Vol. 32 No. 2 (February, 2022) pp. 20-23

THE CHRONIC SILENCE OF POLITICAL PARTIES IN END OF LIFE POLICYMAKING IN THE UNITED STATES, by Bianca Easterly. London: Lexington Books, 2019. 134pp. Hardback $89.00. ISBN: 978-1-4985-5608-8.

Reviewed by Megan S. Wright, Penn State Law and the Departments of Humanities and Public Health Sciences, Penn State College of Medicine, Pennsylvania State University. Email:

Bianca Easterly’s THE CHRONIC SILENCE OF POLITICAL PARTIES IN END OF LIFE POLICYMAKING IN THE UNITED STATES aims to help the reader understand the political context surrounding the evolution of the right-to-die movement and the subsequent adoption of end-of-life laws and policies.

This book provides a concise history and social context of end-of-life laws and policies in the United States and can function as a primer to quickly orient readers new to this topic. Easterly provides excellent tables that summarize the state of end-of-life law and policy in the United States and globally (Table 1.1, p. xvi-xvii); the legislative history of physician-assisted dying laws (Table 2.1 and Table 2.2, pp. 19-22); descriptive statistics about use of physician-assisted dying in Oregon, Washington, Belgium, and the Netherlands (Table 2.3, p. 23-25; readers who would like statistics from other jurisdictions where physician-assisted dying is currently legal can consult these states’ department of public health websites); and summaries of physician-involved mercy killing cases in the United States (Table 4.1, p. 57-62). The downside of a such short history, however, is that readers may want more detail about the end-of-life policies and court cases described in Easterly’s book.

The book begins with two chapters devoted to the history of end-of-life politics and policies in the United States. The author includes the historical connections of the right-to-die movement to eugenics movements that sought to prevent the birth or ensure the death of persons considered socially or physically “undesirable” (Chapter 1) along with modern developments in advance directive laws, physician-assisted dying laws, and end-of-life clinical practice (e.g., the creation of Physician Orders for Life-sustaining Treatment (POLST)) (Chapter 2). These first two chapters rely on and apply the Three Streams Theory, which focuses on “the timely confluence of the problem, policy, and politics streams” (p. 1) that lead to policy reform. The chapters illustrate moments in history where the streams did not align and the right-to-die movement was unsuccessful as well as moments where the streams did align, and end-of-life policies and practices changed.

Easterly then devotes the remaining chapters to institutions that mattered for advancing or thwarting the right-to-die movement, including interest groups, courts, and coalitions of healthcare providers. In Chapter 3, Easterly analyzes various interest groups, such as early 20th century euthanasia societies, right-to-die groups such as the Hemlock Society, physicians, professional medical associations, the Catholic church, disability rights groups, and select policy entrepreneurs. She also considers their role in end-of-life policy reform using the lens of pluralism, economic/transactional, and neo-pluralistic theories and literatures. In this chapter, Easterly notes how sometimes interest groups successfully bypass state legislatures that do not act on their proposed reforms and instead achieve change by taking their end-of-life proposals directly to the public through ballot initiatives. In Chapter 4, Easterly turns her attention to important sets of end-of-life court cases, such as physician-involved mercy killing cases wherein most criminal defendants are not found guilty or if found guilty, are not subject to severe sanctions; state and federal cases establishing that the right to refuse life-sustaining treatment survives loss of capacity (e.g., QUINLAN, CRUZAN) and federal and state court cases challenging state bans on physician-assisted dying (e.g., GLUCKSBERG, BAXTER V. MONTANA, etc.). In Chapter 5, Easterly discusses policy diffusion using the case of the POLST paradigm, noting that the development and spread of POLST did not involve elected officials, but instead began with healthcare providers who intentionally tried to keep politics out the development of this end-of-life planning tool.

The benefit of the book’s organization is that readers can turn to chapters of interest, each of which contains endnotes with citations or additional comments. If readers are interested in the role of courts in end-of-life policies and politics, for example, they can reference Chapter 4 as a stand-alone resource without having to read the entire book (although readers should consult the index to ensure the content in which they are interested is not also mentioned elsewhere in the book). A drawback of this organization is that the book jumps back and forth in time, which can be both jarring and repetitious.

I also would have appreciated more political analysis rather than mere description as Easterly’s analytical choices are not always clear. For example, why did the author choose to list various court challenges to states’ bans on physician-assisted dying, but only include an in-depth discussion of challenges in Montana and New Mexico? And at points in the book, I wished some points had been better supported by existing literature or defended by the author. For instance, Easterly asserts that POLST was created by physicians to better support patient autonomy, but also discusses how physicians were dissatisfied with legal tools such as advance directives. It seems like a more complete analysis would include a discussion of professional expertise and jurisdiction disputes between law and medicine and the recursive nature of changes in one jurisdiction affecting changes in another (e.g., creation of advance directives in law, problems with advance directives in clinical practice leading to creation of POLST, institutionalization of POLST in clinical practice leading to statutes authorizing POLST, etc.).

Further, the title of this book, THE CHRONIC SILENCE OF POLITICAL PARTIES IN END OF LIFE POLICYMAKING IN THE UNITED STATES, promises something that Easterly does not quite deliver: an analysis of end-of-life policy in light of political parties, the discussion of which is not explicit in every section. This was especially noticeable in Chapter 4, which focused on court cases. While political party affiliations of state and federal executive branch officials were mentioned in some cases (e.g., noting that Jeb Bush was the Republican governor involved in the Schaivo saga), the analysis of political parties was absent. Perhaps readers are meant to infer from the lack of discussion of political parties that they were “silent,” but this should be an explicit part of the author’s argument.

Finally, although no fault of the author’s, one issue of writing in an area where law and policy is rapidly changing is that that information can become quickly dated since publication. Easterly’s monograph was published in 2019. Since then, several more states have adopted physician-assisted dying, including New Jersey, Maine, and New Mexico, and other states have amended their physician-assisted dying laws. There is some variation in procedural safeguards and substantive law compared to existing laws, but readers interested in up-to-date policies will have to look elsewhere. Further, it is odd experience to be writing this review in the middle of a global novel coronavirus pandemic that has killed millions. It remains to be seen how end-of-life politics and policy will be affected by the pandemic in countries including the United States, which could be the subject of future books.


BAXTER V. MONTANA, 224 P.3d 1211, 2009 MT 449, 354 Mont. 234, 2009 Mont. LEXIS 695 (Mont. Dec. 31, 2009).


IN RE QUINLAN, 70 N.J. 10, 355 A.2d 647 (1976).

WASHINGTON V. GLUCKSBERG, 521 U.S. 702 (1997).

ⓒ Copyright by: Megan S. Wright