In terms of time and paper spent on the polemical, euthanasia appears to challenge for supremacy that other emotionally labile subject, abortion. The landscape is littered with good, even excellent, anthologies on both euthanasia and physician-assisted suicide. Keown has organized, edited, and contributed to this excellent collection of philosophical as well as practical papers.

With 14 different contributors, the sections of this text necessarily vary in quality. One hopes that any anthology on such a controversial subject would bring together strong representation from both sides. The pro-euthanasia presentations in this text are the least persuasive, perhaps because these writers have the most difficult and troublesome position to defend. Indeed, as proponents of change, they have the greatest challenge: convincing society and the reader that euthanasia should become an acceptable part of medical culture.

One of two contributors from the United States, Dan Callahan, has written the foreword. Given Callahan's well-developed and uniquely argued views on euthanasia, he must have had to bite his tongue with extra vigor to maintain his philosophical neutrality.

A six-chapter tit-for-tat joust between a philosopher and proponent of euthanasia (Harris) and his law-professor opponent (Finnis) consumes the first quarter of the book. Harris opens with his argument for euthanasia, well-known from his earlier thesis and text, The Value of Life. He argues that life cannot have value if a person can no longer value his or her own existence. Finnis' opening gambit examines the moral importance of intention in an effort to develop a philosophical case against euthanasia. What follows in the next four chapters is a point-counter-point rebuttal that could have been more exciting than it is. Occasionally, one has the sense that these two prolix authors are like the proverbial two ships passing in the night, only tangentially responding or recognizably attempting to respond to each other's argument.

Those who view euthanasia through the prism of a strong theological focus are well represented in this book, perhaps a bit more than the average exponent of euthanasia would like. In separate pieces, Joseph Boyle, Rev. Dr. Anthony Fisher, and Luke Gormally of the Linare Centre in London provide theologically based, if not entirely convincing, arguments for why the withdrawal of food and water may be more problematic than U.S., Canadian, and British courts recognize when they allow the removal of such life-sustaining support for patients in a persistent vegetative state.

There are stronger chapters in this anthology; noteworthy are the contributions of Robert G. Twycross, Bryan Jennett, Yale Kamisar, and Keown himself. Twycross and Jennett are experienced clinicians; Twycross has a highly productive career in palliative medicine and, like the author of this review, finds that terminally ill patients who are adequately cared for almost never request euthanasia. Practically speaking, for the expert in palliative care, the question of euthanasia is an interesting philosophical challenge that rarely needs to be addressed in the day-to-day care of sick patients.

Like Kamisar's excellent chapter, the chapter by Keown is one of the most important in the book. Even if one gets tied in intellectual knots when trying to discern the moral distinction between killing and letting die, and even if one tumbles along the murky path of defining the limits of autonomy (if there are to be any), in the end it is the social or utilitarian concerns that should make us all hesitate before endorsing euthanasia or its moral cousin, physician-assisted suicide. For almost four decades, Kamisar has raised the concern that socially sanctioned euthanasia will capture persons who are not anxious to die but feel the need to do so in response to their perception of what others may want for them. In this text, Kamisar greatly expands on this fundamental notion, which has never been adequately refuted by proponents of euthanasia.

Keown provides us with the most damning chapter on euthanasia, "Euthanasia in the Netherlands: Sliding down the Slippery Slope?" His analysis of the logical and empiric forms of the "slippery slope" in the Netherlands leaves little doubt about the already existing moral drift (should I say "slip"?) from active, voluntary euthanasia to nonvoluntary euthanasia. No intelligent response to his analysis will be forthcoming. A successful response to the facts of what has happened in the Netherlands is precluded because the "slip" has already occurred.