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Journal of Health Politics, Policy and Law 25.2 (2000) 415-430



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Review Essay

On the Structure of the Euthanasia Debate:
Observations Provoked by a Near-Perfect For-and-Against Book

Euthanasia and Physician-Assisted Suicide:
For and Against

Tables

Review Symposium on Euthanasia and Physician-Assisted Suicide

Gerald Dworkin, R. G. Frey, and Sissela Bok. Euthanasia and Physician-Assisted Suicide: For and Against. New York: Cambridge University Press, 1998. 151 pp. $14.95 paper.

Something is amiss with the euthanasia debate, and I want to use a smart new book to try to show what it is. The book is Euthanasia and Physician-Assisted Suicide: For and Against, an eagerly awaited volume by three well-known philosophers, Gerald Dworkin, R. G. Frey, and Sissela Bok. Dworkin and Frey are on the "for" side of the euthanasia and physician-assisted suicide debate; Bok is on the "against" side. This little book provides an ideal occasion to comment on the structure of the debate over euthanasia and physician-assisted suicide, a debate that has been developing over the past ten years or so in medical, academic, and public circles; indeed, this little book is a virtually perfect specimen for showing what is going on in these debates. More important, however, it is also a near-perfect specimen for showing what, unfortunately, isn't going on.

Of course, the Dworkin, Frey, and Bok book is just one of many, many current volumes in the controversies over euthanasia and physician-assisted suicide, and it is a better book than many--among other things, in the distinction of its authors, in the clarity and rigor with which most of it is argued, and in its sensitivity to many of the deepest issues. It has everything: discussions of the difference between killing and letting die, the distinction between foreseeing and intending; the tenuous relationship [End Page 415] between allowing and causing. It discusses the principle of double effect, the risks of the slippery slope, the delicate matter of the integrity of the medical profession. But while this little book serves as a model of the entire debate, it also serves to show what is wrong with this debate.

The Structure of the Assisted-Dying Debate

From its beginning, the structure of the debate over physician-aided dying has pitted arguments about self-determination or autonomy and about relief of suffering on the "for" side of the case, against arguments about the intrinsic wrongness of killing, the integrity of the medical profession, and damaging social effects--the slippery-slope argument--on the "against" side. The debate can be mapped as detailed in Table 1.

This structure then invites an extended back-and-forth pattern of objection and counterobjection, which I've described in previous works 1 as looking something like Table 2 on the following pages.

Of course, this is only a truncated skeleton of the back-and-forth, adversarial character of the for-and-against debate; it could be extended in great detail. Just the same, most of the points made by most of the major partisans in this debate can be plotted fairly specifically somewhere on this scheme. For example, Dan Brock's analyses of autonomy would fit under I; Bernie Gert's defense of terminal sedation under II.A.1.a. Timothy Quill's defense of physician assistance in suicide as a "last resort" would fit under II.A.2; Ezekiel Emanuel's concerns about the physician's role would fit under IV.A.1. In the Dworkin, Frey, and Bok volume, Frey's spirited attack on the attempt of opponents of legalization to defend such practices as overuse of opiates and terminal sedation, while at the same time rejecting euthanasia and physician-assisted suicide, [End Page 416] [Begin Page 419] would fall under II.A.2.a.i; Sissela Bok's sensitive analysis of the slippery-slope argument would fall under V, V.A.1, and V.A.2. Historical figures fit here too; for example, Thomas Aquinas argues III; David Hume I.A.2. Indeed, virtually all of the...

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