Book Review - Euthanasia and Physician-Assisted Suicide - Killing or Caring

January-February 2000


As our national debate about assisted suicide and euthanasia continues, it would seem that a book on the subject whose author is both a physician and a priest would be extremely useful. Michael Manning's work, however, although well meaning, ultimately offers nothing that cannot be obtained elsewhere in clearer and occasionally more correct form. Of the 120 pages in his book, only 88 are text, and these 88 pages are divided into nine chapters. This gives Manning very little space to develop his arguments, and consequently the book is superficial.

In the preface, Manning explains that he wrote the book as a personal reaction to the horror he felt at euthanasia as performed in Nazi Germany and now in the Netherlands. He became alarmed when he realized that it could happen here, and this alarm became the motivation for his book. In the first two chapters he gives definitions of terms and an historical overview of the euthanasia debate. He then addresses the traditional arguments used in this debate, devoting a chapter to each: self-determination, compassion and mercy for the dying, the distinction between killing and allowing to die, the common good, the slippery slope argument, and medical professionalism.

In each of these chapters, one as short as four pages, he states general arguments but does not develop them in any detail. In the third chapter, for example, he argues against the notion of self-determination understood as an absolute right. In doing so, he follows much of Daniel Callahan's argument in his classic, The Troubled Dream of Life (Georgetown University Press, Washington, DC, 1993). Manning confuses his argument, however, by using the traditional Catholic distinction between formal and material cooperation, especially when he states that material cooperation "is wrong, but can be justified if proportionate reasons exist" (p. 38). In the fourth chapter he argues that the use of compassion as justification for assisted suicide and often for involuntary euthanasia actually contradicts the value of self-determination. Although his is an interesting argument, it needs more nuance than Manning provides.

In the next chapter he discusses the crucial distinction between killing and letting die. This should be the keystone of his argument, but again he drops the ball. Rather than discussing the traditional distinction between ordinary and extraordinary means, Manning invokes the principle of double effect, but the questions he asks leave further doubts regarding his understanding of the use of this principle (p. 51). He briefly brings up the issue of medically assisted nutrition and hydration and, finally, reduces to one paragraph the appeals court rulings regarding the constitutionality of assisted suicide and the Supreme Court decision they occasioned. For anyone writing about assisted suicide in the United States, these rulings need to be a greater part of the discussion.

Manning devotes his sixth chapter to the issue of the common good, but he merely states that "the common good ultimately upholds the collective good as more important than the good of any one individual" (p. 56). Such a statement needs to be qualified before it can become an adequate description of the Catholic understanding of the common good. The seventh chapter is devoted to the slippery slope argument, which is central to Manning's own argument. It is the most developed chapter and the one in which he is able to discuss his reaction to euthanasia as practiced in Nazi Germany and the Netherlands. The book ends with a chapter on medical professionalism.

As written, the book seems to be an extended argument against an article by Dan Block, published in the March-April 1992 issue of The Hastings Report. In addressing Block, Manning quotes extensively from authors such as Daniel Callahan, William F. May, and Richard Gula. One leaves Manning's book, however, feeling that one is better served by reading these other authors directly rather than Manning's revision of them.

Reviewed by Rev. Thomas A. Nairn, OFM, Associate Professor of Christian Ethics, Catholic Theological Union, Consulting Ethicist, Alexian Brothers Health Care System, Chicago


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