As Lavi writes at the beginning of the last chapter of his book,
Our study of euthanasia in America began with colonial times, when the word still signified a pious death blessed by the grace of God. It continued with the medicalization of death in the nineteenth century, which was soon followed by attempts to legalize the hastening of death. The struggle to legalize euthanasia took a radical turn with the founding of the Euthanasia Society of America, when proposals to hasten death were applied to handicapped and mentally retarded patients. The final section of this study compared the legalization of euthanasia with two alternative means of actively hastening death: the sublegal act of legal dosing and the supralegal act of mercy killing (p. 163).
In his study, awarded the ASA Sociology of Law section book prize, Lavi explains how dying has moved from “art” to “technique,” from an experience overseen by a minister and family to one of “technique” overseen by doctors and constructed by law. This study charts how medicalization, expertise, and regulation cohere, elevating “pain” to a social problem and developing strategies to foreshorten life—or, intervening to allow death to occur. Lavi's work represents the best of sociolegal scholarship: it is impressive for its clear conceptualization, its marshalling of an impressive array of historical and cultural evidence, and its lucid, clear, and elegant writing.
Lavi convincingly argues that how we die reveals a great deal about how we live. He maps the changing meaning of euthanasia, but rather than asking the expected—how did law and medical technique change the way we die?—Lavi asks, instead, why have law and medical technique come to play important and distinct roles in the way we die? The answer is delivered in three parts.
Chapter 1 considers the Colonial way of dying in America, focusing on the Methodists. For the Methodists, “dying was a work of art” (p. 39). Death was, in a sense, a part of life where the “deathbed became a microcosm of Methodist life” (p. 39). Methodists were not concerned with the pain of dying, but rather with a “death in which pain was overcome” (p. 39). Gradually, doctors intervened and, with this, a role conflict emerged between minister and doctor—allowing, as subsequent chapters argue—the emergence of “technique” over “art” at the deathbed scene.
Chapter 2 considers the emergence of the medical profession and the ways it balanced the contending images/demands of hope and life with pain and suffering. In this constellation, the doctor's role emphasized hope that the moment of death would not involve pain. Two streams of medical technique and thought reinforced each other: “the scientific assertion that dying could not be painful and the technological call that it should not be painful” (pp.73–4; emphasis in original).
Chapters 3 and 4 argue that sociolegal processes promoted “technique” to a central place. That is, “[t]he new constellation of science and law set the ground for the state to regulate the process of dying as one among many aspects of public health” (p. 76). Two processes were woven together: first, dying became a medical problem and euthanasia its solution; second, administrative law produced a “medicolegal regime”; thus the state became the regulator of public health. This process captured the transition of dying from an art to a technique (p.77).
Chapter 5 deploys the concepts to explain the problem case of “legal dosing,” a technique proposed in 1936 by a British doctor, Lord Dawson, who argued that terminally ill patients should receive sufficient medication to alleviate pain. In the United States, legal dosing became the taken-for-granted way for doctors, and others, to allow death at the end of life. When challenged, the Supreme Court wrote that “There is no dispute that dying patients … can obtain palliative care, even when doing so would hasten their death” (p. 127). The growth of lethal dosing and the hospice movement signaled a broad acceptance of dying as “technique.” Given all the contestation around other forms of euthanasia, including the aftermath of the Nazi period, the degree to which “legal dosing” became part of the venue of the deathbed was truly remarkable; thus legal dosing demonstrates, for Lavi, the supremacy of “technique” over “art.”
In his epilogue, Lavi argues that the “autonomous” patient who “controls” his or her death is in fact bounded and constructed by the medical context. Thus the individual's autonomy is subordinated to that context—and the law plays a role in that subordination. What his scholarship does is make the circumstances, participants, historical trajectory, and resulting conditions visible. Along with the other members of the prize committee, I urge you to read the book—you will not be disappointed. As a model of concerned and rigorous scholarship, Lavi's book is exemplary.
