Euthanasia and the Law in Europe seeks to deliver the definitive dispassionate account of the situation in reviewing the legal frameworks of the Netherlands, Belgium, England and Wales, Switzerland, France, Italy and Spain in the area of Euthanasia and other Medical Behaviours Potentially Shortening Lives (MBPSL). No more complete description of the situation in the Netherlands could be envisaged: the volume essentially calls upon Griffiths and Weyers's previous work (Griffiths, Bood and Weyers, 1998) as a firm base from which to update on changes in Holland since 1998. Similarly, the process of legalisation in Belgium is comprehensively covered. However, the reviews of the legal frameworks of the other nations do not delve as deeply into the political and legal developments as the primary focus of the book. Likewise, the scales are finely balanced as to whether the book achieves its aim of being dispassionate: the authors are sensibly cautious in predicting future legal developments (pp. 521 − 32), but surprisingly candid in their disdain of the ‘deceptively simple’ (p. 513) slippery slope argument. Regardless, the book achieves its objective of delivering an informed and exquisitely well researched insight into the law surrounding euthanasia in Europe.

The book is divided into four parts; the first three are predominantly descriptive accounts of developments in each country. The most voluminous, spanning nigh on half the book, is of course dedicated to the authors' previously explored area of the Netherlands, Part II is dedicated to Belgium, and Part III is given to the legal frameworks in the rest of the countries. That such attention is paid to the situation in the Netherlands and Belgium is not surprising, as they possess legislative frameworks which allow for euthanasia. For each country concerned, the reader is presented with a host of empirical data on euthanasia, particularly concerning the reporting of MBPSL. This regulatory data is supplemented with attitudinal surveys regarding the issue. Intertwined with the quantitative evidence is a well researched and coherent representation of the law and regulatory bodies in each country: the reader will be hard-pressed to find a more accessible or succinct interpretation.

Part VI offers an analytical review of the data, leading to three separate assertions. First (pp. 501 − 512), the legalisation of euthanasia, far from leading to the ‘existing rules of prohibition being eliminated’ (p. 501), has brought about a process of juridification in the doctor − patient relationship. That is to say, there has been an increase in regulation over the practice in order to safeguard it. Second (pp. 513 − 20), it is asserted that the slippery slope proposition, the only significant argument against the legalisation of euthanasia common to European countries, is defunct. This assertion is based upon the empirical data, which shows that since the legalisation of euthanasia in the Netherlands, the tightening of due care requirements in the process has led to increasingly high reporting standards, in order to make the process more transparent. Finally (pp. 521–32), the authors offer cautious predictions about the future progression of legal frameworks in the European countries which have not legalised the procedure. These predictions are made not only on the basis of the legal developments that have already taken place, but also the willingness of the medical profession to engage in the debate, public pressure and, most importantly, the political atmosphere in each country.

The strength of this work lies in its comprehensive attention to detail, especially in the area of the empirical data and regulatory frameworks in the Netherlands and Belgium. Each regulatory and advisory committee is described in minute detail, evidencing exactly what input they have in the decision-making field. For example, in Part I the authors update the situation in the Netherlands post 1998 with cogent skill. The Termination of Life on Request and Assisted Suicide (Review Procedures) Act brought into force in 2002 changed very little, as the criteria for permissive use had long been established. However, the book excels in informing the reader of the heightened procedural regulation that is an outcome of the Act. For example, because of the Act, since 1998 a number of procedural changes have been initiated, by bodies such as the Regional Review Committees (p. 129) and the State Commission on Euthanasia (p. 138), which qualify the due care expected of each practitioner and give advice to the physician when confronted with such cases. The book also predicts that a possible area of expansion is people who request euthanasia because of somatic suffering, who currently can benefit only from assisted suicide (pp. 113 − 24).

Explaining the effects of the regulatory frameworks in conjunction with the use of empirical data offers insight into the defunctness of the slippery slope argument often used by opponents of legalisation of any form of euthanasia. The depth of the regulatory and procedural guidelines itself proves that legalisation has led to the practice being more intensely regulated.

