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"Killing as Therapy: The Case of Terri Schiavo" is presented as a study of hypocrisies concerning euthanasia, physician-assisted suicide, the medicalization of death and dying, and access to drugs. Szasz observes that "The Schiavo drama was a classic battle of words: he who controlled the vocabulary controlled the debate and was assured of victory," (118) and he details how the language of ethics (e.g., 'rights', 'persons', 'autonomy') and medicine (e.g., 'coma', 'permanent vegetative state', 'irreversible brain damage', 'patient', 'physician', 'treatment', 'physician assisted suicide') shaped the unfolding of the case which, on his view, was badly handled by all parties involved: the husband, the parents, the media, medical ethicists, religious groups, physicians, the courts, and the state. He concludes that "Terri Schiavo was killed ... [b]ecause no one --not her husband, not her parents, not any philanthropist, not the American taxpayer- was willing to pay to keep her alive ... If we believe that executing innocent people is wrong, then the Schiavo case presents no ethical problem. It presents economic, political, and social problems." (129-130) And the deeper moral is supposed to be that practices concerning death, dying, and dependency, matters that previously have been problems for the family and the church, are now becoming problems for the state and are increasingly being framed in medical terms (e.g., 'physician-assisted suicide"). But, again, such medicalization comes with a cost: "In short, the legal definition of PAS as a procedure that only a physician can perform expands the medicalization of everyday life, extends medical control over personal conduct, especially at the end of life, and diminishes patient autonomy." (129)
"Peter Singer's Ethics of Medicalization", is a study of the views of Peter Singer, a medical ethicist. Szasz writes as follows: "Why do I consider his views --which I think are mistaken and wicked- in this volume? I do so because he is a prominent figure in contemporary bioethics and because his "preference utilitarian perspective" is a striking example of the contemporary debauchment of morality and politics by means of the medicalization of ethics." (134) Szasz sees in Singer a prime example of how processes of medicalization and the therapeutic state, with their objectionable consequences for personal responsibility and freedom, are buttressed by medical ethicists.
Unfortunately, for the most part, the above recommendations are negative, far too abstract to be of much use, and not terribly responsive to the demands of the context in which change might be pursued. In the case of alternatives to a disease conceptualization of behavior, Szasz seems to promote the false dichotomy, "brain disease or moral failing" that is relied upon by many defenders of psychiatry. In general, more detailed and constructive proposals are called for: e.g., proposals which clarify not only what viable alternative forms of discourse, institutions, and practices might be like, but also how change might be realistically implemented with alternatives that do not reinforce problematic dichotomies and assumptions that inform current practices.
~Snip~
Despite the critical points just rehearsed, this is a valuable collection of papers. In a culture of rampant medicalization with many apparent crises brewing (e.g., widespread psychiatric diagnosis and drug treatment of increasingly younger children; deep confusion in the development of the DSM system of classification), most of us are quite ill-equipped for recognizing and resisting the powerful social and linguistic influences that promote such practices and breed such crises. Szasz's writing stimulates thought, motivates a desire for change, and demonstrates forms of criticism in which everyone (especially those in the mental health professions) should be well versed....
Review - The Medicalization of Everyday Life
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