

ISBN-13:	9780801880704
Publisher:	Johns Hopkins University Press
Publication date:	10/13/2004
Pages:	320
Product dimensions:	6.00(w) x 9.00(h) x 0.83(d)
Age Range:	18 Years

About the Author

Timothy E. Quill, M.D., is a professor of medicine, psychiatry, and medical humanities at the University of Rochester and author of A Midwife through the Dying Process, also available from Johns Hopkins.

Margaret P. Battin, Ph.D., is Distinguished Professor of Philosophy and an adjunct professor of medical ethics at the University of Utah. She is the author of The Least Worst Death.

Table of Contents

Acknowledgements
List of Contributors
Introduction. False Dichotomy versus Genuine Choice: The Argument over Physician-Assisted Dying
Part I: Perspectives on Mercy, Nonabandonment, Autonomy, and Choice
Chapter 1. The Quality of Mercy
Chapter 2. Nonabandonment: A Central Obligation for Physicians
Chapter 3. The Role of Autonomy in Choosing Physician Aid in Dying
Chapter 4. Disability and Physician-Assisted Dying
Chapter 5. When Suffering Patients Seek Death
Part II: Clinical, Philosophical, and Religious Issues about the Ending of Life
Chapter 6. Why Do People Seek Physician-Assisted Death?
Chapter 7. Doctor-Patient Communication about Physician-Assisted Suicide
Chapter 8. When Hastened Death Is Neither Killing Nor Letting Die
Chapter 9. Physician-Assisted Suicide as a Last-Resort Option at the End of Life
Chapter 10. Death: A Friend to Be Welcomed, Not an Enemy to Be Defeated
Part III: Open Practice in a Legally Tolerant Environment
Chapter 11. The Oregon Experience
Chapter 12. The Distortion of Cases in Oregon
Chapter 13. A Model That Integrates Assisted Dying with Excellent End-of-Life Care
Chapter 14. Thirty Years' Experience with Euthanasia in the Netherlands: Focusing on the Patient as a Person
Chapter 15. The Death of My Father
Chapter 16. Assisted Death in the Netherlands: Physicians at the Bedside When Help Is Requested
Part IV: Political and Legal Ferment
Chapter 17. Political Strategy and Legal Change
Chapter 18. Legal Advocacy to Improve Care and Expand Options at the End of Life
Chapter 19. Physician-Assisted Suicide: Shifting the Focus from Means to Ends
Chapter 20. Choice in Dying: A Political and Constitutional Context
Chapter 21. Hastening Death: The Seven Deadly Sins of the Status Quo
Conclusion. Excellent Palliative Care as the Standard, Physician-Assisted Dying as a Last Resort
Index

What People are Saying About This

Laurence H. Tribe

Although presented as a series of separate essays written by the most knowledgeable medical and legal experts dealing with end-of-life issues, Physician-Assisted Dying: The Case for Palliative Care and Patient Choice is in truth a perfectly realized whole—one that will reward any careful reader with a rich, detailed, and historically grounded understanding of how we have at times come to grips with, but more often tried to evade, the moral, legal, and ultimately political dilemmas that are posed by one overwhelming question: How can we better assure the ethical and compassionate treatment of those who are approaching the end of their days, and of those closest to them, in ways that fully respect the needs, values, and choices of the individuals most intimately involved?

Ruth Macklin

This book is a must-read for everyone interested in the rights and welfare of patients at the end of life. The editors have put together a star-studded cast of knowledgeable and experienced contributors. The introductory and concluding essays by Quill and Battin make a compelling, principled case for a legally regulated practice of physician-assisted dying.

From the Publisher

This book is likely to be the definitive argument for physician-assisted dying. Cogent, thoughtful, and never strident, it is of interest to a broad audience, including physicians, neurologists, oncologists, bioethicists, philosophers, social essayists, patients, and the general public. As a text, it could be used in courses in medical schools, theological schools, and departments of philosophy and sociology.
—Daniel D. Federman, M.D., Senior Dean for Clinical Teaching and Walter Distinguished Professor of Medicine and Medical Education, Harvard Medical School

This book is a must-read for everyone interested in the rights and welfare of patients at the end of life. The editors have put together a star-studded cast of knowledgeable and experienced contributors. The introductory and concluding essays by Quill and Battin make a compelling, principled case for a legally regulated practice of physician-assisted dying.
—Ruth Macklin, Ph.D., Albert Einstein College of Medicine

Although presented as a series of separate essays written by the most knowledgeable medical and legal experts dealing with end-of-life issues, Physician-Assisted Dying: The Case for Palliative Care and Patient Choice is in truth a perfectly realized whole—one that will reward any careful reader with a rich, detailed, and historically grounded understanding of how we have at times come to grips with, but more often tried to evade, the moral, legal, and ultimately political dilemmas that are posed by one overwhelming question: How can we better assure the ethical and compassionate treatment of those who are approaching the end of their days, and of those closest to them, in ways that fully respect the needs, values, and choices of the individuals most intimately involved?
—Laurence H. Tribe, Harvard University

Daniel D. Federman

This book is likely to be the definitive argument for physician-assisted dying. Cogent, thoughtful, and never strident, it is of interest to a broad audience, including physicians, neurologists, oncologists, bioethicists, philosophers, social essayists, patients, and the general public. As a text, it could be used in courses in medical schools, theological schools, and departments of philosophy and sociology.

