In Search of Solace and Mercy

Abstract

Over the past decade, there have been numerous books and journal articles written on the subject of death and dying, pain and symptom management, and palliative care. In addition, there have been an equal number of journal articles that have expressed various arguments for or against physician-assisted dying. Timothy Quill and Margaret Battin bravely attempt to explore all of these subjects in one text, Physician-Assisted Dying: The Case for Palliative Care and Patient Choice. This book is well organized and beautifully written. It blends the contributions of well-respected physicians, philosophers, lawyers, and other health care professionals. The result is a balanced text that explores several poignant, interrelated queries regarding the pros and cons of physician-assisted dying. Some examples are as follows: Is it considered physician abandonment if a physician refuses to consider a patient's plea for help in dying? How far should a health care professional go in order to seek mercy for a patient whose pain does not respond to professional therapies? And finally, is a request to plan one's death the ultimate reflection of autonomy? The introduction carefully outlines the debate surrounding physician-assisted dying. The authors argue that “physician-assisted dying” is superior to other terms such as physician-assisted suicide. In Section 1, arguments for physician-assisted death are discussed, including the preservation of autonomy, the promotion of mercy, and the importance of nonabandonment, especially at the end of life. Section 2 explores “The Clinical, Philosophical and Religious Issues That Arise at the End of Life.” Sections 3 and 4 present the legal viewpoints and the political perspectives, respectively. Sections 3 and 4 also take the reader through a view of the open practice of physician-assisted death in Oregon and then discuss the resulting legal and political discourse. Well-chosen patient stories, combined with each author's personal exploration of their topic, may move the reader to an intellectual or moral precipice. In Section 1, the chapters on mercy and suffering highlight the quandary facing even experienced clinicians: how to relieve existential angst? This form of suffering usually cannot be quelled through traditional methods of symptom management and may not be reduced by therapeutic discussion, support, and spiritual exploration of the pain. It is this form of suffering which causes the internal stress within the professional caregiver. According to Angell and Cassell, it is the inability of the professional to relieve this suffering that results in the patient's request for physician assistance in dying. The final message of the book is that physician-assisted death is an option of last resort, available only when all other palliative mechanisms fail. This is the intellectual and moral precipice, which requires that the readers reevaluate their individual belief structure and value system as they relate to the question of physician-assisted death. This book is a must read for all who care for patients at the end of life. The book's well-respected, well-known authors openly discuss all of the traditional arguments for and against physician-assisted death. They do so while interjecting the many benefits of the provision of palliative and hospice care at the end of life. The result is a complex intellectual examination of the topic through the use of gripping patient stories, thoughtful arguments, and an eloquent, erudite linguistic style.