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EthicsUpdates Lawrence M. Hinman, editor 

Decisions at the End of LifeUnder Construction

Although I hope that you individually will not have to face directly questions about your own death until many years from now, it is clear that almost all of us face such questions in regard to those we love--grandparents, aunts and uncles, perhaps parents or even siblings. Dying, as we shall see in this section, is often a family affair.

One of the most difficult decisions in the process is the transition from aggressively treating the patient's diease to trying to make the patient's final final as peaceful, pain-free, and satisfying as possible.  Often aggressive treatments at the end of life fail to extend life but produce pain and discomfort during the remaining time.  Increasingly, palliative care and hospice seek to make that remaining time as pain-free as possible and to make that time as possible.

The fifth edition of this book expands the focus of the chapter to larger issues of death and dying, not just issues of physician-assisted euthanasia. What is a good death?  What, more specificially, is a good death for you, or for me?  Many of us might want to say that there is no such thing as a good death, but the incontrovertible fact is that each of us will die.  And we ignore the question of how we want to die at our own peril.  We are then more likely to die the way someone else (a doctor, a hospital, an insurance company, a relative) wants us to die than the way we want to die ourselves. There is an art to dying--the medievals called it the ars moriendi, the art of dying.  Given that we have no choice about facing death, the question becomes how we can face it well. 



  • Ezekiel J. Emanuel, “Why I Hope to Die at 75.” The Atlantic Oct. 2014.  Zeke Emanuel is a noted bioethicist and oncologist, and in this piece he argues that we should avoid going down the path of physician-assisted dying, but we should not attempt to extend life at any cost.  Indeed, Emanuel argues that after a certain point, living too long can be just as much a loss as dying too young.  Also see his article, "Whose Right to Die?" The Atlantic, March 1997, for a series of arguments against physician-assisted dying.
  • Atul Gawande, Being Mortal: Medicine and What Matters in the End This is a superb book, blending Gawande's narrative about his physician father's death and the changing face of death in contemporary medicine.  Gawande, a practicing surgeon from Harvard Medical School and a regular contributor to The New Yorker, is a keen, thoughtful observer.  There is much to learn from this fine book. Also see Atul Gawande "Being Mortal: Medicine and What Matters in the End" MacLean Center.  Oct 27, 2014.   Gawande discusses his book, sharing personal experiences of his father's death as well as the perspective of a practicing surgeon.  Not to be missed. 
  • Henig, Robin Marantz. “A Life-or-Death Situation.” New York Times Magazine 17 July 2013. Web. <>."As a bioethicist, Peggy Battin fought for the right of people to end their own lives. After her husband’s cycling accident, her field of study turned unbearably personal." Also see Henig's follow-up piece: Henig, Robin Marantz. “Choosing to Die After a Struggle with Life.” The New York Tim,es 21 Aug, 2013. Battin is the author of several books on death and dying, including Ending Life: Ethics and the Way We Die (New York: Oxford University Press, 2005).

Room for Debate: Expanding the Right to Die.  New York Times. Contributors to the debate, representing various sidethis this issue.

Elizabeth Kübler-Ross, On Death and Dying. (1968)  One of the most influential books on the topic, Kübler-Ross's On Death and Dying introduced the concept of the five stages of grief and loss. 

The Data


Gallup Research 

The Narratives

See the Bill Moyers video listed under "Videos."

The Law

State-by-State Guide to Physician-Assisted Suicide

Source: Wikipedia

Court Decisions

Legislative Information

The Oregon Death with Dignity Act

State-by-State Guide to Physician-Assisted Euthanasia Laws

Other Basic Documents Relating to Euthanasia

The Issues

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Many who are concerned with issues of disabilities are highly critical of calls for the legalization of physician-assisted dying, often concerned that people with disabilities will be urged (or worse) to end their lives early.  See the group, Not Dead Yet, "a national, grassroots disability rights group that opposes legalization of assisted suicide and euthanasia as deadly forms of discrimination." Nat Hentoff has been a strong voice in opposition to the legalization of euthanasia.

In her book On Death and Dying, Kübler-Ross suggests that we go through five stages in coming to terms with dying:

  1. Denail and isolation;
  2. Anger;
  3. Bargaining;
  4. Depression;
  5. Acceptance.



Stanford Enclyclopedia of Philosophy    This is the single best online resource in philosophy.  The articles are carefully done and meticulously reviewed and are updated as needed.  The model for an online encyclopedia.

