Euthanasia Examined: Ethical, Clinical and Legal Perspectives edited by John Keown (review)

Euthanasia Examined: Ethical, Clinical and. Legal Perspectives, edited by John Keown. Cambridge: Cambridge University Press, 1995. Pp. 340. $69.95. One of the advantages of reading this collection is that it will provide the reader with a clear definition of euthanasia and the distinctions between different forms of euthanasia: active or passive, voluntary, non-voluntary and involuntary. Euthanasia is defined by Keown as "the intentional killing of a patient by act or omission as part of his or her medical care". Forms of passive euthanasia are familiar to the physician involved in decisions of omission of treatment or non-intervention in the process of dying. These decisions have been accepted ethical and legal medical practice for many years in the U.S. However, active euthanasia, described in hospice physician Twycross' chapter as the "compassion-motivated, deliberate, rapid and painless termination of the life of someone afflicted with an incurable and progressive disease" is significantly different from Keown's definition as "the intentional action to terminate a person's life, performed by somebody else than the involved person upon the latter's request" (p.270). This latter definition is more commonly accepted by the other writers in the book than Twycross' description and is illustrative of the problem when discussing euthanasia. Many people have their own definitions of euthanasia and argue pro or con based on their definition alone. This book provides all possible interpretations and a clear exposition of each, which is its primary value. For example, the three categories of euthanasia whether active or passive are: 1) voluntary at the request of a competent patient; 2) nonvoluntary which applies to an incompetent patient; and 3) involuntary in which a competent patient has made no request to die. Giesen's chapter on the ethical and legal issues for different classes of persons seeking or nearing death (competent, incompetent, mentally ill, unconscious, or minor) and physician options towards these classes (assisting, withdrawing, witholding, palliating) is worth reading for its meticulousness and lucidity in identifying the issues within each class or option. That his discussion is directed toward the British medical profession is only a slight drawback in this chapter for the American reader but more so in other chapters (Boyd, Gormally, Davies, Report of the House of Lords and Hornett) where recent British court and legislative decisions provide the backdrop for the topics. Not infrequently, American laws and court cases are cited, especially in Jennett's "Letting vegetative patients die". This chapter is a model of clarity in diagnosing the vegetative state, a term the author and Professor Plum in New York coined in 1972. He carefully and thoroughly reviews the decisions in British and U.S. courts of relevant cases involving the care of patients in a persistent vegetative state (PVS), as well as the ethical decisions physicians caring for these patients may face. Boyle's discussion following in "A case for sometimes feeding patients in PVS" focuses ultimately on the need to make individualized decisions about tube-feeding dependent upon societal resources and the family's ability to provide support for the level of care morally required. The only chapter based on Americanjurisprudence exclusively is Kamisar's "Physician -assisted suicide: the last bridge to active voluntary euthanasia". This is a cogent legal discourse about why we do not currently have a "right" to die, the slippery slope of accepting this as a right, and the consequences of the likelihood that this will be declared a right in the near future in U.S. Courts. This elegant and 308 Book Reviews intelligible discussion puts the "right to die" movement within the context of the euthanasia movement as a whole. Various authors mention and an entire chapter by Keown is devoted to the experience of euthanasia in the Netherlands. The data support an argument for the growing incidence of non-voluntary euthanasia and Keown reports that a Dutch court has just held that non-voluntary euthanasia was lawful when a physician killed a disabled newborn at the parent's request. Keown documents a lack ofadministrative control over physician-initiated euthanasia and suggests that there is a greater willingness by physicians to kill than there was when the Netherlands first legalized voluntary...