The book is also a useful tool in understanding the different motives driving the legalisation agenda in each country. For instance, we learn that the concept of self-determination was not the underlying principle driving the legalisation of euthanasia in the Netherlands: rather it was the doctor's readiness to assume responsibility; the legal emphasis in the Dutch system is therefore focused on balancing the physician's duty to protect the patient's interests with his or her duty to end suffering. Conversely, in Belgium the driving force behind legalisation was the public's acceptance of self-determination as key to the debate, whilst the medical profession was largely silent. However, to reiterate, the most valuable aspect of this book is its inclusiveness in detailing all of the relevant procedural and regulatory activities which take place in this area.

Several criticisms can also be made of the book. That the book fails in its aim to be dispassionate is clearly illustrated by the authors' consideration of the validity of the slippery slope argument. Throughout, the book gives scant regard to philosophical polemic, and so the assertion that ‘the empirical slippery slope argument deserves more respect’ (p. 513) than the conceptual slippery slope argument is not surprising. However, the assertion is tainted with bias, highlighted by the book's lack of consideration of philosophical concepts such as self-determination and autonomy. Whilst this assertion is not surprising, neither is it unsupported: the weight the authors have attached to the careful dissemination of empirical data across the board in each practice related to euthanasia, as well as to the public sentiment in each country considered, does indeed persuade the reader. The data prove their claim that the legalisation of euthanasia has led to heavily regulated practice which is more open and thus less likely to slip into abuse.

This dense tome contains a relatively small amount of analytical focus. The climax of this focus is the cautious prediction that ‘legal change in the direction of wider held values will occur first in England, France, Denmark and Sweden’ (p. 532), hardly a startling revelation. However, the predictive ability of the authors should not be underestimated: their 1998 book recognised the need for greater regulation of euthanasia processes in Holland. Nor should their limited focus on analysis detract from the fact that the book is a valuable referencing system and comparative aid. Even so, the major problem with this approach is that regulations quickly become outdated, whilst the legal philosophies that underpin the arguments tend to linger. For example, Chapter 11 concerns the guidance in England and Wales for the withdrawal or withholding of life-prolonging treatment, which have recently changed;Footnote ³ the chapter is likewise now out of date because it lacks consideration of the effects of the DPP's newly disseminated policy for prosecutors in relation to encouraging or assisting suicide.Footnote ⁴

Finally, the relevance of the book's attention to other European countries in Part III is somewhat confusing. Whilst the expert would be hard pressed to find a more encompassing account of the law in Holland and Belgium, the brief chapters on the other countries are more of an introduction to the law in each of these jurisdictions. This does not serve to lessen the book's appeal: the work is relevant, concise and accurate. However, the sheer amount of attention paid to developments in the Netherlands and Belgium contrasts with the approach taken towards other jurisdictions, giving a rather deflated feel to the title ‘Euthanasia and Law in Europe’. It might perhaps have paid dividends to have focused less on these ‘minor’ jurisdictions and their regulations and more on comparisons between Holland and Belgium as well as what their systems may learn from each other.

In conclusion, this work is a welcome addition to the materials in this area. That is commendation in itself: the density of the literature in the well-established field of assisted dying and euthanasia is such that only quality tomes such as this can now be truly helpful. However, the book goes further than being merely welcome: it can be relied upon as a truly informative aid in a uniquely practical way, because of its almost scientific approach to the subject. The use of empirical data as a supporting tool in its arguments is a novel addition in an area which often focuses on legal philosophy. Furthermore, this work is an invaluable catalogue of the rules and regulations in Holland and Belgium for both expert and novice. Although its portrayal of the other European countries is sketchy, it is still valuable to those wishing to build a sturdy and accurate foundation in the topic. This book will clarify matters for anyone investigating the surveyed countries' legal standing in relation to euthanasia.