  • Young, Robert, "Voluntary Euthanasia", The Stanford Encyclopedia of Philosophy (Summer 2016 Edition), Edward N. Zalta (ed.), URL = <>.
  • Cholbi, Michael, "Suicide", The Stanford Encyclopedia of Philosophy (Summer 2016 Edition), Edward N. Zalta (ed.), URL = <>.

Web Sites Relating to Euthanasia

  • ProCon site on Euthanasia. An excellent starting point
  • Information on euthanasia, right-to-die, mercy killing, living wills, etc. "On this Web site we will provide information on the issue of euthanasia in the modern world. We are committed to the fundamental belief that the direct killing of another person is wrong. We have deep sympathy for those people who are suffering."
  • Patients Rights Council .  A rich set of resources.  The site features speakers who are generally strongly opposed to assisted suicide.
  • Compassion in Dying. Website of the organization that "brought two landmark legal challenges to achieve Constitutional protection for personal liberty and dignity at the end of life." Includes extensive links to materials on both the Washington case and the Quill case.
  • CURE -- Citizens United Resisting Euthanasia a grassroots advocacy network that defends the rights of patients to receive medical treatment, particularly when care is critical.
  • ERGO! Information Center, The Euthanasia Research and Guidance Organization maintains a site with extensive bibliography, court decisions, and links.
  • ERGO!'s Euthanasia World Directory includes links, bibliography, and extensive coverage of recent news articles.
  • The Ohio Right to Life Page on Euthanasia
  • "Euthanasia: The Debate Continues", a philosophical debate between Bob Lane and Richard Dunstan on the morality of euthanasia
  • Scottish Voluntary Euthanasia Society Homepage. Voluntary Euthanasia Society of Scotland. Excellent set of resources.
  • The WEBster: Death and Dying. An extensive list of resources related to death, dying, and grief.
  • Death in American Reader. This is a regularly-updated listing of new articles dealing with end-of-life decisions.

Selected On-Line Full Text Articles Relating to Euthanasia and End-of-Life Decisions

A Bibliographical Survey of Selected Philosophical Literature on Euthanasia Hinman, Contemporary Moral Issues.  4th edition.

Biliographical essays are drawn from Lawrence M. Hinman, Contemporary Moral Issues, 4th Edition


In addition to the standard journals in ethics mentioned in Chapter One, see The Hastings Center Reports, The Journal of Medicine and Philosophy, Bioethics, and The Kennedy Institute of Ethics Journal.


There are several very helpful anthologies that deal with euthanasia. Beneficent Euthanasia, edited by Marvin Kohl (Buffalo: Prometheus Books, 1975) contains a very good range of pieces; Ethical Issues Relating to Life and Death, edited by John Ladd (New York: Oxford University Press, 1979); Euthanasia: The Moral Issues, edited by Robert M. Baird and Stuart E. Rosenbaum (Buffalo: Prometheus Books, 1989) contains a nice balance of philosophical and popular pieces; Euthanasia: Opposing Viewpoints, edited by Carol Wekesser (San Diego: Greenhaven Press, 1995) also contains a good balance of philosophical and popular pieces, all in relatively short segments. Also see, Voluntary Euthanasia, edited by A. B. Downing and Barbara Smoker (London: Peter Owen, 1986), which includes a number of important essays, including an exchange between Yale Kamisar and Glanville Williams; and The Dilemmas of Euthanasia, edited by J. A. Behnke and Sissela Bok (New York, 1975); and Suicide and Euthanasia, edited by Baruch Brody (Dordrecht: Kluwer).. On the distinction between killing and letting die, see Killing and Letting Die, edited by Bonnie Steinbock and Alastair Norcross, 2nd edition (New York: Fordham University Press, 1994), which contains virtually all the major essays on this topic; it also contains an excellent bibliography.

Review Articles

For an excellent survey of the philosophical issues (and a very helpful annotated bibliography), see Marvin Kohl, "Euthanasia," Encyclopedia of Ethics, edited by Lawrence C. Becker and Charlotte B. Becker (New York: Garland, 1992), pp. 335-39.

