Angels of Death: Exploring the Euthanasia Underground

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9780522849707: Angels of Death: Exploring the Euthanasia Underground

Public discussion of euthanasia and assisted suicide is growing. In Australia as elsewhere the debate is difficult, contentious and confronting, and hampered by the secrecy that necessarily surrounds illegal practice. Most people simply have no way of knowing how, and how often, medically assisted death actually occurs. Roger Magnusson presents, for the first time, detailed first-hand accounts by doctors, nurses, therapists and other health professionals who have been participants in assisted death. All have been intimately involved in caring for people with AIDS, both in Australia and in California. He places these ambivalent, self-incriminating accounts within the broader context of the right-to-die debate and the challenges of palliative care. The frankness of the health workers and the richness of their collected evidence set this book apart. From within a culture of deception they speak knowingly and movingly of the merciful release of a peaceful death, while acknowledging the reality of 'botched attempts', euthanasia without consent, precipitative euthanasia, lack of accountability and professional distance, and many other disturbing issues. Angels of Death provides a wi

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About the Author:

Dr Roger Magnusson is senior lecturer in the Faculty of Law at the University of Sydney and co-ordinator of the Faculty's postgraduate Health Law Program.

From The New England Journal of Medicine:

Roger Magnusson's Angels of Death describes the practice of extralegal assisted suicide and euthanasia by physicians, nurses, technicians, and other health care professionals who provide care to seriously ill patients and patients with AIDS who are dying. It is based on a snowball sample of 49 detailed interviews carried out over a period of three years with health professionals specializing in the care of patients with the human immunodeficiency virus and AIDS, principally in Sydney and Melbourne, Australia, and in San Francisco. This book is about cooperative euthanasia -- that is, physician-assisted suicide and euthanasia occurring underground, mainly among patients with AIDS at home and those in large, tertiary-care hospitals in the United States and Australia. It describes networking among sympathetic physicians, nurses, and other health care workers and traces patterns of referral. It portrays ways in which health care professionals provide advice about drugs, assistance to those who wish to obtain drugs (often from an underground pharmacy), and informal psychiatric assessments. It also describes how they manipulate hospital procedures, fabricate information when signing death certificates, and collaborate with funeral directors in the orchestration and general facilitation of assisted dying at the bedside. It describes ways they may support both the patient and the family as well as debrief the family after a death. In Angels of Death (the name given to informal groups of physicians and nurses known to be willing to provide assistance in suicide or euthanasia), Magnusson finds, as have other researchers, that cooperative aid-in-dying is easier and more direct in the community than in the hospital but that it frequently still occurs in hospital settings. Some occasions of cooperative euthanasia involve direct, deliberate, life-ending measures: "A common example of shared involvement was for one health care worker to access the patient's vein, while another injected the drugs." Other occasions involve stretching applications of the principle of double effect, particularly in deaths that involved "understood," deliberate overdoses of morphine: The physician in charge of Erin's unit . . . approached Erin [a nurse] about another distressed patient they were caring for. ‘Use as much morphine as you need,’ said the physician. ‘I'll sign for it.’ Erin was taken by surprise. ‘Do you know what I mean?’ said the physician. ‘I'm not sure,’ said Erin. ‘Do you want me to make him comfortable, or do you want me to make him ultimately comfortable?’ ‘Yes,’ replied the physician, ambiguously. The patient died that night. Magnusson, professor of law at the University of Sydney, and his associate, Peter H. Ballis, of Monash University, also in Australia, applied considerable skill in eliciting first-hand accounts from physicians, nurses, and other health care professionals working in legally delicate settings, and as a result they obtained very revealing interviews. They stress that the physicians involved in these cooperative networks are "not isolated and wild-eyed miscreants acting from the fringes of their professions" but rather respected, mainstream physicians. Underground euthanasia is a "culture of deception," and it is practiced everywhere, although Magnusson observes that it is "more deeply entrenched, with a longer and richer history" in California than in Australia. Angels of Death has several limitations. The study was limited to patients with AIDS in cities where large, interactive, and mutually supportive populations of gay men have helped shape the nature of health care. Its methodology involved reportorial interviews that were not cross-checked by interviewers of different background commitments. Most irritating, the book does not clearly identify the three-year period during which the interviews were conducted, so the reader cannot know when, during the years of the AIDS epidemic, the practices described were implemented, whether before or after the development of protease inhibitors and other drugs. The study is also presented with a certain sensationalism, which its title betrays. And it does not explore the philosophical issue of whether occasions of the "understood" overuse of morphine -- as in the example of Erin, noted above -- are conceptually closer to a "double effect" and hence legally permissible or, as Magnusson clearly believes, closer to euthanasia. Despite these shortcomings, Angels of Death is a comprehensive, compelling, and deeply responsible description and analysis of practices in contemporary health care, and it includes an extensive bibliography. A superbly thought-provoking book, it should be read by both opponents and proponents of the legalization of assisted dying. It is here that Angels of Death has its greatest strength, as an importantly ambiguous, litmus-test book. Opponents of physician-assisted suicide, euthanasia, and aid-in-dying generally will see it as an account not merely of a potential abuse but of an already existing abuse of seriously ill and dying patients within the health care system: a wink here, a nod there, and the patient is dead. Proponents of legalized aid-in-dying, in contrast, will see the same account, with the same rich observations of winks and nods, as a comforting reassurance that seriously ill and dying patients can still manage to obtain what they want -- easeful death -- even in a climate of legal suppression. What Magnusson describes is a fact that both proponents and opponents of the legalization of euthanasia must face: practices such as those delineated in the book occur when a practice is kept illegal. Magnusson's view is not to be mistaken for the naive belief that such practices can be stamped out; he believes that this is simply not possible and that "it is not a choice between having no euthanasia and making euthanasia legal." Moreover, he does not think that the cooperative practices he describes are the only forms of euthanasia now being used. "Protestations aside," he writes, "there is little doubt that hospitals do provide euthanasia, under the guise of sedation." Although Magnusson believes that the prohibition of such practices is not tenable, that the existence of "euthanasia networks illustrates the failure of the policy of prohibition," and that the legal prohibition of assisted dying produces a culture of silence, resulting in flawed transmission of information, botched euthanasia processes, substantial stress for care providers, and "a complete absence of stable criteria for involvement in assisted death," he does not supply a remedy. That will be the work of the many physicians, nurses, policymakers, and patients who should be encouraged to read this book. Reading it will permit them to diagnose their own biases; it will also allow them to see that there are multiple ways to view the phenomenon of collaborative, underground aid-in-dying. Whatever one's view of the stories he tells, Magnusson is clearly right about one thing: "the closing times of life are too important, and patients deserve better." Margaret P. Battin, Ph.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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Magnusson, Roger S.
Editore: Melbourne University Press, Carlton South (2002)
ISBN 10: 0522849709 ISBN 13: 9780522849707
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Descrizione libro Melbourne University Press, Carlton South, 2002. Pictorial Wraps. Condizione libro: Fine. First Edition. With contributions from Peter H. Ballis. Foreword by The Hon. Justice Michael Kirby. Illustrated with tables. Includes appendix, notes, bibliography, plus index. A LIKE NEW very nice clean tight solid softcover copy. 325pp. SB-162. Size: 23 x 15.5cm. Codice libro della libreria 015809

