'...not just the premier Christian bioethics institute in Britain,
but one of the finest in the world, Christian or secular'
Most Rev. Anthony Fisher O.P., Auxiliary Bishop of Sydney
Euthanasia, Clinical Practice and the Law
The first part of this volume contains a reprint of the important Linacre Centre Working Party Report on Euthanasia and Clinical Practice first published in 1982.
The second part of the volume contains the substantial Submission made on behalf of The Linacre Centre to The House of Lords' Select Committee on Medical Ethics (1993), together with studies on 'Living Will' Legislation, the BMA Report on Euthanasia and the practice of euthanasia in Holland.
Book One: Euthanasia and Clinical Practice; Trends, Principles and Alternatives. A Working Party Report (1982)
Book Two: Euthanasia and the Law: The Case Against Legalisation
"A collection of very valuable materials, including the 1993 testimony to the House of Lords' Select Committee on Medical Ethics, which helped persuade the committee to conclude unanimously that euthanasia and assisted suicide should not be legal in the U.K. In addition, there are philosophical and theological examinations of euthanasia, together with an informative update on legal trends and medical practices in the Netherlands."
"... an impressive volume ... the approach used in the volume as a whole is in line with the Linacre Centre's stated aim to make intelligible to non-Christians (and non-Catholics, for that matter) the Church's moral teaching in its bearings on the practice of medicine. This is the common morality, whose central tenets belong to the moral heritage of civilised societies.... Anyone willing to see argument met with argument will benefit from reading this book."
"This book is a wonderful antidote for anyone tempted to despair of the obfuscation, duplicity and just plain muddleheadedness of many of the participants in the public debate about euthanasia..... If you are interested in the debate over euthanasia (and none of us can afford not to be) beg, borrow or buy this book."
"A splendid pro-life book, which has already had striking influence in England, is now available here. It will brace the spirits of anyone working to halt ongoing lethal assaults against the unborn and the debilitated. Though focused on euthanasia, many of the volume's most striking passages, e.g. about the limits of civil authority and the intrinsic value of human life, are of real value to persons working against abortion.
Pro-lifers understandably feel that the news media and the world of scholarship are arrayed on the side of death... In the academic world, even as interest in euthanasia runs at fever pitch and ringing endorsement of 'cultural diversity' resound, current medical ethics texts crowd into an astonishingly narrow band on the spectrum of positions and perspectives. With one or two isolated exceptions, the available texts run the gamut of positions from Y to Z: from authors who argue for active euthanasia to those whose dissent consists in defending passive euthanasia.
Onto this bleak scene arrives a remarkable book... It contains a wealth of valuable analyses and strong arguments against euthanasia. Gormally and the other distinguished authors represented in the book are first rate scholars and resolute defenders of the vulnerable."
"... a case is made powerfully against euthanasia and against those who appear to use quality of life yardsticks of human worth."
"The text is written in a very lucid fashion, and therefore anyone with an interest in the subject will find it of help."
"Several of the views expressed in this book seem to have impressed the select Committee of the House of Lords and are reflected in the Committee's recommendations, which in turn have been broadly endorsed by the Government. As a result, the book may be of interest, not merely as one contribution among many to the euthanasia debate in general, but also as a briefing document instrumental in shaping Government legislative policy."
"The book on euthanasia that those of us who work in bioethics always recommend-and refer to ourselves time and again as the best ever statement of the classical position was published in 1982 by the Linacre Centre. Euthanasia and Clinical Practice has become 'a classic' not just among Catholic cognoscenti but more widely, for instance on the course lists of secular universities. ...that its relevance endures despite the passing fashions in bioethics and the new directions in the euthanasia debate is a tribute to the authority not just of its authors but of their arguments.
One 'gap' in the 1982 work was its focus on ethical and clinical concerns to the exclusion of legal and political ones. That lacuna has now been filled by Gormally, Finnis and Keown's submission on behalf of the same Centre to the House of Lords Select Committee on Medical Ethics. This work is unparalleled for its professionalism among the submissions made by church groups to state authorities, and even those who were not in full agreement with its views recognized that it was the single most influential submission of the hundreds the Lords received. Its arguments (and very words) are in evidence in the best parts of the Lords' report.
Now the two reports (the first of which has been out of print for some time) have been published together in Euthanasia, Clinical Practice and the Law. The new book will undoubtedly be once again the classic in its field. As well as the two reports, this new volume includes articles by Finnis on living will legislation (which demonstrates what a mine field this is), by Gormally on the BMA's case against euthanasia (which it finds wanting in significant respects), and by Keown on the situation in Holland (which dispels widespread illusions about Dutch euthanasia practice).
