DENIAL OF THE SOUL - Spiritual and Medical Perspectives on Euthanasia and Mortality, M. Scott Peck, MD, Harmony Books, New York, 1997, xi & 242 pp, $23, ISBN: 0- 517-70865-5.

Physician, psychiatrist, theologian, and author of the best-seller, The Road Less Traveled, F Scott Peck, MD, gives us an in-depth look at the current euthanasia movement and its origins in the inability of physicians to "pull the plug." Peck states that although Dr Kevorkian gives him the shivers, he must credit him more than any other individual for the genesis of this book. Almost single-handedly over the past five years, Kevorkian has turned the debate over euthanasia into a national issue within the United States.

But Kevorkian didn't inspire Dr Peck to write this book–it was the public response to his behavior. Peck was surprised by the number of people who admire Kevorkian..He was even further surprised by the larger number who, though they feel no affections for Kevorkian, nevertheless deeply approve of what he has been doing in assisting the suicides of those who are ill. Most of all, Peck has been surprised by the huge number of Americans who do not find Dr Kevorkian's work particularly objectionable.

The whole debate is strangely passionless and seemingly simplistic. But the subject of euthanasia is far from simplistic–it involves questions about who, if anyone, has a right to terminate a life; whether it’s the same as or different from suicide or homicide; whether it differs from merely "pulling the plug;" and what role does pain, both physical and mental, play in euthanasia decisions. Among the stories he tells, is one about Tony, a patient of his when he was a psychiatric resident. He felt Tony’s craziness was organic and referred him to neurology where he was found to have a large frontal brain tumor. The tumor was inoperable and failed to respond to radiation treatment.

Weeks later when Peck rotated on the neurology service, Tony, now unresponsive and on a ventilator, reentered his life. He wondered why anyone would decide to place Tony on life support. Was this "heroic" medicine, or just a measure to prolong a life that had lost its essence? Peck asked his chief of neurology at Letterman General Hospital whether this effort to prevent inevitable death was the right thing to do? The Colonel commended him, obtained a portable EEG, and found an occasional distorted brain wave and pronounced that the patient was not yet certifiably brain-dead.

Recalling the anguish of the family in waiting, Peck looked at Tony for the next 15 minutes, cut the levophed drip in half, went to the doctor's lounge, smoked a cigarette, returned 10 minutes later, found Tony dead, and informed the family. As they wept, speaking to each other in Italian, he could not tell whether they were weeping in grief or relief. He concluded, probably both. He, of course, had the presence of mind not to tell anyone about what he had done.

Peck wishes that he could have shared his solo decision 30 years ago. If he had, he would have opened himself to court-martial for unacceptable medical behavior. His actions would have been considered euthanasia or physician suicide. Today the decision to "pull the plug" is made in conjunction with the family and other physicians and occasionally the ethics committee.

Peck then takes us on a journey of inadequately treated pain, which is now a precursor to physician assisted suicide. Nothing fuels the euthanasia debate so much as the fear of intractable pain. Peck states that if there were such a thing as intractable untreatable agonizing pain, one could make a case for physician-assisted suicide. In his entire professional life, Peck has never found one case in which pain could not be controlled with the appropriate type of morphine cocktail. Peck gives the fear of pain a lengthy treatment because he feels that many people look to euthanasia as a cure for physical pain they believe they will have to endure during the natural process of dying. But according to Peck, it is emotional–not physical pain that is the center of the euthanasia debate.

Once Peck establishes that it is emotional, not physical pain that is the center of the euthanasia debate, he then turns to mental illnesses, to suicide, natural death, and murder. Although he believes physician-assisted suicide should be illegal, he points out that not all people can obtain Hospice care to relieve pain and suffering and there are many unsympathetic physicians out there. He wishes there were a vigorous discussion in religious congregations, but feels they will do almost anything to avoid open debate. The author contends feels that all of these issues must be adequately explored before the underlying simplicity of the spiritual perspective will be accepted. We must become articulate in the Euthanasia–Physician Assisted Suicide debate before it’s too late.