Journal Articles

The distinction between active and passive euthanasia was seriously question in our selection from James Rachels, "Active and Passive Euthanasia," New England Journal of Medicine, Vol. 292, No. 2 (January 9, 1975), pp. 78-80. Rachels position has been criticized by a number of philosophers, including Tom L. Beauchamp, "A Reply to Rachels on Active and Passive Euthanasia," in Social Ethics, First Edition, edited by Thomas A. Mappes and Jane S. Zembaty (New York: McGraw-Hall, 1977), pp. 67-76; Thomas D. Sullivan, "Active and Passive Euthanasia: An Impertinent Distinction?", in Social Ethics, Fourth Edition, edited by Thomas A. Mappes and Jane S. Zembaty (New York: McGraw-Hall, 1992), pp. 115-21; Rachels' reply to Sullivan in variously reprinted, including in Mappes and Zembaty's Social Ethics, Fourth Edition, pp. 121-31. Also see Bonnie Steinbock, "The Intentional Termination of Life," Ethics in Science and Medicine, Vol. 6, No. 1 (1979), pp. 59-64.

Among the important philosophical essays, see Philippa Foot, "Euthanasia," reprinted in her Virtues and Vices (Berkeley: University of California Press, 1978), pp. 33-61; Judith Jarvis Thomson's "Killing, Letting Die, and the Trolley Problem," and "The Trolley Problem," reprinted in her Rights, Restitution, and Risk, edited by William Parent (Cambridge: Harvard University Press, 1986), pp. 78- 93, 94-116; in "Euthanasia: A Christian View," Philosophic Exchange, Vol. 2, No. 2 (1975), pp. 43-52, R. M. Hare develops a version of the Golden Rule argument against euthanasia.


Among the philosophical books devoted primarily to euthanasia and decisions at the end of life, see especially James Rachels, The End of Life: The Morality of Euthanasia (New York : Oxford University Press, 1986); Fred Feldman, Confrontations with the Reaper: A Philosophical Study of the Nature and Value of Death (New York: Oxford University Press, 1992); Jay F. Rosenberg, Thinking Clearly about Death (Englewood Cliffs, N.J.: Prentice-Hall, 1983); Marvin Kohl, The Morality of Killing: Sanctity of Life, Abortion, and Euthanasia (New York, Humanities Press, 1974); Kenneth L. Vaux, Death Ethics: Religious and Cultural Values in Prolonging and Ending Life (Philadelphia: Trinity Press International, 1992); Daniel Callahan, Setting Limits. Medical Goals in an Aging Society (New York: Simon and Schuster, 1987); and Margaret Battin, The Least Worst Death: Essays in Bioethics on the End of Life (New York: Oxford, 1994).

Among the more popular literature on euthanasia, see Derek Humphrey's Final Exit: the Practicalities of Self-deliverance and Assisted Suicide for the Dying (Eugene, Ore.: Hemlock Society, 1991). Perhaps the most (in)famous public figure in this area is Jack Kevorkian; see Prescription& endashMedicide : the Goodness of Planned Death (Buffalo, N.Y.: Prometheus Books, 1991). For a much more moderate voice, see C. Everett Koop, The Right to Live, the Right to Die (Wheaton, Ill.: Tyndale House Publishers, 1976). In Death and Dignity. Making Choices and Taking Charge (New York: W. W. Norton, 1993), Timothy E. Quill, M.D. argues, at least in part on the basis of his experience as a hospice director, in favor of physician-assisted euthanasia; for an interesting contrast, see Euthanasia Is Not the Answer: A Hospice Physician's View, by David Cundiff. (Totowa, N.J.: Humana Press, 1992)

On the Nazi euthanasia program, see most recently Michael Burleigh's Death and Deliverance (Cambridge: Cambridge University Press, 1994) as well as Robert Jay Lifton's The Nazi Doctors (New York: Basic Books, 1986).


There are a number of excellent anthologies of selections dealing solely with the issue of suicide. These include: On Suicide, Introduction by Robert Coles, edited by John Miller (San Francisco: Chronicle Books, 1992); and Essays in Self-Destruction, edited by Edwin S. Shneidman (New York: J. Aronson, 1967). For a more strictly philosophical approach, see the anthologies Suicide, the Philosophical Issues, edited by M. Pabst Battin and David J. Mayo (New York: St. Martin's Press, 1980) and Suicide: Right or Wrong?, edited by John Donnelly (Buffalo: Prometheus Press, 1990) for excellent selections of philosophical works on suicide.

