Board for Social Responsibility of the Church of England, Church House Publishing, 2000, £4.95, 94 pages, 0 7151 6587 9

• Board for Social Responsibility of the Church of England. On Dying Well: A Contribution to the Euthanasia Debate

For any reader interested in euthanasia, On Dying Well gives an accessible yet detailed account of the Church of England's view on the subject. First published in 1975, this short report is the product of the Church's Board for Social Responsibility, which brought together theologians, philosophers, lawyers, and medical professionals to form a working party with the remit of examining euthanasia. The second edition of On Dying Well leaves most of the original working party report findings unaltered, but adds a new introduction by Professor Stuart Horner, chairman of the British Medical Association's ethics committee from 1989 to 1997. Other changes to the first edition are a redrafted chapter on the legal questions surrounding euthanasia in light of new cases pertinent to the debate and additional reflections on the report's medical content. Also included is an updated bibliography, listing publications produced after 1975 and, in appendix form, the 1993 Joint Submission to the House of Lords Select Committee on Medical Ethics made by the House of Bishops of the Church of England and the Roman Catholic Bishops' Conference of England and Wales.

On Dying Well is a report of broad-ranging scope which, not surprisingly, robustly rejects the legalisation of voluntary euthanasia. This rejection operates in two ways—marshalling both principled, theologically grounded rhetoric and more practical, medically orientated arguments and clinical case studies. Thus, in his introduction, while acknowledging that most churches “would now approve the language of human rights”, Professor Horner rejects what he terms an “unbridled” notion of autonomy which ignores an “ultimate accountability to God”. Then on a more practical level, he stresses the significant impact that developments in palliative care have had on care of the dying, arguing that in the vast majority of cases “there is almost no reason today for patients with an incurable condition to die in agony and distress”. Lamenting that hospice care is not available to all terminally ill patients, Professor Horner nevertheless maintains that this is no reason to write euthanasia into the statute books. He dismisses arguments that focus on poor standards of terminal care as a justification for legalising euthanasia, adding that it seems “utterly illogical that if doctors are guilty of bad terminal care, society should then award them greater powers to remedy the problem”.

This reference to the distribution of “power” within the doctor-patient relationship goes to the heart of the euthanasia debate, as conceptions of what constitutes “good death” are negotiated and renegotiated against a backdrop of ever-changing medical practice and wider societal values. There are those who do, of course, reject the view that the legalisation of euthanasia represents an allocation of “greater powers” to doctors, but instead view euthanasia as a crucial element in securing personal autonomy and self determination for the patient. When the Voluntary Euthanasia Society published its 1976 rejoinder to the first edition of On Dying Well it concluded that the church's report was “determined, and often distorted by . . . an absolute prior rejection of euthanasia”.

However, the focus of the church's report is largely on the potential implications of legalising euthanasia and interestingly, both the theological and the medical chapters of the book concede that there may be “exceptional cases” in which euthanasia is morally permissible. It is argued that such instances, judged by the report to be extremely rare, are best dealt with on a case by case basis rather than by altering the status of the law. The report concludes that the legalisation of euthanasia would have numerous damaging effects, including reducing the incentive to improve provision of care for the dying; placing patients under pressure to seek an end to their lives, and, ultimately, increasing the risk of non-voluntary euthanasia.

Some readers will be left unsatisfied by this endorsement of the “slippery slope” view of legalising euthanasia. Similarly, not every reader will be satisfied with the conclusion that euthanasia excludes the administration of drugs to relieve pain or distress, even if this does, on occasion, and as the report concedes, carry the risk of shortening life. On this front, the report is vulnerable to the charge that it retreats behind euphemisms—emphasising the proposed “intention” of a doctor solely to relieve pain, but avoiding difficult questions that accompany the acknowledgement that a patient's life may be shortened as a result. Nevertheless, the medical and theological pragmatism of the report stands in contrast to the unbending position that might have been offered. There will be those who, perhaps unable to view the question of euthanasia through the particular religious lens of the Church of England, will share similar anxieties about the repercussions of legalising assisted suicide.

The highly publicised efforts of motor neurone disease patient Diane Pretty to secure her “right to die” have once again stirred the sometimes dormant but ever present debate over euthanasia. The media coverage has brought into focus now well rehearsed positions—where respect for autonomy and individual choice compete with sanctity of life and “slippery slope” arguments. On Dying Well reiterates these arguments but also offers new insights and analysis. It is worth noting that in the same week that Diane Pretty's case made the headlines, Dame Cicely Saunders, a contributor to the church's report, was awarded the $1m Hilton Humanitarian Prize for her hospice work in the care of the dying. The philosophical debate surrounding euthanasia has reached an impasse. The “solution” for now, appears to lie in allowing death with at least some degree of self regulation but without appeals to changes in the law.