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When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context
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217 pages. New York: The New York State Task Force on Life and the Law; 1994.
The Task Force on Life and Law began in New York in 1984, convened by Governor Mario M. Cuomo to examine public policy concerns raised by technical advances in medicine. Therefore, it is not surprising that this latest report consists of a timely and topical analysis of assisted suicide and euthanasia in a medical setting. Given the current level of societal agitation about assisted suicide and euthanasia, this seems an obvious extension of the Task Force's original mandate.
The eight chapters and seven appendixes have much to recommend them to the general medical reader. Although the authorship of this Task Force appears reasonably well balanced, comprising representatives from various fields, the number of practicing physicians appears small. Despite this, the subject matter is well covered, and, although clothed in the languages of lawyers and historians, the implications for practicing physicians are both profound and important.
The first section of the text provides background on the epidemiology of suicide; pays particular attention to suicide in special groups of patients; examines how poorly we as a profession assess and manage pain and depression in late disease; traces the evolution of laws governing suicide and assisted suicide; and ends by highlighting the ethically challenging aspects of standard arguments for and against the legalization of assisted suicide. If the book has any weaknesses, they are the occasional lack of attention to detail (for example, the wrong date is given for the Atkins suicide assisted by Jack Kervorkian), the contradictory statements about depression in patients with cancer in chapters 1 and 2, the rather one-sided discussion of the ethical arguments, and the absence of an index.
The second section summarizes the Task Force's argument for not legalizing physician-assisted suicide or euthanasia and its explanations for why we as a society are better off keeping these events illegal. The Task Force turns the pain and suffering argument, often used by proponents of euthanasia, on its head, reasoning that to avoid a premature dependence on literally killing our problems, we need to improve our management of pain and depression in the terminally ill and thereby decrease the perceived need for assisted suicide. Some of the text in this latter section is unavoidably redundant because of the Task Force's effort to educate the medical reader on what constitutes adequate pain control and on recognizing and treating depression. If taken seriously by the profession, this report cannot help but benefit terminally ill patients.
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