Book Review

Life's Dominion: An Argument about Abortion, Euthanasia, and Individual Freedom

N Engl J Med 1993; 329:2043December 30, 1993

Article

Life's Dominion: An Argument about Abortion, Euthanasia, and Individual Freedom
By Ronald Dworkin. 273 pp. New York, Alfred A. Knopf, 1993. $23. ISBN: 0-394-58941-6

Ronald Dworkin is one of the country's leading constitutional scholars, and in Life's Dominion he presents his argument about how the U.S. Constitution should be interpreted when a state seeks to restrict abortion. Dworkin focuses on what he sees as the mismatch between public antiabortion rhetoric and the reality of personal opinion about abortion. In his view, people who describe the fetus as a person and equate abortion with murder cannot really mean what they say (even if they act as if they do in trying to intimidate physicians and their patients). Thus, he argues that the abortion controversy is not about the “derivative” rights individuals have as persons, but is really about different views of the intrinsic value of human life -- the “detached” objection to abortion on the grounds that it undermines the sacredness or sanctity of all human life.

Adopting this detached or sanctity-of-life model leads Dworkin to use analogies based on the creation of a work of art. He argues, for example, that the destruction of art is seen as wrong because it “demeans the creative process.” Likewise, the destruction of human life, at any stage, seems wrong because it “wastes” human life in a way that devalues the sacredness of life and “frustrates” the “investment” made in it. The investment-frustration model helps explain why abortions early in pregnancy are less problematic than late ones, and why the death of a young child is sometimes seen as less traumatic than the death of a teenager.

Government can properly coerce people “to protect certain intrinsic values” (e.g., by collecting tax money for museums). But Dworkin argues that the two things that make abortion unique -- the tremendous impact of pregnancy and the fundamentally religious nature of our views of the intrinsic value of the fetus -- suggest that the government should foster responsible decision making in this realm rather than force a uniform decision on every woman. In the three central and strongest chapters of the book, Dworkin argues that Roe v. Wade was properly decided in 1973 and that the Supreme Court was right to affirm its central holding in Casey in 1993. I entirely agree, but he is naive to think that many, if any, antiabortion adherents or demonstrators will be persuaded by his logic. This book will neither end nor temper the abortion debate as it continues to move out of the courts and into the streets.

The strength of this powerful and intellectually stimulating book is that it requires us to think more deeply and differently about abortion and its relation to other life-and-death issues. Its weakness is its almost obsessive focus on the U.S. Constitution and the role of the state; there is more to life than constitutional law. Dworkin writes, for example, that he wants to learn more about science. But we mistrust him when he states early in the book that he will ignore distinctions biologists make to refer to different phases of fetal life and use the term “fetus” to “refer indiscriminately to all stages.” Physician readers are also likely to find it strange that their profession is seldom mentioned, and that when it is, physicians are seen as essentially irrelevant and described variously as “third parties” and “strangers in white coats.”

Finally, the last two chapters (on euthanasia) are not strong and tend to undercut the much more sophisticated and provocative arguments presented in the rest of the book.

George J. Annas, J.D., M.P.H.
Boston University Schools of Medicine, Public Health, and Law, Boston, MA 02118