book reviews

‘civilization’. Prehistoric people did many they may not be. Despite the belief that such another 3 per cent from physician-assisted weird and wonderful things; the way to read wills are legally binding, Woodman claims . This type of reliable empirical this book is as an entertaining and enlighten- they have often been set aside by doctors. research about ‘end-of-life’ decisions ing account of prehistory’s greatest hits. ‘Right-to-life’ movements have mobi- achieves two ends. It provides an evidential John Robb is in the Department of Archaeology, lized in opposition to any attempts to legalize base for ethical discussion and it brings end- University of Southampton, Southampton and physician-. of-life decisions into the open. Openness SO17 1BF, UK. Spearheaded, not surprisingly, by the and transparency must be the best guards Catholic Church, they have been supported against abuse. by organized medicine. Doctors do not wish Woodman has written a readable book to be openly associated with rather about this legal and ethical minefield. H8er Happy endings? than life. Woodman recounts the British journalistic style will not appeal to everyone. Last Rights: The Struggle over the Euthanasia Society’s failed attempts in the However, the book has the advantage of 1930s to have the practice legalized. The starting with the of real people from by Sue Woodman Royal Physician, Lord Dawson, argued then which she attempts to draw general conclu- Plenum Trade: 1998. 293 pp. $26.95 that legalizing euthanasia was unnecessary sions. The result is more powerful than start- John Galloway because good physicians already helped their ing with abstract ethical principles and patients die. However, the desirability of applying these to individual cases. Some “It is silliness to live when to live is torment; doctors acting secretly, above or outside the deaths, like Nancy Cruzan’s, are included and then have we a prescription to die when law, has to be questioned. because they were pivotal in changing the death is our physician.” These words, spoken In the Netherlands until recently, law. Others, like that of Woodman’s aunt, by Roderigo in Othello, are the mainspring euthanasia and physician-assisted suicide are simply an attempt to tell it ‘like it is’. for Last Rights, Sue Woodman’s history of were illegal, but nevertheless practised with Woodman also introduces us to the other ‘right-to-die’ movements. The title is not just increasing openness. The government side of the coin of dying — to crusaders like a neat play on words, but goes straight for the would not legalize either, but only prosecut- the retired US pathologist, , jugular. Last rights, not last rites; end of life ed when doctors failed to abide by strict who helps people die. Working on the decisions by doctors have replaced dying guidelines. However, fears that the entente fringes of the law, he has been tried and with the ‘comfort of clergy’. The secular has between law and medicine was being abused acquitted several times on charges of elbowed aside the spiritual. Why is there still resulted in a series of national studies. The unlawful killing. How much of his success in an issue? Roderigo’s words seem uncontro- first was commissioned in 1990–91 by a avoiding conviction can be put down to the versial. The problem now is that modern committee chaired by the Attorney-General weakness of the law, and how much to his medicine can keep people alive beyond their of the Dutch supreme court and led to new lawyer, Geoffrey Fieger, is itself a significant ‘sell-by date’. On the one hand, people are procedures for reporting end-of-life deci- question. It reminds us that the law is kept physically alive long after their person- sions. Further studies were published in 1996 an imperfect instrument. Enshrining the alities have been destroyed; on the other, and 1997, which showed little change from principle of ‘right to die’ in statute is one some with their mental faculties intact live the earlier studies. In 20 per cent of deaths, a thing; implementing it in a way that delivers lives of dependency and pain. decision had been taken to withdraw or what the ‘right-to-die’ movements want In reality, ‘right-to-die’ movements are withhold treatment. Ten per cent had would undoubtedly be another. about the legal right not to be kept alive at all followed drugs given to relieve pain. Less John Galloway is at the Eastman Dental Hospital, costs, and in extremis the right to be killed or than 3 per cent resulted from euthanasia, and 256 Grays Inn Road, London WC1X 8LD, UK. helped to commit suicide. Put like this, there are clearly issues. Euthanasia is almost uni- versally illegal, but the line between killing and not keeping alive is one that is easily crossed. For many people, removing a feed- ing tube from someone on life-support is not so different from giving an ‘overdose’ of morphine. As a result, medical institutions have often refused to withdraw life-support without court sanction. Courts tend to uphold the opinions of doctors and their medical institutions against the wishes of patients and their families. Woodman points out that it was not until the Patient Self-Determination Act in 1991 that US federal legislation upheld patients’ wishes against those of doctors or medical institu- tions. This may have been triggered by the Nancy Cruzan case. Severely injured in a car crash, Nancy was kept on life-support for eight years until a judge agreed there was ‘clear and convincing’ evidence that she would not have wished to live in a ‘vegetable state’. A popular measure, encouraged in the Shaping the Earth by the Hemlock Society, is the Our knowledge of the remarkable and complex Sington look at these forces and their ‘living will’. This enables people to make forces that have created the Earth we see today interactions in Earth Story: The Shaping of our decisions about their medical treatment continues to grow. Simon Lamb and David World (Princeton University Press, $29.95). while of ‘sound mind’ to cover events when 232 Nature © Macmillan Publishers Ltd 1998 NATURE | VOL 396 | 19 NOVEMBER 1998 | www.nature.com