Grief, Loss, Death & Dying

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Living and Dying WellReview - Living and Dying Well
by Lewis Petrinovich
MIT Press, 1996
Review by Glenn Branch
Aug 5th 1999 (Volume 3, Issue 31)

Living and Dying Well is the second installment in the psychologist Lewis Petrinovich's trilogy in bioethics. In the first few chapters, after reviewing the background principles advanced in the first installment of the trilogy, Petrinovich discusses the ethical issues relevant to genetic screening and the Human Genome Project. He then turns his attention to the ethics of human death, spending four chapters addressing suicide, euthanasia, and organ transplantation. The remainder of the book is devoted to arguing for the ethical necessity of health care reform in the United States.

Living and Dying Well continues the project begun in Human Evolution, Reproduction, and Morality (also reviewed on Metapsychology); it is unsurprising, then, that it shares the virtues and vices of its predecessor. Like its predecessor, Living and Dying Well consists largely of Petrinovich's summarization of the relevant literature, again in prose that is neither lively nor elegant. Again his exposition is frequently tedious, occasionally unclear, and sometimes erroneous. I cite three examples, taken more or less at random from the first half of the book. On p. 54, he warns that "one danger with genetic engineering is that it ignores the fact that gene expression differs […]"; the danger is not with genetic engineering per se but with genetic engineering in the service of eugenics. On p. 106, he claims that "Aquinas affirmed that, being contrary to natural law, [suicide] precluded repentance"; what precludes repentance for suicide is not its unnaturalness but its finality. On p. 134, he sees fit to define "unjustifiable murder"; the definition is redundant, for homicide, if justifiable, is not murder.

The philosophical core of Living and Dying Well, occupying chapters 4 through 7 and dealing with suicide, euthanasia, and organ transplantation, is regrettably unclear and contributes little to the ongoing debates in bioethics. Particularly flagrant is Petrinovich's appalling moral judgment in his discussion of infants with Down's syndrome (p. 136):

"There are two stages in the Down's syndrome example […]: one in which there is an intestinal blockage requiring surgery; the other in which the infant will develop normally to reach its full, although restricted, potential. In the first case, the decision to have the surgery or not should be left to the informed decision of the parents. If they do not wish to raise a retarded infant, then the surgical intervention should not be done against their wishes, and it should be morally permissible for the infant to be allowed to die using either active or passive euthanasia. [Note, by the way, if active euthanasia is used, the infant is not allowed to die, it is killed.] In the second case, the parents should be encouraged to care for the child if possible, and if they do not wish to, or are not able to assume such responsibility, then society should provide facilities and provisions for the sustenance and care of the child […]"

Here Petrinovich in effect declares that the presence or absence of the intestinal blockage is morally relevant to the fate of the infant - which is absurd. Indeed, the ethicist James Rachels, whose views on euthanasia are approvingly discussed in Living and Dying Well, explicitly argued for the absurdity of the position in his well-known 1975 essay "Active and Passive Euthanasia" (New England Journal of Medicine 292:2, pp. 78-80).

Thankfully, however, the exposition improves as the book moves on. In the penultimate chapter - "The Great Health-Care Debate" - Petrinovich provides a blow-by-blow account of the disastrous national discussion of health care policy in 1993 and 1994; the chronological approach seems to steady his writing. Overall, I rather enjoyed the second half of Living and Dying Well, in which Petrinovich argues fervently that the U.S. ought to move as quickly as possible to adopt the sort of government-mandated, single-payer, universal health care system that is in place already in Canada. Still, in my case he was preaching to the already converted. I am doubtful that Petrinovich's arguments are sufficiently convincing to change anybody's mind.

Glenn Branch received his BA in philosophy from Brandeis University and is presently on leave from the PhD program in philosophy at UCLA. Among his philosophical interests are the philosophy of mind, evolutionary psychology, and the scientific status of psychoanalysis.


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