Book One begins by identifying the trends, issues and confusions in the euthanasia debate. It then looks at euthanasia in five specialised fields of clinical practice - care of the newborn, the handicapped, the dying, the elderly and intensive care - and the thinking behind each. Several influences alien to traditional medical ethics are identified: utilitarianism, individualism, social Darwinism, pluralism, the pro-euthanasia lobby, and economic factors. In the time since writing this book two of these have come particularly to the fore: individualism (under the slogan of autonomy) and economics (under the slogan of healthcare rationing). The book then presents a classical philosophical and theological analysis of euthanasia, arguing from the point of view of the first that euthanasia is no good exception to the norm against killing the innocent, and from the perspective of the second, that it is a breach of a divinely-given trust. Thereafter follow some important clarifications of the right to refuse treatment, the distinction between 'ordinary' and 'extraordinary' means, and duties toward incompetent patients. Finally some excellent practical advice is offered to healthworkers on good practice in dealing with dying and incapacitated patients and in various specialised fields of care.
This book insists, against common misconceptions of the classical and Christian position, that doctors ought neither to undertreat nor to overtreat their patients. There may be good reasons to discontinue or to withhold certain available treatments, without buying into a homicidal or suicidal mind-set or behaviour: treatment may be futile; it may be overly burdensome (in terms of associated pain, indignity, risk, cost...); or (and here the authors charter relatively new territory) the patient may have made a reasonable judgment that he or she does not have an obligation to seek to prolong life, (e.g. where life is wretched one has no special responsibilities to others, and death is imminent: pp.64-66). Catholics and other 'pro-lifers' do not cling to a survival-at-any-costs ethic: quite the contrary, such an approach can well be due to therapeutic obstinacy, a refusal to face up to the limitations of healthcare and human mortality, a product more of despair than respect for life. Death is an evil, but not the greatest evil. For many people it is a merciful release, the natural end to a life-story well-written and, as we believers claim, the door to eternal life. So while one should always value the gift of life, the time may come when one is no longer obliged to take such strenuous efforts to prolong it; the focus of attention may properly become one on managing pain and dying well.
When Book One was first published a Catholic reader might have been surprised by how little consideration was given to the 'proportionalist' (or Christian utilitarian) case for euthanasia, a position which writers such as Mahoney, Anscombe and Finnis would have been well-placed to present and critique. But given how little influence proportionalism has had outside the Catholic ghetto, the fact that it has now rather 'had its day', and the excellent treatment of proportionalism's secular cousins in Books One and Two, this proves in hindsight to be no drawback. Furthermore the work has the admirable feature of relying entirely on the 'common morality' implicit in many of the great world religions, the secular enlightenment, the international covenants on human rights, the common law, and the tradition of medical ethics stretching back at least to Hippocrates and forward at least to the modern declarations of world and local medical associations.
The note at the end of Book One, on the Arthur Case, might suggest that the volume would have benefited from a similar note on the Bland Case, and perhaps some of the other British and American cases in this area. But Book Two certainly points us in the right direction by presenting a most powerful case against the legalisation of euthanasia, both voluntary and involuntary. There is a cogent restatement of the basis and content of traditional medical ethics, a critique of influential pro-euthanasia writers such as Dworkin and Warnock, an analysis of the pre-eminent themes in the current debate (dignity, dualism, autonomy...), recommendations regarding appropriate care of PVS patients, and an exploration of the roles of living wills, proxies, 'responsible medical opinion' and the courts. The Centre's 1982 position is greatly strengthened by reflection upon data of recent experience: the outstanding successes of Britain's hospice movement and the appalling failure of the Dutch euthanasia experiment.
As a work of modern apologetics and polemics (in the good sense of each) this volume is a model: forthright yet balanced, fair to opponent views, analytically precise, well evidenced, compassionate, immensely persuasive. Yet as the authors recognize, "it is not to be expected that in a pluralistic culture the insights into the nature of human existence on which the tradition of common morality depends will come easily to all readers, even to all Christian readers." For all that, "unless these insights are reappropriated and medicine honours the traditional conception of human dignity, it is difficult to see what in principle stands in the way of a repetition of the historical betrayal of medicine that took place in Germany in the second quarter of this century" (p.12).
This new volume is a representative fruit of a foundation which has built a reputation not just as the premier Christian bioethics institute in Britain, but as one of the finest in the world, Christian or secular. All this despite resources so meagre it should make the Catholic community blush. Bravo, Linacre Centre."
The Linacre Centre for Healthcare Ethics
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