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The Future of Assisted Suicide and Euthanasia Neil M. Gorsuch Princeton University Press 2009 Reviewed by Berel Dov Lerner, PhD Since the publication of its original hardcover edition in 2006, this book has been widely and rightfully praised for restoring some balance to the literature of medical ethics, which has been dominated for decades by authors who champion the legalization of assisted suicide and ethics. Gorsuch currently serves as a rather young Federal judge on U.S. Court of Appeals for the Tenth Circuit (he is the verge of his 42nd birthday at the time of this writing), after having earned his J.D. from Harvard Law School as well as a doctorate in the philosophy of law from Oxford. His book surveys a large body of relevant case law, legislation, and social scientific studies mostly from the U.S.A., the U.K., and Holland (a country notable for having decriminalized euthanasia). Some important medical ethicists, such as Peter Singer, are also discussed, but philosophy definitely plays second fiddle to law in this book. While in-depth legal scholarship and argument may not be everyone's cup of tea, Gorsuch's lucid style and concern for the big ethical picture makes it accessible and even interesting for non-lawyers. The Future of Assisted Suicide and Euthanasia is worth reading just to catch up with the current state of play on these issues of deep social concern. More importantly, Gorsuch argues for a number of well-defined theses relating to the debate. Among these, some of the most important are: 1) Legal historians are wrong to suggest that the law has increasingly legitimized suicide over the past few centuries. Rather, changes in law reflect the identification of suicide as a symptom of mental illness and a recognition that

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posthumous "punishments" meant to deter suicides merely add to the suffering of bereaved families. 2) Once euthanasia and assisted suicide are accepted as legitimate options for terminally ill patients, there remains little rational basis for keeping anyone from seeking euthanasia or assistance in committing suicide. 3) Regulation of euthanasia and physician assisted suicide in the Netherlands and in the State of Oregon (where physicians are allowed to prescribe lethal drugs to assist in suicide) is shockingly haphazard. Reporting procedures are practically worthless and in Oregon the law makes no serious effort to keep patients suffering from treatable depression from receiving lethal drugs for the purpose of suicide. Despite the decriminalization of euthanasia in the Netherlands, in many cases doctors do not go to the trouble of following official procedures in performing euthanasia. More generally speaking: by definition, euthanasia and physician assisted suicide are matters of life and death, but when decriminalized they have astonishingly - invited much less concern for malpractice than do normal medical procedures. 4) Many of the great legal and ethical quandaries surrounding euthanasia and physician assisted suicide cold be better dealt with in terms of a principle of the "iviolability-of-life," which rejects any intentional killing of human beings (including suicide) but which also accepts the legitimacy of some actions that might bring about the death of human beings as an unfortunate - but expected secondary consequence. Here Gorsuch is arguing for the classic "principle of double effect," which, under certain circumstances, allows people to act so as to gain a desired positive effect even though they are aware that their action will also bring about an unintended additional negative effect. More specifically, Gorsuch holds that the right of the patient to refuse treatment because it is painful, futile,

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etc. can trump the fact that the patient will die more quickly without the rejected treatment. He is, however, skeptical about the power of custodians to make such decisions for legal incompetents. These are just a few of the book's main themes; I can only join the chorus of praise and recommend it to anyone interested in end of life issues.