The Future of Assisted Suicide and Euthanasia by Neil M. Gorsuch: A Book Review

The issue of doctor-assisted suicide first came to my attention in 1990-91. My psychologist brother, Dr. Ron Newman, Ph.D. and I were in the process of outlining a book proposal on the topic of suicide, in part because we had both been affected by the suicides of people close to us personally and in part because we desired to help bring comfort to those with broken wings who've been left behind to shoulder the aftermath. While outlining our book and organizing our thoughts, someone asked a critical question that neither of us had yet considered. Dr. Kevorkian had begun making headlines at the time, but I'd never connected it to our theme until asked, "What about doctor-assisted suicide?"

The end result of that single question was a year-long project of researching and writing a series of articles on Ethical Issues In Terminal Health Care. The fifth article in the series addressed the pros and cons of physician-assisted suicide, with insights that I believe continue to remain relevant.

Against this backdrop it caught my attention when Neil M. Gorsuch was being considered as a Trump nominee for the Supreme Court, especially when I learned that in 2006 he had authored a book titled The Future of Assisted Suicide and Euthanasia. (He is now a seated Justice on the bench.)

Justice Gorsuch has impressive credentials in both his education and experience. It should be noted that impressive credentials doesn't necessarily make one correct since people with brilliant minds and excellent cred exist on both sides of most arguments. Trivia note: He went to Harvard as a classmate of President Obama. A little over a dozen years ago he went to England to do research on assisted suicide and euthanasia and received his Doctor of Philosophy degree in law from University College, Oxford. This book summarizes what he learned and his conclusions on this topic.

In the introduction Gorsuch summarizes the two purposes of this book in this manner: "to introduce and critically examine the primary legal and ethical arguments deployed by those who favor legalization, and to set forth an argument for retaining existing law that few have stopped to consider. It aims to be of interest to all of those curious about the ethical and legal aspects of the assisted suicide debate, whatever views they espouse, and contribute to a fuller and more fully informed debate."

Eugene Volokh of the UCLA School of Law affirmed that the book did just that, calling it
"a thoughtful, sober, and thorough work, which should be read by supporters, opponents, and the undecided alike."

I see it the same way. The book achieves exactly what the author set out to do, presenting a thoroughly researched history of the issues pertaining to suicide and assisted suicide as well as a careful dissection of each of the arguments which advocates have used to win public opinion and move the needle toward a more widespread acceptance.

When I looked at the ratings of the book's reviewers, I was surprised at how strong the negative sentiment was. A full 36% gave the book a one-star rating. Why is the book so strongly criticized? Two reasons. First, he draws conclusions that pro-assisted-suicide troops disagree with. Second, Gorsuch draws a connection between the current euthanasia movement and the eugenics* societies and social Darwinists of the 20's and 30's. This latter may be why some of the railing against the book, by detractors, is so visceral.

Currently five states (California, Oregon, Washington, Colorado, Vermont) and the District of Columbia have legalized physician-assisted suicide. Several other states are reviewing legislation that has been proposed. The topic is relevant and important, especially as more Baby Boomers enter their twilight years.

When I wrote about these matters in the 90's I summarized the pros and cons into what I believed were a succinct set of self-evident observations that I titled Making The Final Choice: Should Physician-Assisted Suicide Be Legalized?.

Gorsuch has distilled a tremendous quantity of research into an organized presentation, providing historical context as well as lucid examination of the nuanced ethical issues that surround this subject. Even if you disagree with his conclusions, I've yet to see a better summary of the primary arguments and their historical antecedents. Here are what some of the reviewers have written at Amazon.com:

This book is written for the general reader rather than the historian, academician nor lawyer. It was a quicker read than I'd anticipated. Statistics are digested and presented in easy to read tables. Vocabulary is distinctly easy to comprehend, confirming my suspicion that there are still some lawyers left in the world who speak English as a native language. --invisible

Legal scholar, and now (EdNote: in 2007) Federal Appeals Court Judge, Neil Gorsuch has written a comprehensive study of the legal and moral issues in the physician assisted suicide debate. This is the right book at the right time because the practical consequences of mindless "reform" have been largely ignored in the current discussions. The author's detailed descriptions of what has actually happened in Oregon and in the Netherlands which have legalized assisted suicide are especially helpful. The author also presents medical evidence from respected sources including the Journal of Clinical Oncology showing that the major motivation behind physician assisted suicide is not unbearable pain but clinical depression. --Robert O Devries

Most of the one-star reviews were also one-sentence dismissals. "This book is terrible." and "Don't waste your time." Still, there were a few reviewers who simply disagreed with his arguments and took the time to lay out their reasons. I believe the book is  worthwhile read for anyone on either side of this issue who seeks to be more informed.

Available here on Amazon.com.


*Eugenics is a topic I've previously written about here on this blog. Our history prefers to sweep certain inconvenient realities into the shadows, including the dark side of Social Darwinism. Here are three articles from 2010 and 2012.
Bad Ideas: the Eugenics Movement in America
Eugenics Revisited

Why Physician Assisted Suicide Has Been Legalized

Yesterday I wrote about Ludwig Minelli and Dignitas, an organization is Switzerland devoted to helping people die. Euthanasia is a subject I wrote about in the early nineties when Dr. Kevorkian was a hot topic in the news. Physicians have always wrestled with the ethical issues surrounding terminal health care, but with technical advances in modern medicine many new questions have arisen.

Some things have changed since I wrote those articles in '92. One is that suicide or attempting suicide in North America is no longer against the law. If you fail to die when you jump off a building, at least you don't have to worry about also going to court.

In addition, three states have now passed laws permitting physician assisted suicide. Oregon's law went into effect in 1997, the first in this country. Washington passed its own "Death with Dignity" bill the following year. And on the very last day of 2009 Montana's Supreme Court handed down a decision that legalized physician assisted suicide in that state.

California, Maine and Michigan have all experienced failed ballot inititiatives and 75 legislative attempts were defeated in 21 states.

When you get into reading all the literature on this topic, there are four primary arguments for legalizing physician-assisted suicide. Here's how I summarized them in my article The Pros and Cons of Doctor Assisted Suicide.*

l. The Mercy Argument, which states that the immense pain and indignity of prolonged suffering cannot be ignored. We are being inhumane to force people to continue suffering in this way.

2. The Patient's Right to Self-determination. Patient empowerment has been a trend for more than twenty-five years. "It's my life, my pain. Why can't I get the treatment I want?"

3. The Economics Argument, which notes that the cost of keeping people alive is exceedingly high. Who's footing the bill for the ten thousand people being sustained in a persistent vegetative state? Aren't we wasting precious resources when an already used up life is prolonged unnecessarily?

4. The Reality Argument runs like this: "Let's face it, people are already doing it."

The combined effect of these four arguments is persuasive. And many people I talk to have been persuaded by them. They can't imagine why we have waited so long to make this an alternative treatment option. The need for legalized physician-assisted suicide is self-evident, they conclude.

On the other hand, whenever I have presented the arguments in opposition to these apparently self-evident truths, I invariably hear an "A-ha!" and an "Oh!" and "Well, I never considered..."

If able, please bookmark this page and re-visit my site tomorrow for the other side of the story.

*Published in the Truth Seeker (Volume 121 No. 5)