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BOOKREVIEW: The Maintenance of Life from Frances Norwood

The Maintenance of Life is about what has developed in one present-day society to address social death and modern dying. It is based on a 15-month qualitative study of home death in the Netherlands with general practitioners, end-of-life patients and their family members.

The book develops from two study findings:

  1. that euthanasia in practice is predominantly a discussion, which only rarely culminates in a euthanasia death; and
  2. that euthanasia talk in many ways serves a palliative function, staving off social death by providing participants with a venue for processing meaning, giving voice to suffering, and reaffirming social bonds and self-identity at the end of Dutch life.

Through the mainstream practice of euthanasia talk, space has been created within healthcare which helps people live longer as active participants engaged in Dutch social networks at the end of life. Using direct observation and in-depth interviews with patients, families and physicians, this book looks critically at Dutch euthanasia policy and broader end-of-life practices from a cultural perspective and in comparison with U.S. end-of-life practices and policies.
It concludes with a discussion of what lessons the U.S. may take from the Dutch experience maintaining life at the end of life.


Nan Maitland: “This clear and beautifully written book is the result of a 3 year study by Frances Norwood, an American anthropologist, who moved to The Netherlands and learned the Dutch language in order to undertake it. A key theme of her book is that the Dutch laws on euthanasia enable people to talk about the possibility of ending their lives legally, even though most of them will never actually ask for assistance to do so. The fact that this “euthanasia talk” happens – with doctors, family and friends – has a palliative effect, she believes, and this in itself helps to affirm social bonds, and prevent or allay social death.”

Maitland concludes: “For me, this is another strong argument for a change of the law in this country. Imagine having the right to choose to die physically before social losses have turned into social death or at least to more closely coincide the timing of the two. The fact that people in the Netherlands can and do frequently take part in “euthanasia talk” with their doctors and families, the fact that they can legally choose the path they want to take is – to me, something to be envied and fought for.”

John Griffiths, PhD, Sociology of Law at University of Groningen and co-author of Euthanasia and Law in Europe:
“The idea that ‘euthanasia talk’ includes far more than ‘the immediate, the obvious (planning for death)…[but also serves] to affirm social bonds and social life at end of Dutch life’ is a point that seems to a ‘native’ both right and important. It corresponds to the Dutch idea that what they have done is to make euthanasia ‘bespreekbaar’ [discussable], not only in public discourse but also as part of the social process of dying.”

The Maintenance of Life
Preventing Social Death through Euthanasia Talk and End-of-Life Care—Lessons from The Netherlands

Frances Norwood
2009 • 320 pp • paper • ISBN: 978-1-59460-518-5 • LCCN 2009022910