In this book, James Dunson explores end-of-life ethics including physician-assisted suicide (PAS) and continuous sedation until death. He argues that ethical debates currently ignore the experience of the dying patient in an effort to focus on policy creation, and proposes that the dying experience should instead be prioritized and used to inform policy development. The author makes the case that PAS should be recognized as a legally and morally permissible option for a very particular kind of patient: terminally ill with fewer than six months to live and capable of conscious consent. Since focusing on the patient's experience of this end-of-life dilemma transforms some of the basic concepts we use to engage in the PAS debate, the argument has implications for patient care and the training of medical professionals.

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.

The book’s main contribution is its interdisciplinary approach to the issue of sedation at the end-of-life. Because it occurs at the end of life, palliative sedation raises a number of important ethical and legal questions, including whether it is a covert form of euthanasia and for what purposes it may legally be used. Many of the book chapters address the first question and almost all deal with a specific form of the second: whether palliative sedation should be used for those experiencing “existential suffering”? This raises the question of what existential suffering is, a topic that is also discussed in the book. The different chapters address these issues from the perspectives of the relevant disciplines: Palliative Medicine, Bioethics, Law and Theology. Hence, helpful accounts of the clinical and historical background for this issue are provided and the importance of drawing accurate ethical and legal distinctions is stressed throughout the whole book. So the volume represents a valuable contribution to the emerging literature on this topic and should be helpful across a broad spectrum of readers: philosophers, theologians and physicians.

Ethical and legal issues concerning physician-assisted suicide and euthanasia are very much on the public agenda in many jurisdictions. In this timely book L.W. Sumner addresses these issues within the wider context of palliative care for patients in the dying process. His ethical conclusion is that a bright line between assisted death and other widely accepted end-of-life practices, including the withdrawal of life-sustaining treatment, pain control through high-dose opioids, and terminal sedation, cannot be justified. In the course of the ethical argument many familiar themes are given careful and thorough treatment: conceptions of death, the badness of death, the wrongness of killing, informed consent and refusal, the ethics of suicide, cause of death, the double effect, the sanctity of life, the 'active/passive' distinction, advance directives, and nonvoluntary euthanasia. The legal discussion opens with a survey of some prominent prohibitionist and regulatory regimes and then outlines a model regulatory policy for assisted death. Sumner concludes by defending this policy against a wide range of common objections, including those which appeal to slippery slopes or the possibility of abuse, and by asking how the transition to a regulatory regime might be managed in three common law prohibitionist jurisdictions.

Thomas Szasz wrote over thirty books and several hundred articles, replete with mordant criticism of psychiatry, in both scientific and popular periodicals. His works made him arguably one of the world's most recognized psychiatrists, albeit one of the most controversial. These writings have been translated into several languages and have earned him a worldwide following. Szasz was a man of towering intellect, sweeping historical knowledge, and deep-rooted, mostly libertarian, philosophical beliefs. He wrote with a lucid and acerbic wit, but usually in a way that is accessible to general readers. His books cautioned against the indiscriminate power of psychiatry in courts and in society, and against the apparent rush to medicalize all human folly. They have spawned an eponymous ideology that has influenced, to various degrees, laws relating to mental health in several countries and states. This book critically examines the legacy of Thomas Szasz - a man who challenged the very concept of mental illness and questioned several practices of psychiatrists. The book surveys his many contributions including those in psychoanalysis, which are very often overlooked by his critics. While admiring his seminal contribution to the debate, the book will also point to some of his assertions that merit closer scrutiny. Contributors to the book are drawn from various disciplines, including Psychiatry, Philosophy and Law; and are from various countries including the United States, Canada, New Zealand, United Kingdom and the Netherlands. Some contributors knew Thomas Szasz personally and spent many hours with him discussing issues he raised in his books and articles. The book will be fascinating reading for anyone interested in matters of mental health, human rights, and ethics.

This book brings together clinicians, ethicists and lawyers to put the practice of continuous sedation under a critical spotlight.

For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.