SAVES is not affiliated with Exit International / Dr Philip Nitschke and opposes the public availability of a 'peaceful pill'.

Although intended primarily to promote discussion in the medical profession on issues related to voluntary euthanasia, many of the 18 articles which comprise this book will be of considerable interest to the general reader. The articles are clearly written and largely devoid of obscure (to the layman) medical terms. Major reference is to the UK and to the US contexts, with two succinct and balanced articles on the position in the Netherlands and in Canada. Surprisingly, developments in Australia get only occasional mention!

Of the articles, eight are by medical specialists in various disciplines where the issue of euthanasia is likely to be met, e.g. chronic severe disablement, neonatal intensive care, dementias of later life, palliative medicine.

The remainder of the book is made up of contributions from other disciplines. Three articles raise general legal issues and describe the legal position in respect to euthanasia in a number of countries. The contributions of Sociology and Philosophy to the debate are limited to single chapters.

The most intriguing of the background articles is by Bishop Rowan Williams of Newport, UK, on "Theological perspectives". He analyses the theological tradition relating to euthanasia based on the writings of St. Augustine, and, incidentally, makes very interesting observations on the possibly adverse effects of advance declarations. This chapter is followed by a rather more obscure (for the reviewer) exposition on "Buddhist principles" in relation to euthanasia.

The book purports to present the issue of euthanasia in a neutral manner. Well, maybe it is in the English context, though there is consensus amongst almost all contributors that active voluntary euthanasia is either unnecessary and/or unethical and that hastening the dying process should not go beyond non-treatment or withdrawal of treatment. Professor Martin Roth is explicit on this matter in his article, "Euthanasia and related issues in dementias of later life..." The case he puts against voluntary euthanasia in any circumstances and non-treatment (letting die) only in extreme cases, merits careful consideration and comment, not possible in this short review.

Dr Keith Andrews expresses a view contrary to the general trend of the book in his article, "Euthanasia in chronic, severe disablement". The summary of the article asserts that, in some cases, the withdrawal of life-sustaining measures is "unsatisfactory if not inhumane" and that "... (active) euthanasia would be more satisfactory". A pity that he did not put the case for this declamatory statement in full!

Quite apart from their views on euthanasia, there are two aspects of the medical contributions which are of great interest. Starting from their specialist experience, the authors describe developments in their respective fields and analyse the effective limits of medical intervention, out of which voluntary euthanasia emerges.

Thus Ross reviews the clinical features of PVS (permanent vegetative state) and Alzheimer's disease, and Andrews details the various forms and features of chronic disability. All the medical writers give a vivid picture of the dilemmas which confront the physician when making end-of-life decisions (although the predominant role, assumed to be the physician's prerogative, is open to question!).

Of equal interest are the comments made in a number of articles on issues directly related to voluntary euthanasia, eg, on quality of life considerations and on the value and limitations of advance declarations. On these matters the reflections of Roth, Williams, and Andrews are especially pertinent.

Overall, there is little doubt Dunstan and Lachmann's book will widen the perspectives of lay readers and many doctors. It may well be of value in promoting debate in the UK although I suspect that it is largely a reflection of official medical and religious attitudes in that country. Here in Australia the debate seems to have moved on to a different level.

[This book is now in the SA State Library system and available through your local library on Inter-Library Loan.

It is hoped to provide reviews of the more interesting articles in subsequent issues of the VE Bulletin, subject to availability of resources and space.]
 
 

The author is well qualified to write about voluntary euthanasia. Her association with the Voluntary Euthanasia Society (VES) in UK goes back many years. In 1989 she was President of the World Federation of Right to Die Societies and, from 1985 to 1990, Chairman of the VES.

Her presentation of the case for VE is unusual and, on the whole, effective. Issues are presented under eight chapter-heading questions. Discussion, illustrated vividly by case studies, is not as restricted as the chapter headings might suggest.

Ch. 1, for example, ("Does anyone really ask for help to die?") makes reference, not only to opinion polls and human need, but also to court decisions on ending life without consent by discontinuing life-saving treatment. Ch. 8, ("Will we ever get the right to forego a lengthy death?"), touches upon the problems of an ageing pop- ulation and the need to ration limited health resources. Other chapters of particular interest are Ch. 3, ("What happens when someone finds that life has no remaining quality?"), with its useful insights into attitudes to, and methods of, committing suicide and Ch. 5, ("Where do family and friends come in?"), focussing on the anguish endured by relatives and friends of the dying and on mercy killing. Ch. 7 gives a good, brief summary of the legal position on VE, as it was in 1996.

It is inevitable that, in a short book on such an extensive topic, that some aspects are given only cursory consideration. In view of their prominence in the VE debate, more detailed attention to the Remmelink Report on death and dying in the Netherlands and to the "slippery slope" case against VE, would have been welcome.

Davies does not attempt to present an "academic" case. Nevertheless it is surprising that there are no references to substantiate quoted facts or suggestions for further reading on specific issues. No support is given, for example, to the statement (p. 63) that "in Australia, 60% of doctors are in favour of voluntary euthanasia." Would that it were so!!

Overall, Davies makes a good general case for VE. Her writing is succinct and economical. Her case studies add dramatic intensity to the text. She presents an encouraging picture, in which VE may, by inference, be expected to be legalised soon in a number of countries and widely accepted for both moral and practical reasons. Recommended as a good, short, introductory survey of the field.