P. J. van der Maas, J. J. M. van Delden, and L. Pijnenborg. 262 pages. Amsterdam: Elsevier; 1992. $160.50.

Dying and Death in Law and Medicine: A Forensic Primer for Health and Legal Professionals

Arthur S. Berger. 227 pages. Westport, Connecticut: Praeger; 1993. $49.95.

When the disciplines of law, ethics, and medicine confront an issue such as death, the relation among them becomes, as Alice once said, "curiouser and curiouser." It is intriguing, for instance, that Dutch physicians have recently been granted immunity from prosecution for what still remains the officially illegal practice of euthanasia. The data generated by the curious Dutch experiment with euthanasia are explored comprehensively in an important book by van der Maas and colleagues. Euthanasia and other Medical Decisions Concerning the End of Life is an English translation of their study for the Remmelink Commission, charged by the Dutch government with investigating the scope and incidence of medical decisions concerning the end of life, especially euthanasia.

It reports on three studies—a physician survey, a prospective study of the circumstances surrounding the deaths of patients under the care of a cohort of physicians, and an investigation of death certificates. Although the method of self-reporting leads one to suspect a bias toward understating the role of physicians in these deaths, even these rather conservative estimates are likely to startle Americans. Approximately 2% of Dutch deaths result from voluntary active euthanasia, 0.3% from physician-assisted suicide, and 5% from the use of accelerating doses of narcotics with the explicit purpose of, at least in part, hastening death. Another 1% of Dutch deaths result from the administration of lethal drugs without any explicit patient request. In the curious language of the Netherlands, these latter deaths are not counted as euthanasia because euthanasia, by their definition, is voluntary.

Readers will find this book fascinating but confusing in its organization, awkward in its English syntax, annoyingly repetitive, and filled with typographical errors. Nonetheless, Americans on both sides of the euthanasia debate will find it important. Knowing our own country's zeal to control health care costs, I found that reading about the Dutch experience with euthanasia caused me to worry that an American mixture of managed care and managed death may prove even more volatile than the mixture of alcohol and gasoline.

Controversies about euthanasia aside, Dying and Death in Law and Medicine by Berger attempts to serve an important need for a lay person's guide to the curious laws surrounding death in America. Unfortunately, it does not serve that need well. It is riddled with inaccuracies, overemphasizing the role of the electroencephalogram in brain death, alleging that the Catholic Church does not accept brain death, ascribing the phrase "primum non nocere" to the Hippocratic Oath, and reporting that most physicians still do not feel obligated to disclose a diagnosis of malignancy. The attempts at philosophizing about death and the attempts at ethical analysis are trivial. Even the parts about the law itself are neither clear nor helpful, particularly for physicians who want practical knowledge about death and the law to better advise their patients. I would not recommend it to either patients or physicians.