Physician-Assisted Death is the eleventh volume of Biomedical Ethics Reviews. We, the editors, are pleased with the response to the series over the years and, as a result, are happy to continue into a second decade with the same general purpose and zeal. As in the past, contributors to projected volumes have been asked to summarize the nature of the literature, the prevailing attitudes and arguments, and then to advance the discussion in some way by staking out and arguing forcefully for some basic position on the topic targeted for discussion. For the present volume on Physician-Assisted Death, we felt it wise to enlist the services of a guest editor, Dr. Gregg A. Kasting, a practicing physician with extensive clinical knowledge of the various problems and issues encountered in discussing physician assisted death. Dr. Kasting is also our student and just completing a graduate degree in philosophy with a specialty in biomedical ethics here at Georgia State University. Apart from a keen interest in the topic, Dr. Kasting has published good work in the area and has, in our opinion, done an excellent job in taking on the lion's share of editing this well-balanced and probing set of essays. We hope you will agree that this volume significantly advances the level of discussion on physician-assisted euthanasia. Incidentally, we wish to note that the essays in this volume were all finished and committed to press by January 1993.

After assessing the strengths and weaknesses of arguments for assisted suicide and euthanasia, Gorsuch builds a nuanced, novel, and powerful moral and legal argument against legalization, one based on a principle that, surprisingly, has largely been overlooked in the debate; the idea that human life is intrinsically valuable and that intentional killing is always wrong. At the same time, the argument Gorsuch develops leaves wide latitude for individual patient autonomy and the refusal of unwanted medical treatment and life-sustaining care, permitting intervention only in cases where an intention to kill is present.

“A remarkably nuanced, empathetic, and well-crafted work of journalism, [The Inevitable] explores what might be called the right-to-die underground, a world of people who wonder why a medical system that can do so much to try to extend their lives can do so little to help them end those lives in a peaceful and painless way.”—Brooke Jarvis, The New Yorker More states and countries are passing right-to-die laws that allow the sick and suffering to end their lives at pre-planned moments, with the help of physicians. But even where these laws exist, they leave many people behind. The Inevitable moves beyond margins of the law to the people who are meticulously planning their final hours—far from medical offices, legislative chambers, hospital ethics committees, and polite conversation. It also shines a light on the people who help them: loved ones and, sometimes, clandestine groups on the Internet that together form the “euthanasia underground.” Katie Engelhart, a veteran journalist, focuses on six people representing different aspects of the right to die debate. Two are doctors: a California physician who runs a boutique assisted death clinic and has written more lethal prescriptions than anyone else in the U.S.; an Australian named Philip Nitschke who lost his medical license for teaching people how to end their lives painlessly and peacefully at “DIY Death” workshops. The other four chapters belong to people who said they wanted to die because they were suffering unbearably—of old age, chronic illness, dementia, and mental anguish—and saw suicide as their only option. Spanning North America, Europe, and Australia, The Inevitable offers a deeply reported and fearless look at a morally tangled subject. It introduces readers to ordinary people who are fighting to find dignity and authenticity in the final hours of their lives.

The proliferation of life-prolonging technology in recent years has made the controversy over the "right to die" and physician-assisted suicide one of the most explosive medical and ethical issues of our day. Dr. Jack Kevorkian's "suicide machine" has commanded front-page coverage for several years, while in 1994 Oregon passed a measure allowing the terminally ill to obtain lethal prescriptions for suicide, and other states have placed similar proposals on their ballots.

In Assisted Suicide and the Right to Die: the Interface of Social Science, Public Policy, and Medical Ethics, Barry Rosenfeld examines how social science can inform policy and practice in the ongoing debates on end-of-life matters. While moral and ethical aspects of the controversy may not be the domain of science, many questions are amenable to scientific study, including the degree to which untreated pain or depression fuel requests for assisted suicide.