Editorial Reviews

Reviewer: Ryan B Spellecy, PhD (Medical College of Wisconsin Health Policy Institute)
Description: This is a much needed counterpart to a previous book, The Case Against Assisted Suicide: For the Right to End-of-Life Care, Foley, K. and Hendin, H. (Johns Hopkins University Press, 2002). The authors and perspectives contained in this book address the legal, political, philosophical, clinical, religious, and personal elements needed for a robust discussion of physician-assisted dying.
Purpose: The editors of this book, spurred by the publication of the The Case Against Assisted Suicide , wanted to counter what they argue are misconceptions and misunderstandings in the literature opposing physician assistance in dying that lead to a false dichotomy between palliative care and hospice or physician-assisted dying at the end of life. To counter this false dichotomy, the editors sought to assemble the best arguments in favor of choice at the end of life, and they have done just that.
Audience: The editors are simply the leading authorities in favor of the legalization and regulation of physician-assisted suicide as a means to choice in dying. By assembling a wide range of contributors, this book will find a welcome audience in clinicians, bioethicists, philosophers, students, policy makers, lawyers, and the like who seek a careful, honest exploration of choice at the end of life.
Features: This is a very complete discussion in favor of choice at the end of life. The centrality of autonomy in the contest of the physician/patient relationship as a relationship between two people that must include mercy and non-abandonment is discussed. There is also a rich, informed understanding of why patients seek assistance in dying, a rigorous analysis of key philosophical concepts in the debate, and a discussion of data from both Oregon and the Netherlands of the practice of physician-assisted suicide.
Assessment: This is an excellent addition to the debate surrounding physician-assisted suicide and choice at the end of life. Reading this book along with The Case Against Assisted Suicide would provide a thorough grounding in this issue.

Doody's Review Service

A very persuasive brief, combining empirical data, logical argumentation, and appeals to compassion.
—JAMA

An excellent addition to the debate surrounding physician-assisted suicide and choice at the end of life. Reading this book along with The Case Against Assisted Suicide (Johns Hopkins University Press, 2002) would provide a thorough grounding in this issue.
—Doody's Book Review Service

Readers who are interested in a balanced counterpoint highlighting the best arguments of advocates and opponents of the legalization of assisted suicide should read both Physician-Assisted Dying and Foley and Hendin's book.
—New England Journal of Medicine

This excellent book presents arguments supporting acceptance of physician-assisted death as an option for terminally ill patients who are suffering from extreme pain unrelieved by narcotics and whose only wish is to die.
—Choice

The collection is the indispensable starting place for anyone wishing to become better informed about the present arguments over physician-assisted dying (especially in the United States), and it belongs in every high school, university, and medical library in the country.
—Humanist in Canada

This is an excellent book for medical students, hospice personnel, and others involved in end-of-life care.
—American Journal of Hospice and Palliative Medicine

An important contribution to the debate as to whether the choice of assisted death should be granted to those who seek it.
—Bulletin of Medical Ethics

Provides a comprehensive account of the issue and will be of interest to professionals and patients at large.
—Antonio Casado da Rocha, Metapsychology

From the Publisher

"This excellent book presents arguments supporting acceptance of physician-assisted death as an option for terminally ill patients who are suffering from extreme pain unrelieved by narcotics and whose only wish is to die."

Choice

Provides a comprehensive account of the issue and will be of interest to professionals and patients at large.

— Antonio Casado da Rocha

Metapsychology

"Provides a comprehensive account of the issue and will be of interest to professionals and patients at large."

Metapsychology - Antonio Casado da Rocha

"An important contribution to the debate as to whether the choice of assisted death should be granted to those who seek it."

Bulletin of Medical Ethics

"This is an excellent book for medical students, hospice personnel, and others involved in end-of-life care."

American Journal of Hospice and Palliative Medicine

"The collection is the indispensable starting place for anyone wishing to become better informed about the present arguments over physician-assisted dying (especially in the United States), and it belongs in every high school, university, and medical library in the country."

Humanist in Canada

"Readers who are interested in a balanced counterpoint highlighting the best arguments of advocates and opponents of the legalization of assisted suicide should read both Physician-Assisted Dying and Foley and Hendin's book."

New England Journal of Medicine

"A very persuasive brief, combining empirical data, logical argumentation, and appeals to compassion."

JAMA

5 Stars! from Doody