Book
Review

Easeful Death. 
Is There a Case for Assisted dying?

Mary Warnock and Elizabeth MacDonald.

Published by Oxford University Press.

Price £12.99

I came to this book with high hopes. For a long while now I have considered one of its authors, Baroness Mary Warnock, a National Treasure. Although a brilliant academic, a distinguished scholar, moral philosopher, teacher and writer, she has inhabited no ivory tower. Braving the political spotlight, she has gone out into the world and addressed the practicalities of life, examining wide and complex social issues with cogency, wisdom, wit, learning, determination and profound humanity. All of this leavened with bracing common sense. We're lucky to have her. 
           
My hopes were high, therefore, and I'm happy to say they've been completely fulfilled. In collaboration with Elizabeth MacDonald, a long-time cancer specialist and teacher of medical ethics, Mary Warnock here comprehensively examines both sides of the current philosophical, medical and ethical debate over the legalisation of assisted suicide and/or euthanasia. The book is short - admirably so, only 139 pages - but does the job better than any other I've come across.  It's a quiet, scrupulously fair account, jargon-free, thumping no tubs and waving no banners, and its principal conclusions are suitably judicious. No answers are going to be easy, one size positively doesn't fit all, there's a lot of thoughtful discussion needed.
     
Ultimately, though, the authors do conclude that a change in the official approach to assisted suicide is both desirable and morally acceptable, and that the British public is ready to support one, provided that any such measure is carefully managed and monitored.
           
As their book jacket declares, 'whatever the results of the legislative argument, compassion must be both the guide and the restraint upon the way we treat people who are dying or who want to die.'
           
Whatever your views, I rate this a must-have book. Every adult in the developed world should read it. I mean that. Obviously its subject is universally relevant, but it's also seriously under-discussed, and of growing importance as medical advances widen our options. Perhaps even more significantly, though, this book also helps us sort out our thinking, not only about its immediate subject, death and dying,  but also about the nature of identity, self, spirit? what life is. What's more,: it never talks down to us.  At every stage the argument is closely case-based, providing recent examples of human situations, conflicts, judgements, and their outcomes. It's also up-to-the minute on current palliative care and possible future developments, and frank about present legal suicide options - self-starvation in particular. It's sympathetic, too, when recording the emotional difficulties experienced by doctors involved in helping to bring about a patient's death.
           
Also, very briefly and usefully, this book examines the record in the Netherlands and North America's State of Ontario, where legislation permitting assisted suicide, with meticulous regulation, has been in operation now for a significant number of years. The results are wholly unsensational. There's been no great flood of suicide-seekers and no sign of pressure being put on vulnerable individuals. Furthermore, of those patients who have gained permission for the measure, only about half have finally taken advantage of it. Many of the remainder, however, have spoken strongly of the comfort the knowledge of its possibility was to them. They no longer need fear a future of unacceptable pain and diminishment.
           
Another thing I like about this book is that these aren't know-it-all authors. Often the problems faced by legislators attempting to frame enactable bills will principally be only linguistic, but in two particular areas Warnock and MacDonald admit that the difficulties lie much deeper. Where  the newborn are concerned, advances in our ability to preserve the lives of severely disabled - or premature - babies often place on doctors intolerable burdens of decision-making.  And in cases where an incurably sick and anguished mental patient begs for assistance in dying, basically unanswerable questions of competence are raised. Compassion is all very well, but what about the rational, informed consent so essential in any assisted suicide decision? 
            
I have just one small criticism of this book: of its title. In the first place, broadly interpreted it signals the authors' eventual reformist conclusions, which might put off potential readers. And secondly, more pickily interpreted, it suggests muddled thinking: we may forgive poor unhappy Keats, in his romantic, poetic way, for blurring the difference between 'easeful' death and easeful dying - especially as he clarifies the situation four lines later when he concedes that being dead involves having 'ceased' and therefore being beyond ease or regret or any other human emotion. After all, we lesser folk often make the same mistake. We pity or envy the dead, imagining their feelings were they still alive. It's understandable, and usually harmless. But not so when we imagine, for example,  the post mortem regrets of a suicide, and use them as a reason to prevent or reverse the act.
           
Bother all that. Title or no title, I urge you to read Easeful Death.  Compassion-based legislation permitting assisted suicide will be hard to write and probably harder to find Parliamentary time for, but if the citizens of  the Netherlands and the American State of Ontario could do it, and apparently so successfully, then so can we..

D G Compton