Book Reviews
Assisted Dying: Reflections on the need for law reform
Sheila AM McLean
ISBN: 978-1-844720-54-5 2007 214 pages Routledge-Cavendish
Romaine Rutnam
Avoca Beach NSW
I accepted the offer of reviewing this book for three reasons. First, I thought it would help inform my current activities as convenor of the Central Coast membership of the Voluntary Euthanasia Society (VES) of New South Wales (NSW), Australia. Second, I looked forward to reading something more from the author whose excellent work I remembered from my doctoral research into the ethics and law of assisted reproductive technology in the late 1980s and ‘90s. McLean is now International Bar Association Professor of Law and Ethics in Medicine at the University of Glasgow, Director of the Institute of Law and Ethics in Medicine. Third, I welcomed the opportunity to exercise my brain again, after some five years of retirement from my last paid job as a senior disability policy advisor in Canberra. My expectations were met, to some or a great extent, on all three counts.
Apart from a brief introduction and an 11 page index, the book consists of seven chapters:
(1) An outline of the debate
(2) An evaluation of the arguments for and against legalisation
(3) Choosing death
(4) Choosing death for others
(5) The United Kingdom position
(6) Is there a way forward? and
(7) Conclusion.
Chapter 2, evaluating the pros and cons of legalising assisted dying, comprises a quarter of the book. These arguments are grouped under the broad headings of Sanctity of life; Autonomy; Compassion/relief of suffering; The slippery slope; Being a burden; The doctor/patient relationship; Devaluing disability; Respect for persons' dignity; It's happening anyway; and a brief Conclusion. This chapter provides a comprehensive discussion of the important principles governing the contemporary debate over whether legislation for or against assisted dying is justifiable.
I found the third and fourth chapters were the most interesting and helpful, because they clarified the situations in which I and my friends and family could/should choose death as against a long drawn out and painful dying, and highlighted the ambiguities of current practice (both in the UK and in Australia) where doctors often choose death for others without regard for those patients' autonomy.
Chapter 3 covers the distinction between actively killing someone and letting someone die. Its sections canvass refusal of life-sustaining treatment; the use of advance directives; recent European and UK legal cases adjudicating requests for assisted dying; and discussion of the debates over acts and omissions (eg administering a lethal injection versus omitting cardio-pulmonary resuscitation) and the Catholic doctrine of double effect (where a doctor may gradually increase morphine doses intending to relieve pain but also having the effect of hastening death). I was pleased to read McLean's opinion, one that I have long held, that ‘Refusing life-sustaining treatment and asking for assistance in dying are essentially indistinguishable - unless we resort to sophistry' (p.101).
Chapter 4 reflects on the fact that in practice death is brought about not on the request of the person him- or herself but based on the opinions and choices of others, whether they are doctors, families or courts. Its four sections cover the case law governing Permanent vegetative state (PVS); patients in ‘near' PVS; Do not resuscitate orders; and Handicapped neonates. McLean's conclusion at the end of this chapter is that ‘Patients in PVS arguably show most clearly the difficulties inherent in maintaining a distinction between acts and omissions'.
The next chapter details the UK position, where actively assisting in the death of another person is a crime, whether by statute in England and Wales, or at common law in Scotland. I think this would only be of interest to those especially needing to know the details of the recent (failed) attempts by Lord Joffe between 2003 to 2006 to amend the law in the UK.
In 'Is there a way forward?' McLean focuses on two well publicised jurisdictions where some form of law reform has taken place (The Netherlands and the state of Oregon, USA) Here you can find the recent evidence of the numbers and demographics of the people who have availed themselves of that legislation. I will find it useful to have this as an authoritative reference when updating my lobbying letters to the Australian Federal and NSW governments in favour of voluntary euthanasia legislation, since it backs up my argument that only a minority of people take up this choice at the end of life. Far from the fears of the opponents, that it would lead ‘to a wholesale slaughter of the weak and the vulnerable' (p.175), the use of physician-assisted suicide in Oregon has been strongly associated with a higher level of education and wealth enough to have some form of health insurance. This contradicts the policy justification given by the Australian Senate's Legal and Constitutional Legislation Committee in its May 2005 report (sections 3.2 to 3.4) on the Provisions of the Criminal Code Amendment (Suicide Related Material Offences) Bill 2005. Passage of that bill subsequently made it illegal from January 2006 for Australians to use the Internet, e-mail or telephone to provide another person with suicide-related material, thus potentially making criminals of advocates for voluntary euthanasia legislation in Australia.
McLean concludes her argument by saying that ‘The opacity of the current situation mandates reconsideration of the law' (p.197). I was pleased that she advocates a resolution by essentially deregulating this area of law following the Swiss model where assisted dying is a crime only if the person committing it is acting in their own interests rather than the interests of the other person (p.145).
Overall I found the book readable though repetitious, as someone who has no legal qualifications but has had a career in implementing administrative law and developing public health and disability policies. There was only one small passage, in an otherwise interesting section titled Is ‘assisted' dying ever truly autonomous? where I failed to grasp the argument.
I feel sure that other readers interested in the debates for legislative reform in the area of assisted dying will find this thorough contemporary review of its principles valuable. The book may also be of particular use to graduate nursing or social work students in courses relating to end of life care.
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