Death, Dying, and the Biological Revolution by Robert M. Veatch (review)

is in the relationship between human beings and their environment that the key to health ües. From this premise Carlson sees health being achieved through the strategic collaboration of human beings with their world expressed through a series of relationships. These relationships include the relationship between mind and matter; humans and nature; humans and the social roles they play; and humans and higher consciousness, even spirituality. The physician can help, but the individual must be responsible for those relationships and must "learn" to control bodily processes and relearn their interconnectedness with nature. By expanding consciousness and self-awareness, the individual wiU discover his more spiritual capacity. While this contention incorporates a basicaUy holistic health perspective, Carlson calls for something further, something more consciousness evoking, in that he persuasively encourages the reader to indulge in the somewhat idealistic philosophy born of the author's personal Weltanschauung . Most impressive to me is Carlson's methodology of dealing with this complex issue, and his thorough research certainly validates his perspective. Written in a crisp, clear, and comprehensive style, his work is an excellent and edifying contribution for professional and layman aUke. Krysten Latham, D. D. Chaplain's Office University of Chicago Death, Dying, and the Biological Revolution. By Robert M. Veatch. New Haven, Conn.: Yale University Press, 1976. Pp. ix+323. $12.95. Here is a comprehensive "first" analysis ofpublic policy and its potential evolution in the field of thanatology. The plight and possibiüties of die dying person are prismatically reflected through central issues of personal as well as public dimensions of death, the dying process itself, the rights of newly dead bodies, and natural death. Veatch carefully clarifies, distinguishes, and delineates questions relating to personal and public aspects of decision making. His overriding concern is the protection of personal freedom against technocracy, and his fundamental thesis is "diat, especially in issues as basic as these, the patient must be the one who decides." He sets forth themes to highUght the importance he asserts for the preservation of patient freedom, dignity, and autonomy. Respect for freedom is so central that, even in the question ofthe very meaning ofdeath, he asserts that we may wish to give patients and their agents some choice in individual cases, leading to a public policy where "we may have to tolerate philosophical pluralism." Patient freedom, however, is not boundless. While Veatch agrees with the general consensus of the civil courts that one ought to have the right to refuse treatment, even when the consequence is death, he holds that only "allowing to die" ought to be publicly sanctioned, never direct killing. He does recognize, however, that the "differences between commission and omission are much more subtle than some traditions would indicate." At the same time, "the wisdom Perspectives in Biology and Medicine ¦ Summer 1978 | 635 ofthe commonjudgment [regarding die differences] is sound." Although there might be some exceptions to a prohibition on direct killing, "we may want active killing ofdying patients to remain illegal even in those rare cases where it might be moraUy justified." In other words, for Veatch, individual exceptions ought not to become normative social policy, as there are greater risks in legalizing such actions than in continuing the legal prohibition. The case for freedom and dignity of the patient is similarly developed when Veatch presents his reflections on truth telling. He asserts that, although there might be exceptions to the rule of always telling the truth, "only in extremely rare instances of overwhelmingly negative consequences can withholding of the trudi be tolerated." Finally, even the newly dead ought to have prior wishes respected. The responsible treatment of the body by the family is a responsibility to honor die deceased's wishes, fulfiU commitments to them, protect the integrity of the corpse, and provide a respectful disposal of the body. The book ends with some reflections on public policy and the concept ofdeath from natural causes. The concept ofnatural death has only recently emerged in die literature. Veatch points out the ambiguity of the term "natural" and then sketches two scenarios—death as natural and death as evil—and considers the relative merits of each. His own opinion is that, "although prolonging life and...