Book Review

Euthanasia and Law in Europe

N Engl J Med 2009; 360:1915April 30, 2009

Article

Euthanasia and Law in Europe
By John Griffiths, Heleen Weyers, and Maurice Adams. 595 pp. Portland, OR, Hart Publishing, 2008. $126. ISBN: 978-1-84113-700-1

Euthanasia and Law in Europe is an examination of physician-assisted dying or physician-performed euthanasia and the laws concerning these practices in European jurisdictions where the issue has been most visible. The authors focus primarily on the Netherlands, where the practice has been open since the early 1980s and fully legal since 2002, and on Belgium, where a law modeled on that of the Netherlands was passed in 2002. They discuss briefly the relevant law and medical practices in several European countries where physician-assisted dying is not legal but nevertheless takes place: England, Wales, France, Italy, Spain, Norway, Denmark, and Sweden. They also examine Switzerland, where assistance from nonphysicians is legal, and which has become controversial for permitting what has been labeled “suicide tourism.”

Euthanasia and Law in Europe is a book of real weight — it is superbly researched, consummately serious, and resolutely unbiased. For these reasons, it is an extraordinarily valuable book, and even though it is about European law and practice, its value is not limited to European readers. It also serves as a model of dispassionate discussion for readers elsewhere, including the United States.

Physician-assisted dying has been legal for a decade in Oregon, and the state of Washington passed a measure that was modeled on Oregon's Death with Dignity Act in the 2008 general election (now in effect). The Netherlands permits both physician-performed active euthanasia and physician-assisted suicide; the Dutch law requires that the patient be facing intolerable suffering but not that the patient be terminally ill, nor even that the suffering be physical. In contrast, the Oregon and Washington statutes permit only the writing of a prescription for a lethal drug but not active euthanasia, they require that the patient be terminally ill, and they make no mention of suffering. Despite such differences between European and American law, the authors demonstrate what is essential in looking at medical behavior that has the potential to shorten life in any jurisdiction — not only ample documentation of the practices themselves, but also attention to the health care systems that are in the background, evidence concerning the effectiveness of the law as an instrument of control, and reactions to aid-in-dying practices from abroad. Dutch euthanasia practices have been subject to virulent criticism from abroad in the past — especially from the United States — but in the view of the authors, such criticism is growing more careful and accurate.

In focusing their analysis, the authors of Euthanasia and Law in Europe make use of four theoretical themes: the emergence and diffusion of euthanasia law, the increase in the number of legal rules and the intensity of their enforcement, the issue of the slippery slope, and a multilayered approach to comparative law that is functional and not formalistic. The book is dense with information about legal, medical, and ethical issues, and heroic attention is given to minute detail — as exemplified in the discussion of the “palliative filter procedure” that was implemented in Belgium to ensure that all pertinent caregivers, including physicians, nurses, and palliative care experts, inform one another when a patient requests euthanasia and inform the patient about options for palliative care. Despite this level of detail, the book is eminently readable, a definitive account of euthanasia practices, and a model for accounts that might be made of similar practices elsewhere.

Margaret P. Battin, Ph.D.
University of Utah, Salt Lake City, UT 84112
battin@utah.edu