Vol. 12 No. 6 (June 2002) pp. 260-264

EUTHANASIA: DEATH WITH DIGNITY AND THE LAW by Hazel Biggs. Oxford: Hart Publishing, 2001. 187 pp. Cloth $50.00. ISBN: 1-84113-091-5.

Reviewed by Rita J. Simon, Department of Justice, Law and Society, The American University.

EUTHANASIA analyzes the legal, medical, social and moral implications of taking ones life. It views the process and the decision from the perspective of the patient, the clinician and the law. In the authorís words: Whether it is possible to achieve dignity in dying with or without euthanasia and with or without legal reform is the subject of the book.

Given the advancement in science and medical knowledge life expectancy in the developed nations of the world has increased by more than twenty years during the 20th Century. With the increased length of life the number of persons suffering from incurable diseases has also increased. Thus the issue of a personís right to determine when and how to die has come under increasing scrutiny and public debate. Specific questions raised in the debate over euthanasia, assisted dying, and the withdrawal of treatment include the following.

(1) Should the patient be kept alive as long as medical technology allows?

(2) Is it ethical to keep the patient alive if he/she wants to die?

(3) Does his/her family have the right to decide whether medical treatment should be withdrawn or maintained?

(4) What are the legal rights of the patient and the patientís family?

(5) What responsibilities does the clinician--charged with patient careóhave? Legally, can he/she withdraw treatment?

(6) Finally what role does the patient play? Does he/she have the legal right to decide his/her life or death?

The author provides a comprehensive review of the current legal status of euthanasia in Great Britain and the attempts that have been made to legalize the voluntary taking of oneís own life. A review of the recent history indicates that in 1936 a Euthanasia Bill was introduced that would have permitted adult patients (i.e. over 21) suffering from a terminal of incurable disease to sign a form requesting euthanasia. Two witnesses would have been required at the signing, and the form then would then have been examined by a referee authorized to interview the patient and all interested parties. Following those procedures a court would have been authorized to issue a certificate permitting euthanasia to be performed by a doctor in the presence of witnesses.

In 1969 the Voluntary Euthanasia Bill was introduced that would have allowed euthanasia for patients 21 and older who requested it if two doctors agreed that the patient was suffering from an incurable disease that would or did cause him/her severe distress and would render him incapable of rational experience.

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In the 1970s several bills were introduced that would have allowed patients with incurable diseases to receive pain relieving drugs in quantities that would have resulted in unconsciousness followed by death. In 1991 a Euthanasia Bill was introduced that would have allowed doctors to grant euthanasia to incurable patients who requested it.

A change in direction occurred in December 1999 when a bill was introduced, the intention of which was to make it unlawful for clinicians to withdraw treatment from a patient with the intention of causing or hastening the patientís death.

Following this review, the major thrust of the authorís analysis is the examination of how euthanasia and the law of homicide interact and how they relate to the concept of human dignity.. In pursuing this examination Biggs examines how far the right of self determination, i.e. the right of patients to exercise independent choices actually extends

In 1961 suicide was decriminalized in England. Suicide is the highest cause of death in young people, not only in England but in all developed nations. While suicide is not a crime, what is legally prohibited, is assisting someone to take his or her life. What is the role of the clinician in cases in which the patient does not wish to
lie. According to Biggs, a competent patient has ďan absolute right to consent to or refuse medical treatment even if a refusal will lead to death. Tensions arise in situations in which the patient lacks the capacity to choose. Their clinical discretion becomes crucial and even more complicated when the value judgments of the doctor and the patient conflict. How much information has the doctor provided the patient, how much of the information provided does the patient understand, and
what role do next of kin play all enter in the situation.

A living will is a device that helps people maintain control of their lives until the point of death. Under the provisions of a living will a person can make decisions about future medical treatment before the treatment is required and while the person still has the mental capacity to decide for him or herself. Written into the will are
provisions about family membersí involvement in the decision making process. Crucial to the activation of living wills is the mental capacity of the author of the will at the time the will is written and at the time the treatment becomes necessary. According to British law a medical judgment that a certain treatment is inappropriate cannot be overridden by the patient or any of his family even if it is stipulated in the living will. The law is clear that for patients who are not competent i.e., do not have the capacity to give or refuse consent the clinician or the court will decide on the basis of the patientís best interests.

That a majority of the British public supports making living wills legally binding is shown by the results of a 1998 national poll in which 1960 adults were asked their views on whether Parliament should pass an act to ensure that doctors comply with advanced treatment decisions made in writing by people who could no longer speak for themselves. Sixty-five percent favored the passage of a law making the provisions in advance directives binding on doctors, 21 percent disapproved.

Biggs makes the point that ďalthough living wills are usually promoted on the assumption that they enhance patient autonomy and individual choice, there may be situations where rigid adherence to the

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provisions contained in an advance directive can limit choice and apparently becomes less than beneficial to the patient concerned.Ē She concludes that decisions made by patients at the time the living will is written are often overruled or disregarded.

Although the major focus of the book is on British law and practice, Biggs also, provides brief summaries of the legal status of euthanasia in other countries. The Netherlands, Switzerland and Germany permit assisted suicide but only under very limited and strictly controlled circumstances. In the United States, only in the state of Oregon is physician assisted suicide legal.

The author briefly considers how non-Western non-Christian religions: Buddhism, Hinduism, and Jainism treat the issue of dying with dignity. She concludes that many of the insights of those religions are consistent with modern Western thought on euthanasia as a means of achieving death with dignity.

Finally Biggs ends with a plea that Britain adopt laws that enable patients to exercise their authority through euthanasia; and at the same time protect medical practitioners who assist in their patientsí decision. Such a law would operationalize the concept of dying with dignity.


Copyright 2002 by the author, Rita J. Simon.