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Reviewed by:
  • In the Arms of Others: A Cultural History of the Right-to-Die in America
  • Howard I. Kushner
Peter G. Filene. In the Arms of Others: A Cultural History of the Right-to-Die in America. Chicago: Ivan R. Dee, 1998. xvii + 282 pp. Ill. $27.50.

Framing his discussion of the right-to-die with the 1975 case of Karen Ann Quinlan, Peter Filene uncovers ambiguous and contradictory attitudes that he attributes to “two American values: abundance and individualism” (p. 158). Heroic individualism (never surrender), and a postwar affluence that enabled [End Page 749] the adoption of life-sustaining technology regardless of cost, reinforced a denial of death. This tendency contradicted a popular attitude that seemed to accept the right of others to terminate life when the recovery of consciousness (roughly defined as self-awareness) was no longer a reasonable expectation. “In other words,” writes Filene, “how we die, or hope to die, is a cultural construction” (p. 158).

Filene briefly contrasts what he sees as a new attitude toward dying with a Victorian culture in which death was viewed as an event: “As modern medical technology prolonged that process, it often prolonged suffering” (p. 54). As death moved from the home to the hospital, Americans spent, on average, eighty days of their last year of life in a care facility often attached to machinery: “Death no longer was beautiful or good. It had become the process of dying, fraught with the confusions of modern culture” (p. 55).

To illustrate his thesis, Filene examines the Quinlan case in great detail, comparing and contrasting it with other, less well known episodes of the last quarter-century. No matter what an individual’s intention, the final decision of how and when that individual will die has been placed in the hands of others: physicians, ethicists, courts, and guardians. Filene contextualizes the right-to-die movement, arguing that it has been nurtured by both human-potential advocates and the equal-rights crusades of African-Americans and women. These influences translated into a personal concern for death with dignity, which led to political action demanding the right to control one’s own death. Yet, as Filene’s evidence reveals, there were many possible readings of the personal and political. The Quinlan case achieved its emblematic status because of its media construction as a sympathetic narrative. Other parallel cases were either dispatched quickly or ignored by the media because they lacked the appeal of the Quinlan drama—the portrait of Karen as an almost saintly figure, and of her parents as driven more by their religious beliefs than by a political agenda. While other attempts to end life were characterized by the religious Right as the first steps toward Nazi-like euthanasia, the Quinlans’ plea seemed too sacred to assail. The fact that Karen continued to cling to life for almost a decade after being removed from a respirator did not undermine her role as a symbol for the right-to-die.

But it was the very sacredness of the Quinlan case that made it sui generis and, therefore, difficult to transfer onto other efforts to terminate life. Thus, the 1983 decision of a New York couple to deny surgery to their child born with spina bifida, microcephaly, hydrocephalus, a prolapsed rectum, and other severe debilities was met with a lawsuit from a right-to-life attorney and, when that failed, from the Reagan administration. Although the courts upheld the parents’ decision, the right-to-die had been linked with abortion and the emotional issues attached to it. This and subsequent cases signaled that the Quinlan case had not removed even the seemingly most unambiguous cases from the arena of public contest. That lesson was brought powerfully home in the case of twenty-five-year-old comatose Nancy Cruzan, whose parents, after three years of watchful waiting, requested the removal of her feeding tube. It took almost three additional years of legal battles, including a U.S. Supreme Court ruling, before Cruzan’s tube [End Page 750] could be removed. The battle had so scarred her father, that several years later he committed suicide. The current controversy surrounding assisted suicide reveals that...

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