Euthanasia and the Right to Die: A Comparative View.

Harris, Helen Wilson

Jennifer M. Scherer and Rita J. Simon, Euthanasia and the Right to Die: A Comparative View. Lanham, Maryland: Rowman and Littlefield Publishers, Inc., 1999. 122 pages, $59.00 cloth and $22.95 paper.

This is, simply put, a difficult subject. Do people have the right to decide when to end their lives? If so, under what circumstances and with what safeguards? Jennifer Scherer and Rita Simon address the challenging questions of euthanasia and physician-assisted suicide from multiple historical, cultural and religious perspectives even as they establish their clear pro-euthanasia argument. Euthanasia and the Right to Die is an engaging and detailed book which incorporates survey data, historical data, policy reflection and anecdotal information. The authors' bias in favor of legislation legalizing euthanasia and physician-assisted suicide is obvious throughout the book. However, that does not detract from their fairly balanced treatment of the opposing side.

Scherer and Simon begin their comparative study by examining attitudes toward death and suicide throughout history, noting particular philosophical and religious positions. They report historical discussions of euthanasia, advocacy groups lobbying for legalization of euthanasia, cases of "mercy killing" and physician-assisted suicide, and assumed subsequent legislation introduced through the years. Particular emphasis is given by the authors to the negative impact of Adolph Hitler's mass extermination policies and programs on the pro-euthanasia movement. Scherer and Simon believe that public opinion shifted from pro-euthanasia in an effort to distance from the ethnic and disability cleansing that Hitler called euthanasia, and that negative impact continues in both discussions and legislative forums today.

In the second chapter, the authors identify the fundamental issues in the euthanasia debate, and in the process define and distinguish between the terms suicide, euthanasia (passive, active, involuntary and voluntary), physician-assisted suicide, and mercy killing. There are points in the book, however, when some terms are used interchangeably and in tandem in the apparent effort to make the proponents' argument. Scherer and Simon believe that the proponents' position is grounded in the principles of self-determination and mercy while opponents cite concerns about potential abuse and misuse and religious sanctity-of-life concerns. They acknowledge that these arguments are emotional and controversial and turn their focus to informational treatment of the euthanasia debate in countries across the globe.

In its review of the state of euthanasia legislation around the world, Euthanasia and the Right to Die examines the historical and cultural context, the current laws and enforcement, the status of right to die organizations, the impact of health care systems, and issues of life expectancy in countries in the continents of North America, Europe, Australia, Asia, and South America. The authors frequently cite public opinion polls and surveys which are largely in favor of euthanasia. They do not offer a cogent explanation for the failure to pass and maintain legislation legalizing euthanasia and physician-assisted suicide in most of the world. The Netherlands, Australia, and Colombia are held up as enlightened countries with favorable positions on end of life issues. The decision of the courts in the Netherlands to ignore laws against euthanasia is applauded, and the Australian experience with legalization for a short period of time is touted as the result of fierce independence. Finally, Colombia is identified as the only country in the world that makes euthanasia a legal medical option for consenting terminally ill patients. One of the real values of the book is this examination of the historical context and current state of euthanasia legislation in sixteen countries on five continents.

The informational treatment of the subject gives this book the appearance of objectivity. Scherer and Simon have a good grasp of the opposing points of view and posit several theories around cultural changes and historical events that have prevented the widespread legalization of euthanasia. They argue for example that in privatized health care systems there is financial incentive for keeping people alive as long as possible as terminally ill patients continue to use their health insurance for expensive life prolonging interventions that do little to raise quality of life and may in fact compromise quality of life. They seem critical of the notion that reimbursement drives the euthanasia debate in countries with privatized health care. However, the authors seem to ignore the possibility that managed care in privatized health care systems would in fact benefit from shortened treatment and life expectancy in the terminally ill. Further, in discussing public health care systems in industrialized nations, the authors acknowledge that an increasingly aged population and increases in health care and retirement costs could influence the acceptance of euthanasia. They don't seem bothered in this scenario that reimbursement and money potentially drive the legislation in those circumstances.

One of the most beneficial features of the book is a charting in the last chapter of twenty countries around the world with specific demographic information and listings which include a summary of the type of legal system, type of health care system, the current public opinion, the dominant religion, the type of government, the average life expectancy age, and the status of euthanasia and physician-assisted suicide law. This table provides a powerful overview of the status of euthanasia in a variety of countries with the sociological features identified by the authors as being significant. Euthanasia and the Right to Die concludes with the authors' predictors of right to die attitudes and regulations and their determination of a working social policy. Scherer and Simon acknowledge that current laws are contradictory and ambiguous and recommend that well-balanced law is necessary. They make recommendations that lawmakers prescribe clear guidelines to protect against abuses and in fact list the most frequently made stipulations to laws legalizing euthanasia. Finally, they make the argument that existing hospice and palliative care services are inadequate to the need, are under-utilized and sometimes ineffective. The authors find that current practices of passive euthanasia in palliative care are less humane than the lethal injections available to animals and condemned criminals. It is interesting that they spend an entire book examining historical contexts, surveys, data and law to arrive at a simple, almost anecdotal argument. Even so, I found the book to be interesting, engaging, and a thorough treatment of the subject and will use it as a reference in my courses on death and dying.

Scherer and Simon make their case that advances in medical technology make it possible to extend the dying process, and make it "possible to end life painlessly for those in agony." While books on death and dying and the death awareness movement abound, there are fewer addressing the subject of euthanasia and physician-assisted suicide. This work is compelling as the authors Scherer and Simon provide readers with a quick and concise summary of major arguments and legislation which acknowledges its bias while presenting and addressing the opposing point of view.

Helen Wilson Harris School of Social Work Baylor University