A. Alvarez's The Savage God: A Study of Suicide (New York, Random House, 1972) is a classic study. On the effects of depression, see especially William Styron, Darkness Visible (New York: Random House, 1990).

Among contemporary philosophical approaches to suicide, see the interesting contrast between the Kantian approach of Thomas E. Hill, Jr., "Self-Regarding Suicide: A Modified Kantian View," Autonomy and Self-Respect (Cambridge: Cambridge University Press, 1991), pp. 85-103 and the utilitarian perspective of Richard Brandt, "The Morality and Rationality of Suicide," in his Morality, Utilitarianism, and Rights (Cambridge: Cambridge University Press, 1992), pp. 315-35. For an excellent longer study, see Margaret Pabst Battin, Ethical Issues in Suicide (Englewood Cliffs, N.J.: Prentice-Hall, 1982).

Recent Popular Literature on Euthanasia

"On the Border of Life." - Darcy Frey New York Times Magazine, July 9, 1995, Section 6, pp. 22 ff. This is a very interesting example of what some contemporary moral philosophers have called "thick" moral descriptions. It is an empathetic and insightful account of the decision-making process that occurs when a woman goes into labor during the 23 week of pregnancy at the Brigham and Women's Hospital in Boston. The fetus at this point is on the very edge of viability. Attempts to save it are clearly extraordinary, costly, and fraught with danger. The chances that the infant may be severely compromised are high. This article provides an excellent account of the many factors that come into play in making the decision to attempt to save the infant. The discussion of a number of important moral issues can be generated from this article, including:

  • who should make such decisions about employing extraordinary means to save such infants?
  • what role should costs play in such decisions?
  • to what extent has technology created new moral issues?

"Baby's Death in '92 Still Being Fought," - Frank Bruni New York Times, March 9, 1996 (A-6). This is a very interesting article about an extremely disturbing case where life support equipment for 3 year old Brianne Rideout was turned off against the family's wishes and without a court order. The Rideouts are a strongly Christian, African-American family with comparatively little experience in dealing with medical bureaucracies. Their insurance coverage was also reaching its limit. The case raises a number of unsettling questions about religious freedom, racism, patient advocacy, and financial considerations.

"Man Who Aided Suicide to Go to Prison," - Pam BelluckNew York Times, March 16, 1996. Interesting article about George Delury, who helped his wife kill herself. During the trial, his diary revealed motives that were far from altruistic. He will be sentenced to six months.

"Ruling Sharpens Debate on 'Right to Die." - Tamar Lewin New York Times, March 8, 1996, p. A8. An excellent article about the possible implications of the 9th Circuit Court of Appeals decision affirming the right to die and permitting physician-assisted suicide.

"Mother's Last Request. A Not So Fond Farewell." - B. J. Nelson Harper's (Volume 292, No. 1750) March 1, 1996, pp. 35 ff. An autobiographical account of a son's assistance in his mother's euthanasia.

"Why the Courts Are Dead Wrong." - Stephen L. Carter The New York Times Magazine, July 21, 1996. A strong critique of the claim that there is a constitutionally-based right to die.

"A New Pro-Life Movement in the Making," - Paul Wilkes The New York Times Magazine, July 21, 1996. An interesting and surprisingly sympathetic portrait of a number of those who are opposed to physician-assisted suicide, including Daniel Callahan, Yale Kamisar, Herbert Hendin, and Kathleen Foley.



  • Atul Gawande "Being Mortal: Medicine and What Matters in the End" MacLean Center.  Oct 27, 2014.   Gawande discusses his book, sharing personal experiences of his father's death as well as the perspective of a practicing surgeon.  Not to be missed.
  • Bill Moyers, On Our Own Terms: Moyers on Dying
    This is a four-part documentary by Bill Moyers, a Baptist minister from Texas, press secretary to President Lydon Johnson, documentary film maker who specializes in religious issues and the history of religion, and political commentator.  This is a superb series, especially "A Death of One's Own," which follows three dying people through the last months of their lives.  Moyers has the ability to listen and bring the feelings and insights of various sides into clearer focus.  The website contains the streaming video of all four episodes, as well as transcripts and other ancillary material.  I have a few notes on this video from when I used it in class.