Richard N. Côté
Mt. Pleasant, SC, Corinthian Books, 2012, xiv + 405 pp., US$29.95, ISBN 9781929175369 hbk, 9781929175437 (Amazon Kindle eBook format) and 978192917537X (generic epub format)
A book review published in Prometheus: Critical Studies in Innovation, Vol. 31, No. 1, 2013, pp. 75-77
Medical technology is making it possible to stave off death ever longer but, for some people with serious health problems, without much quality of life. Palliative care, also using ever more sophisticated medical interventions, can usually minimise pain and other symptoms. Nevertheless, some individuals experience severe ongoing suffering, whether from pain, breathlessness, nausea, indignity or lack of autonomy. They would rather die sooner than later.
For these reasons, euthanasia has become more significant as a social issue. Most church leaders are strongly opposed and so are most governments, though opinion polls show strong support, typically 70 percent or so in favour.
The euthanasia debate is dominated by ethical, medical and legal considerations. Opponents argue that it is wrong to end a person's life prematurely and that legalising euthanasia will open the door to abuses such as killing people with disabilities. Proponents say it is inhumane to force people to suffer when it is their rationally expressed wish to end their life.
The movement for peaceful death has received considerable examination previously (e.g. Hillyard & Dombrick, 2001; Humphry & Clement, 2000; Woodman, 2001). Richard Côté's In Search of Gentle Death is an impressive addition to this genre. Unlike most previous studies, which have focused on events within a single country, Côté surveys a range of countries.
Côté tells what is happening primarily via the stories of key figures in the campaign for peaceful death. These include Derek Humphry in Britain and the US, Jack Kevorkian in the US, Philip Nitschke in Australia and Pieter Admiraal in the Netherlands. Even in countries where there is no single central figure, Côté weaves the story of developments around stories about individuals.
He begins the book with the story of his friend George Exoo, a US clergyman whose efforts to help people die peacefully led to his arrest and imprisonment for four months while a US court considered an extradition request by the Irish government for allegedly 'assisting a suicide' in Dublin in 2002. During Exoo's imprisonment, Côté volunteered to serve as his international media representative, refuting derogatory and sometimes fabricated Irish and British tabloid stories about Exoo. The court eventually ruled against extradition and Exoo was released - by which time Côté had become committed to the struggle.
The personal stories make the book engaging to read. It is a set of narratives, from different parts of the world, combining to create an overall narrative of a struggle for peaceful death.
However, the struggle has not been easy. Though they are ever-present, Côté spends little time analysing the opponents, mainly church and political leaders. His focus is on the proponents of peaceful death, who can be roughly divided into two camps or movement strands. One camp favours the legal route, seeking change in laws via public education, lobbying and rational argument. The other camp, smaller and less well known, pursues the technology route, developing and promoting methods by which people can end their own lives legally and peacefully using easily available, reliable tools.
In most discussions of euthanasia, the options are assumed to be either physician aid-in-dying, in which doctors provide the means for dying (usually drugs) to a patient, who uses them, or active euthanasia, in which doctors end the patient's life directly, typically by an injection of drugs. These discussions take place within the assumption that legal euthanasia will involve one of these two means.
The technology route is quite different: doctors do not have to be involved at all. Instead, people seeking peaceful death obtain the tools themselves, for example buying the drug Nembutal or constructing a clear plastic 'exit bag' and buying containers of helium or nitrogen to use with it. These techniques require some level of knowledge and skill. In the case of Nembutal - which in most countries cannot be legally purchased or imported - it is necessary to know where and how to buy it, how to ensure its potency, how much to take, and what to take beforehand, such as an anti-emetic to prevent vomiting. The technology route thus needs informed guides.
Ending life using the technology route when the motives are rational and well considered is called self-deliverance. It is entirely legal wherever suicide is legal - most countries - and does not implicate others in the crime of 'assisting a suicide'. Furthermore, it is available to others besides those suffering with a terminal illness. However, it has received relatively little attention in most discussions of euthanasia. Côté, though, gives self-deliverance equal billing with the legal reform route. He provides a revealing account of the "NuTech" group of campaigners, from several countries, who first met in the late 1990s to brainstorm technology options and share knowledge about self-deliverance. He has chapters featuring key figures promoting self-deliverance, describing their methods, their assistance to individuals and their run-ins with the law. In Search of Gentle Death is the most comprehensive account available of the NuTech story and the technology route.
However, Côté does not assume that self-deliverance is a better approach: he describes those pursuing the legal route in a sympathetic manner, giving special attention to those places where euthanasia has been decriminalised or legalised, including Australia's Northern Territory (for less than a year in 1996-1997), the countries Netherlands, Belgium, Luxembourg, Switzerland and Colombia, and in the US states Oregon, Washington and Montana. The trajectories in these different places are surprisingly varied; Côté gives a good sense of the special features of each case.
In Search of Gentle Death could be considered a social history. Côté has drawn on many sources. He undertook numerous interviews across the globe and scoured written sources. Given the broad scope of his endeavour, no particular locale receives the in-depth treatment available in some specialist sources, but overall the coverage is impressive. Some topics covered are not readily found in any other such treatment, including the story of Columbia's legal situation and that of end-of-life researcher Russel Ogden, who has encountered obstacles to his scholarly investigations at several universities where he has studied and worked.
Côté does not attempt to provide a structural analysis of the driving forces underlying the euthanasia controversy, such as the medicalisation of dying, the role of religious belief and church hierarchies, the relationship between the individual and the state or the dynamics of social movements, nor does he probe into the complicated ethical and legal debates about life, death and dying. His focus is less on why things are happening and more on what is happening, mainly on the side of right-to-die campaigners. In doing so, he has provided the best available account of the international death-with-dignity movement.
In the final chapter of In Search of Gentle Death, Côté steps away from his usual narrative style and outlines the case for death with dignity, presenting it as the only humane option. His concern is less with confronting euthanasia opponents than with reconciling the split among the proponents between those favouring the legal and technology routes. His plea may not make much difference to campaigners with entrenched positions, but for both them and others, the outstanding value of the book is in portraying what is actually happening, and giving a human face to many of the committed campaigners involved.
Hillyard, D. & Dombrink, J. (2001) Dying Right: The Death with Dignity Movement, Routledge, New York.
Humphry, D. & Clement, M. (2000) Freedom to Die: People, Politics, and the Right-to-Die Movement, St. Martin's Griffin, New York.
Woodman, S. (2001) Last Rights: The Struggle over the Right to Die, Perseus, Cambridge, MA.
Brian Martin
University of Wollongong, Australia