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Book Forum: Suicide   |    
Euthanasia and Assisted Suicide: Psychosocial Issues
IVAN FRAS, M.D.
Am J Psychiatry 1999;156:967-967.
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by Samuel I. Greenberg, M.D. Springfield, Ill., Charles C Thomas, 1997, 164 pp., $53.95; $38.95 (paper).

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Dr. Greenberg, a practicing and teaching psychiatrist and psychoanalyst, brings his training and experience to bear on a difficult topic to produce a well-balanced and considerate treatise.

In addition to Dr. Greenberg’s text, the reader is treated to a bonus—the foreword by Prof. Ralph Slovenko, one of the most erudite legal scholars dealing with psychiatric legal issues. Another facet of this book is that the reader can start at different points and, depending on his or her special interests, find material sufficiently cross-referenced to allow reexamination of specific issues. For the more disciplined reader, the book starts with a review of the current conflicts addressing medical, legal, religious, economic, and ethical issues. Landmark cases are then presented, and the experiences of other Western countries, including not only the Netherlands but also Germany and, most helpfully, the United Kingdom.

The author’s examination of the practice of euthanasia by veterinarians and the veterinarians’ emotional reactions to their actions deserves special mention. Physicians’ attitudes and psychodynamics are treated with the skill and expertise one would expect from a well-trained and experienced colleague without going overboard in length or interpretation. The chapter on legal aspects is of practical value. It gives the official definitions of the types of euthanasia and the differentiation of euthanasia from assisted suicide. It also offers clear descriptions of current legal procedures—living wills, durable power of attorney, informed consent, and do-not-resuscitate orders.

The reader will be well informed about the appropriate groups and organizations, both lay and professional; considerable space and effort is devoted to define their attitudes and positions. Likewise, the author repeatedly examines public figures such as Drs. Kevorkian and Quill. A lengthy case report makes the book more readable.

Dr. Greenberg does not reveal exactly where he stands on the issues; instead, he repeatedly emphasizes their complexity and persistence. The message that the dying are not treated with compassion and dignity is repeated throughout the book. Dr. Greenberg also says that medical skills in palliative care, including but not limited to pain relief, are underdeveloped and poorly applied.

The ultimate message, intended or not, is that the solution for physicians is improved understanding and treatment of the terminally ill, dying, and agonizing patients—that is, improved medical skill in terms of sensitivity, humaneness, and knowledge.

By contrast, there is no doubt where Professor Slovenko stands: "The participation of physicians in killing people" is a corruption of the medical enterprise and the very identity of the physician. He warns of the danger of legitimizing euthanasia under the medical mantle.

The one drawback of the book is the complete lack of consideration of the views and reactions of any non-Western cultures or societies and their religions. The other great cultures and religions can offer valuable help in dealing with death and dying. Within its scope, however, Dr. Greenberg’s book is a valuable contribution to a divisive issue, and it can serve as a model of restraint and understanding.

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