A Time to Die: The Place for Physician Assistance
AbeBooks Seller Since May 21, 2012Quantity Available: 20
AbeBooks Seller Since May 21, 2012Quantity Available: 20
About this Item
Title: A Time to Die: The Place for Physician ...
Publisher: Yale University Press
Book Type: Paperback
About this title
This book is written for all those who are concerned about how their life may end—and who wish to die without unnecessary suffering. Dr. Charles F. McKhann discusses many aspects of physician-assisted dying and explains why he thinks it should be made legally available under certain circumstances.
Dr. McKhann, a specialist in cancer surgery, has conducted in-depth interviews with people who were dying from a variety of illnesses and with the physicians who cared for them. Drawing on these interviews and on his own experiences as a physician, he looks at the dying process as it is encountered in painful and debilitating diseases and at the needs of patients and their families. Dr. McKhann presents the case for rational suicide, comparing a failed suicide attempt in the United States with a planned death in the Netherlands and illustrating the differences in approach and attitudes. He explains the ways in which physician assistance is already taking place and considers the physicians personal and professional concerns. And he reflects on relevant religious, moral, legal, and public-policy issues that are currently so widely debated. His thought-provoking book is a valuable resource not only for the general public but also for compassionate physicians who attend people with fatal diseases and for lawmakers who strive for understanding and courage in dealing with this new challenge.
In A Time to Die, Charles F. McKhann offers a comprehensive and thoughtful guide to the hotly contested issue of physician-assisted death. The author draws on extensive clinical experience in the treatment of patients with cancer, detailed interviews with seriously ill patients and the clinicians who care for them, and a thorough survey of the literature. He argues that it is ethical as a last resort for physicians to help dying patients hasten their deaths by prescribing or administering lethal medications in response to their resolute requests, and that physician-assisted death should be legalized. Because McKhann believes that legalization is inevitable, he devotes much of the book to helping patients and physicians think about and prepare for negotiating the practice of assisted death. However, he does not neglect or simplify its practical and moral complexities. By stimulating thought and clarifying the range of clinical, ethical, and social issues associated with physician-assisted dying, the book should be very helpful to those who are uncertain about where they stand on this deeply challenging issue.
Despite its general merits, A Time to Die suffers from several weaknesses. A theoretical question underlying the debate is the ethical distinction between, or equivalence of, physician-assisted death and the legally established, standard practice of forgoing life-sustaining treatment. McKhann effectively rebuts the traditional argument for a moral distinction: that it is the disease that causes death when life-sustaining treatment is withdrawn, whereas in physician-assisted suicide it is the provision of lethal medication that causes death and that terminating life is the intent of physician-assisted death but not typically of the withdrawal of treatment. Yet McKhann does not discuss the position that refusal of treatment, but not assisted death, is grounded in the basic right of persons to be free of unwanted bodily intrusion. According to that perspective, when a competent patient refuses life-sustaining treatment, physicians are morally obligated to comply. In contrast, competent, terminally ill patients are not owed assistance toward death as a right, though it may be the best option for patients facing intolerable suffering.
Within the penumbra of the patient's right to refuse medical treatment is the right to hasten death by voluntarily stopping eating and drinking. McKhann mentions but does not give due attention to this important alternative to physician-assisted death. This legally permitted option may seem less humane than the swift means of ingesting or injecting lethal medication; however, anecdotal evidence suggests that a peaceful death can be achieved by refusing food and water, provided that the patient receives standard palliative and supportive care. The time required to bring about death by ceasing to eat and drink, typically from a few days to a few weeks, should be compared with a mandatory two-week waiting period following a request for lethal medication -- a feature of the law in Oregon legalizing physician-assisted suicide and similar legislative proposals elsewhere. This alternative arguably displays greater evidence of the self-determination of patients and poses less threat to the professional integrity of physicians.
The weakest chapter of the book addresses the concern that legalizing physician-assisted death would invite intolerable abuse. McKhann appears confident that physicians empowered to assist patients in dying will engage in this practice responsibly. For example, he argues that "if withdrawing treatment is not considered to be an easy way out, assisted dying is even less likely to be." This may be true for euthanasia by lethal injection. But prescribing lethal medication at the request of a terminally ill patient, and not knowing whether the patient will actually use the drugs to cause death, may be a tempting "quick fix," obviating the demanding work of caring for the dying. Moreover, McKhann's position that physician-assisted death, authorized by patients' advance directives, should be available to patients with severe dementia is fraught with peril. It remains an open question whether safeguards such as mandatory consultation by an independent physician would provide adequate protection of vulnerable patients. In view of realistic concern about the potential for abuse, there is reason to doubt McKhann's prediction that the legalization of physician-assisted death, beyond the Oregon referendum, is inevitable.
Reviewed by Franklin G. Miller, Ph.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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