Sensitive and high-profile public policy issues often benefit from being considered in comparative perspective. Here, euthanasia and the right to die are examined in the context of the social, legal, and religious settings of a wide range of countries. The authors employ public opinion data, where available, to illustrate the great disparity between approval of physician-assisted suicide and the general illegality of the practice. Ultimately, making and implementing laws to ensure a responsible right to die_as the U.S. has been struggling with in Oregon, Michigan, and elsewhere_will be informed by experiences in such places as the Netherlands, Australia, and the only country in the world where euthanasia is a clear-cut medical option: Colombia.

Medicine and health care generate many bioethical problems and dilemmas that are of great academic, professional and public interest. This comprehensive resource is designed as a succinct yet authoritative text and reference for clinicians, bioethicists, and advanced students seeking a better understanding of ethics problems in the clinical setting. Each chapter illustrates an ethical problem that might be encountered in everyday practice; defines the concepts at issue; examines their implications from the perspectives of ethics, law and policy; and then provides a practical resolution. There are 10 key sections presenting the most vital topics and clinically relevant areas of modern bioethics. International, interdisciplinary authorship and cross-cultural orientation ensure suitability for a worldwide audience. This book will assist all clinicians in making well-reasoned and defensible decisions by developing their awareness of ethical considerations and teaching the analytical skills to deal with them effectively.

When the end of life makes its inevitable appearance, people should be able to expect reliable, humane, and effective caregiving. Yet too many dying people suffer unnecessarily. While an "overtreated" dying is feared, untreated pain or emotional abandonment are equally frightening. Approaching Death reflects a wide-ranging effort to understand what we know about care at the end of life, what we have yet to learn, and what we know but do not adequately apply. It seeks to build understanding of what constitutes good care for the dying and offers recommendations to decisionmakers that address specific barriers to achieving good care. This volume offers a profile of when, where, and how Americans die. It examines the dimensions of caring at the end of life: Determining diagnosis and prognosis and communicating these to patient and family. Establishing clinical and personal goals. Matching physical, psychological, spiritual, and practical care strategies to the patient's values and circumstances. Approaching Death considers the dying experience in hospitals, nursing homes, and other settings and the role of interdisciplinary teams and managed care. It offers perspectives on quality measurement and improvement, the role of practice guidelines, cost concerns, and legal issues such as assisted suicide. The book proposes how health professionals can become better prepared to care well for those who are dying and to understand that these are not patients for whom "nothing can be done."

This book addresses key historical, scientific, legal, and philosophical issues surrounding euthanasia and assisted suicide in the United States as well as in other countries and cultures. Euthanasia was practiced by Greek physicians as early as 500 BC. In the 20th century, legal and ethical controversies surrounding assisted dying exploded. Many religions and medical organizations led the way in opposition, citing the incompatibility of assisted dying with various religious traditions and with the obligations of medical personnel toward their patients. Today, these practices remain highly controversial both in the United States and around the world. Comprising contributions from an international group of experts, this book thoroughly investigates euthanasia and assisted suicide from an interdisciplinary and global perspective. It presents the ethical arguments for and against assisted dying; highlights how assisted dying is perceived in various cultural and philosophical traditions—for example, South and East Asian cultures, Latin American perspectives, and religions including Islam and Christianity; and considers how assisted dying has both shaped and been shaped by the emergence of professionalized bioethics. Readers will also learn about the most controversial issues related to assisted dying, such as pediatric euthanasia, assisted dying for organ transplantation, and "suicide tourism," and examine concerns relating to assisted dying for racial minorities, children, and the disabled.

In The Case against Assisted Suicide: For the Right to End-of-Life Care, Dr. Kathleen Foley and Dr. Herbert Hendin uncover why pleas for patient autonomy and compassion, often used in favor of legalizing euthanasia, do not advance or protect the rights of terminally ill patients. Incisive essays by authorities in the fields of medicine, law, and bioethics draw on studies done in the Netherlands, Oregon, and Australia by the editors and contributors that show the dangers that legalization of assisted suicide would pose to the most vulnerable patients. Thoughtful and persuasive, this book urges the medical profession to improve palliative care and develop a more humane response to the complex issues facing those who are terminally ill.