Ending Life: Ethics and the Way We Die
http://www.100md.com
《新英格兰医药杂志》
Despite the fact that the United States has millions of uninsured citizens, despite abundant evidence of unequal access to care, and despite the enormous expenditures for medical care at the end of life, assisted suicide and euthanasia are the ethical problems that have brought medical ethics to the forefront. The intellectual underpinnings of the debate about death — whether how we die is something we can control by exercising our autonomy or whether death is something that happens to us that we must simply accept — are presented in this book with clarity and passion.
Battin presents a series of essays and stories covering various aspects of the debate. The first section of the book focuses on the ethical principles that are in conflict and on why the issue is so recalcitrant to resolution or consensus. The roots of the debate are traced to the conflict between the Stoic view, expressed by Seneca, that what matters is how well one lives, not how long one lives, and the theistic belief that life is divinely given and can only be divinely taken away. According to the Stoic position, there is individual responsibility for one's life and how it is lived, with the corollary responsibility to seek a good death when life is going badly. According to the theistic point of view, it is a mortal sin to seize control over one's life and death, since this power belongs only to the creator. The current debate about embryonic stem-cell therapy has its origins in these two ancient schools of thought.
The second section contains a fascinating review of the primary texts concerning the ethics of suicide, from ancient Egypt, Greece, and Rome and virtually every other major civilization and religion in recorded history. The diversity of these cultural views has implications not only for the question of assisted suicide in terminal illness, but also for suicide as a form of social protest (hunger strikes) and its use in military tactics (suicide bombing and jihad). The medicalization of suicide (the view that all suicides are, by definition, due to psychopathology) has obvious limitations in explaining suicide as self-sacrifice for purposes of protest or battle.
The third section follows these historical threads into the near future. The possibility of genetic prognostication — the ability to predict when and of what we will die, so that we may live fully beforehand — is presented as a social good, in sharp contrast to the prevailing denial of death and the associated shock and surprise when it comes (as it inevitably does). The more likely eventuality of ever-longer lives and ever-longer periods of incapacity before death is labeled burdensome and undesirable and implies a sound social basis for the legalization of physician-assisted death. The moral obligation to distribute world resources equitably is similarly viewed as a plausible basis for a duty to die — whether by suicide or by declining life-sustaining treatments in old age. Finally, the so-called self-deliverance industry is already busy developing means of suicide that are not dependent on physicians or drugs, rendering moot the question of legalization. Such an industry is linked to a long American tradition of self-determination.
This book, which is engaging, erudite, and often funny, is a fascinating review of the history and implications of the debates — both medical and military — about suicide. Religious leaders, policymakers, health professionals, the sick, and the worried well will find these essays helpful in the effort to extract meaning and morals from modern life and its variety of deaths.
Diane E. Meier, M.D.
Mount Sinai School of Medicine
New York, NY 10029(By Margaret Pabst Battin.)
Battin presents a series of essays and stories covering various aspects of the debate. The first section of the book focuses on the ethical principles that are in conflict and on why the issue is so recalcitrant to resolution or consensus. The roots of the debate are traced to the conflict between the Stoic view, expressed by Seneca, that what matters is how well one lives, not how long one lives, and the theistic belief that life is divinely given and can only be divinely taken away. According to the Stoic position, there is individual responsibility for one's life and how it is lived, with the corollary responsibility to seek a good death when life is going badly. According to the theistic point of view, it is a mortal sin to seize control over one's life and death, since this power belongs only to the creator. The current debate about embryonic stem-cell therapy has its origins in these two ancient schools of thought.
The second section contains a fascinating review of the primary texts concerning the ethics of suicide, from ancient Egypt, Greece, and Rome and virtually every other major civilization and religion in recorded history. The diversity of these cultural views has implications not only for the question of assisted suicide in terminal illness, but also for suicide as a form of social protest (hunger strikes) and its use in military tactics (suicide bombing and jihad). The medicalization of suicide (the view that all suicides are, by definition, due to psychopathology) has obvious limitations in explaining suicide as self-sacrifice for purposes of protest or battle.
The third section follows these historical threads into the near future. The possibility of genetic prognostication — the ability to predict when and of what we will die, so that we may live fully beforehand — is presented as a social good, in sharp contrast to the prevailing denial of death and the associated shock and surprise when it comes (as it inevitably does). The more likely eventuality of ever-longer lives and ever-longer periods of incapacity before death is labeled burdensome and undesirable and implies a sound social basis for the legalization of physician-assisted death. The moral obligation to distribute world resources equitably is similarly viewed as a plausible basis for a duty to die — whether by suicide or by declining life-sustaining treatments in old age. Finally, the so-called self-deliverance industry is already busy developing means of suicide that are not dependent on physicians or drugs, rendering moot the question of legalization. Such an industry is linked to a long American tradition of self-determination.
This book, which is engaging, erudite, and often funny, is a fascinating review of the history and implications of the debates — both medical and military — about suicide. Religious leaders, policymakers, health professionals, the sick, and the worried well will find these essays helpful in the effort to extract meaning and morals from modern life and its variety of deaths.
Diane E. Meier, M.D.
Mount Sinai School of Medicine
New York, NY 10029(By Margaret Pabst Battin.)