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Magnusson, Roger S.
Editore: Melbourne; Melbourne University Press; 2002 (2002)
ISBN 10: 0522849709 ISBN 13: 9780522849707
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Descrizione libro Melbourne; Melbourne University Press; 2002, 2002. paperback in very good condition, small spot on fore-edge; 325 pages. Codice libro della libreria 80096

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Magnusson, Roger S.
Editore: Melbourne University Press, Carlton South, Victoria (2002)
ISBN 10: 0522849709 ISBN 13: 9780522849707
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Good Reading Secondhand Books
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Descrizione libro Melbourne University Press, Carlton South, Victoria, 2002. Soft Cover. Condizione libro: Fine. With contributions from Peter H. Ballis and an introduction by Michael Kirby. "An exploration of the hidden world of illicit physician-assisted suicide and euthanasia. Through the frank and often troubling first-hand accounts of health professionals who have been involved in assisted death, it records this secret but real area of medical and nursing practice. Through face-to-face interviews with these "angels of death", Roger S. Magnusson explores the social practices, relationships and networks that constitute "underground" euthanasia. How is assisted death actually practised within health care settings? What are the issues that surround the making of such a momentous decision? How do health care workers justify their attitudes and actions in this area? This volume aims to offer detailed answers to these questions and many others. The doctors, nurses and therapists who were interviewed pseudonymously for this study work in the HIV/AIDS communities in the United States and Australia. Their perspectives and practices, attitudes and feelings, should illuminate the assisted death debate and expose a variety of disturbing issues, including the reality of "botched attempts", euthanasia without consent, and unduly hasty measures to bring about death." (publisher's blurb) xvii, 325 pages. Size: 8vo - over 7¾" - 9¾" tall. Codice libro della libreria 016078

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Magnusson, Roger S.
Editore: MUP Melbourne 2002 (2002)
ISBN 10: 0522849709 ISBN 13: 9780522849707
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Descrizione libro MUP Melbourne 2002, 2002. 23 x 15.5cm, 325pp, softcover, very good. Collection of detailed first-hand accounts by health care professionals who have been participants in assisted death. Codice libro della libreria 151864

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Magnusson, Roger S.
Editore: Melbourne University Press, Carlton South, Vic (2002)
ISBN 10: 0522849709 ISBN 13: 9780522849707
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Ripponlea Books
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Descrizione libro Melbourne University Press, Carlton South, Vic, 2002. Soft cover. Condizione libro: Fine. 1st Edition. xvii+325pp., Pictorial full colour illustrated covers, foreword by The Hon. Justice Michael Kirby, intro., tables, appends., notes, bibliog., index. Angels of Death provides a window into the 'euthanasia underground'- a secret part of medicine and nursing that few professionals will publicly acknowledge. Size: Octavo. Book. Codice libro della libreria 001778

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Magnusson, Roger
Editore: Melbourne Univ Pr (2002)
ISBN 10: 0522849709 ISBN 13: 9780522849707
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Descrizione libro Melbourne Univ Pr, 2002. Soft cover. Condizione libro: Very Good. Codice libro della libreria 000610

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