Deconstructing Dignity: A Critique of the Right-to-Die Debate, by Scott Cutler Shershow

This is a highly topical book, in view of the intense debates taking place in many countries about the possible legalisation of assisted suicide and euthanasia (for example in Canada and France) or the modification of existing laws (for example in Belgium, where the euthanasia law was recently extended to minors). However, its title is slightly misleading: although Scott Cutler Shershow devotes a lot of attention to suicide, this analysis is insufficiently used as a starting point for discussing assisted suicide and voluntary euthanasia. The discussion on euthanasia is limited to involuntary euthanasia as practised, for example, by the Nazis. Hence he focuses too much on the right to death, understood as the state’s right to command the life and death of its citizens, as distinguished from the right to die, as an individual’s right to decide on the conditions of their death.

The chapter “Human dignity from Cicero to Kant” is highly instructive, if a bit long-winded. The historical discussion of views on suicide is clearly explained and hugely fascinating. In his discussion of contemporary sources, Shershow provides extensive, interesting and at times very original comments on Cruzan v Director, Missouri Department of Health, a 1990 US Supreme Court ruling on the question of a right to refuse life-saving hydration and nutrition, which he regards as the most important ruling by that court on end-of-life decisions. However, he interprets the ruling as having “established at least a partial ‘right to die’ as a principle in American law” when it merely confirmed the right of a competent patient to refuse treatments (including life-saving ones), a right grounded in the common law prohibition of battery. These and related issues are analysed and explained in the more recent US Supreme Court rulings in Washington v Glucksberg and Vacco v Quill, which are not discussed here despite being much more relevant in view of Shershow’s strong focus on the question “has the very question of [a right to die] been formulated clearly?”.

In the academic literature, debates on end-of-life issues are almost always analysed from bioethical or medico-legal perspectives. Shershow deploys an entirely different lens, namely text analysis and deconstruction in the style of Jacques Derrida. In various ethical and political debates, Derrida observed an apparent opposition of “calculation” and “incalculability”, and Shershow identifies this tension in debates on end-of-life issues. Frequently, the textual analyses bringing him to this conclusion are original, fascinating and convincing. Yet occasionally he is too eager to force the arguments of opponents and proponents of a “right to die” into this scheme of calculation versus incalculability.

His strong focus on this scheme is probably also responsible for the fact that he overlooks a key argument in the debate. Arguments relating to the sanctity of life and autonomy (both situated in the sphere of the incalculable) and arguments relating to slippery slopes and cost issues (both linked with “calculation”) get ample attention. Yet Shershow pays no attention whatsoever to the argument that when someone asks for assistance to die (assisted suicide) or asks to be killed (euthanasia), unlike when someone commits suicide, this raises questions as to whether someone can ever expect another person to enter into such a relationship and, if so, which persons/professions are most suited to provide such assistance. Questions such as these are related to issues of integrity and conscience. They do not fit within Derrida’s scheme of incalculability versus calculation, yet they occupy an important place in the “right to die” debate.

Although, as Shershow says at the outset, he “for the most part refrain[s] from taking sides”, he offers many incisive criticisms of ethical arguments. His approach gives rise to many new insights, and bioethicists can certainly learn a lot from this book.