A Merciful End: The Euthanasia Movement in Modern America (review)

This book contains many engaging stories about the "euthanasia movement" in the United States. Ian Dowbiggin is at his best in the early chapters (1-4), which chart the course of the movement to the mid-1970s. The Euthanasia Society of America (ESA) is the focus of attention. In the final two chapters (5-6) the author turns to the post-1975 period, without highlighting a particular group or issue.

Dowbiggin suggests that the meaning of "euthanasia" has changed over time, shifting from "easy death" to "mercy killing" to "the right to die." Yet he does little to specify or to analyze the shades or shifts of meaning, or to document their historical evolution. He brings under the label of "euthanasia" all forms of hastened death and all movements proclaiming a right to die. To cite two unconvincing examples, he judges (1) that Pope Pius XII "announced that passive euthanasia was permissible" (p. 98), and (2) that virtually all proponents of "choice-in-dying," the "right to die," and even "the right to refuse treatment" are supporters of euthanasia (see, e.g., pp. 98-99). While this broad usage has a thin historical basis, the book would have been improved, both conceptually and historically, if more attention had been devoted to the meaning of "euthanasia."

The author sees the evolution of concerns about euthanasia as a continuous history over the last one hundred years. That is, the euthanasia movement today is grounded in many of the same values, objectives, and movements found in the early and middle decades of the twentieth century. Although he sees a "stalemate" from roughly 1940 to 1960 (the argument of chapter 3), he presents the history as a web of interconnected concerns in which individuals and groups perpetuate or repeat the values of their predecessors.

A competing thesis is that the history in America is more discontinuous than continuous, especially the legal history. It is arguable, for example, that In re Quinlan (1976) and its aftermath pushed beyond previous concerns and social movements, giving rise to new movements with strikingly different ideas about the right to die, and introducing new decision-making rights for seriously ill or injured patients. From this perspective, the late 1970s and early 1980s brought such widespread change that the "euthanasia movement" itself was profoundly reconfigured. Dowbiggin does not seriously consider this discontinuity thesis. He largely ignores the impact of the most influential legal developments, and tends to see new right-to-die organizations as reincarnations of "the old ESA agenda" (p. 162). He does occasionally use the language of "sweeping" and "unprecedented" change (p. 110), but he does not entertain a thesis of discontinuity or radical breaks (see pp. 110, 135, 162).

This failure is not surprising, in that there is a near-complete absence of any historical thesis or conclusion in the book. The most interesting, albeit implicit, thesis is that the euthanasia movement has today been stalled by the joint emergence of fears that vulnerable patients will be abused and hopes of improved palliative care at the end of life. However, this thesis is more assumed than defended, and it appears to be more sociological than historical. It also may be mistaken.

On one hypothesis, this book is an attempt to show how the euthanasia movement has, throughout its history, been curbed and often repressed by social fears that euthanasia would spread to innocent populations such as the aged and those with disabilities. This thesis is fundamentally historical. But, on an alternative and equally plausible interpretation, the book is an attempt to show that efforts to legalize euthanasia threaten to place us on a slippery slope in which incompetent or marginally competent persons will be swept under the umbrella of those who have "the right to die." This thesis is more evaluative than...