Edited by Margaret P Battin and Arthur G Lipman, New York, Pharmaceutical Products Press, 1996, 360 pages, US$36.00.

Drug Use in Assisted Suicide and Euthanasia provides a detailed and comprehensive examination of the issues surrounding end-of-life decision making, with a specific focus on the central role often played by death-hastening drugs. The papers in this volume address issues about the use of drugs in actively bringing about death, giving accounts of current practice, both legal and other than legal.

In the introduction to this volume Margaret Battin and Arthur Lipman point out that in the discussion of assisted suicide and euthanasia drugs are often an unrecognised centrepiece. For those seeking a peaceful and dignified assisted death, it is usually assumed that drugs will be the most appropriate means to this end. In many areas of the world policy is becoming more sympathetic to the tolerance of assisted suicide and euthanasia (this volume is particularly concerned with the Oregon Death with Dignity Act 1994). However, the ethical and pragmatic issues surrounding such practices remain largely unresolved.

This volume takes on the onerous task of addressing the empirical, ethical and legal issues surrounding the use of drugs in actively bringing about death. The papers it contains provide a wide variety of viewpoints on this complex area, from personal accounts of individual experience to more formal legal and medical analysis of these issues. The volume attempts to answer ethical and legal questions such as: Is providing a lethal drug the same as killing? Do the terminally ill have a right to decide when and how they die? Does providing information about drugs violate ethical, legal or professional obligations of physicians, pharmacists, nurses, family members, and others who might be involved?

We expect disagreement regarding the answers to these ethical and legal questions surrounding assisted death, but interestingly and somewhat alarmingly, the evidence provided in this volume suggests that there is also little agreement as to the type and dose of drug to be used for this purpose. Barbara Insley Crouch, for instance, in her paper “Toxicological issues with drugs used to end life” claims that there are no good scientific data available to identify the type and dose of a drug that can be relied on to produce a pain-free and gentle death. She argues that “euthanasia recipes” that appear in publications like Derek Humphries's Final Exit, while effective for some patients, may fail for others and serve only to intensify suffering.

Stephen Jamison, in his moving and illuminating paper, “When drugs fail: assisted deaths and not-so-lethal drugs” continues this theme, with evidence taken from interviews with family members, partners and friends who participated in 140 cases of assisted death. Jamison provides harrowing accounts of those caring for the terminally ill patient having to resort to desperate measures when drugs used to hasten death fail, including suffocation using plastic bags and pillows and injecting air to induce heart failure. In one such example Jamison describes the case of a terminally ill patient who persuaded a doctor to help her die. He provided liquid morphine which was injected into a heart catheter. However, a number of hours later the patient remained alive and after a subsequent attempt to end her life by injecting a large dose of insulin failed, the doctor resorted to repeatedly injecting air to induce heart failure. Instead of being a planned and dignified end to a life this patient's death was described by a family member as “nightmarish, horrific, how this process seemed to keep on and on. But it finally worked and she passed on”.

Drugs are used routinely to end the lives of the terminally ill. A careful investigation of these practices must be undertaken if such harrowing cases are to be avoided. If drug-assisted death is deemed ethically and/or legally permissible, then pragmatic issues, including finding effective and reliable means to peaceful death, must be addressed. Measures must be taken to ensure that if such practices are permitted, they do not result in increased suffering. Investigations must be undertaken which increase understanding of the type and amount of drugs needed to hasten death and this information must be made available to those who need it, physicians and patients alike.

This volume provides a valuable resource for all those involved in decisions about ending a life. Whatever your views of assisted suicide and euthanasia you will find this book informative, balanced and thought-provoking. The main message of the book is a powerful one: that we should not ignore this widespread practice but open up the debate on assisted suicide and euthanasia so that the positions we take on the subject are well informed and considered. This volume does much towards achieving this aim.