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Doody's Review ServiceReviewer: Gina M Fullam, BS (Saint Louis University)
Description: The authors of this book present and apply what they call a common-sense ethic to end-of-life issues: withdrawal of life-sustaining treatment, physician-assisted suicide, euthanasia, and vital organ donation.
Purpose: The stated purpose is to dispel the intellectual incoherency and dishonesty of the current discussion and policy on death and vital organ donation, while creating an ethical space for physician-assisted suicide, euthanasia, and live donor vital organ donation. The project is controversial both in its conception and argumentation.
Audience: The audience is unclear. At various points, the authors issue direction to academic bioethicists. However, they presumably direct historical overviews and other background material throughout the book to the general public. In addition, the authors state that their presentation is "bias-free." This statement, as well as their tone and starting assumptions, suggest their intended audience is one that already agrees with them or one that is unfamiliar with the viewpoints with which they take issue and thus is easily persuaded. While the authors are certainly qualified to write this book, their one-sided presentation, combined with lack of clear audience, make suspect their intention of, and success in, producing a bias-free publication. Importantly, they are perhaps insufficiently sensitive toward public trust or distrust of palliative care and organ donation.
Features: The authors first examine the practices of, and justification for, withdrawal of life-sustaining treatment, physician-assisted suicide, and euthanasia. They then apply the arguments they develop in the early chapters to organ donation, and offer both an ideal and a pragmatic way forward in end-of-life discussion and policy. The crux of their argument is that the time has come to abandon the traditional norm against clinicians intentionally causing the deaths of their patients, and thus the dead donor rule for vital organ donation. They aim to demonstrate that this shift in norms has in fact already occurred, despite language and policies suggesting otherwise. Unfortunately, the presentation of many unsupported assumptions undermines their argument. Moreover, they do not accurately characterize or adequately respond to certain objections.
Assessment: Although the authors draw extensively from their argumentation in published articles, this is their first full-length presentation. Despite notable shortcomings, their argument should be taken seriously by academic bioethicists. At the very least, their challenge can help those who disagree with them to be more precise in their own arguments.