Brock - Voluntary Active Euthanasia; An Overview And Defense
aL131 1 1 14291 1 1 1 03691969,;] m , '81Voluntary Active Euthanasia: An Overview and Defense16312.Voluntary Active Euthanasia: An Overview and DefenseDan W. BrockDan W. Brock, Ph.D., is a professor of philosophy and biomedical ethics at Brown University.He is also the director of the Center for Biomedical Ethics at Brown. In this essay, Brock surveys a wide range of arguments used by both opponents and proponents of voluntary activeeuthanasia. He critically evaluates these arguments, particularly those based on the potentialconsequences-good and bad-of making euthanasia available in our society. Brock condudes by admitting that he believes that on the whole the stronger arguments are on theside of the proponents. In particular, he favors arguments grounded in the values of individual self-determination and individual well-being.f\):c0cSince the case of Karen Quinlan first seized public attention fifteen years ago, no issue in biomedical ethics has been more prominent thanthe debate about forgoing life-sustaining treatment. Controversy continues regarding someaspects of that debate, such as forgoing life-sustaining nutrition and hydration, and relevantlaw varies some from state to state. Nevertheless,I believe it is possible to identify an emergingconsensus that competent patients, or the surrogates of incompetent patients, should be permitted to weigh the benefits and burdens ofalternative treatments, including the alternativeof no treatment, according to the patient's values, and either to refuse any treatment or toselect from among available alternative treatments. This consensus is reflected in bioethicsscholarship, in repons of prestigious bodiessuch as the President's Commission for theStudy of Ethical Problems in Medicine, TheHastings Center, and the American Medical Association, in a large body of judicial decisionsin courts around the country, and finally in thebeliefs and practices of health care professionals who care for dying patients. 1More recently, significant public and professional attention has shifted from life-sustainingtreatment to euthanasia-more specifically, vol-'l10z !. 'Dan W Brock. ·voluntary Acm·c Euth:mas1a .I,cHasnn. sC(n·"'&port 22 (March/Apnl 1992): 10-22. Used wnh the permiSSion of the author and the Hasungs Ctnttr Report.Cop nght\Cl1992.untary active euthanasia-and to physicianassisted suicide. Several factors have contributedto the increased interest in euthanasia. In theNetherlands, it has been openly practiced byphysicians for several years with the acceptanceof the countrys highest coun. 2 In 1988 therewas an unsuccessful attempt to get the questionof whether it should be made legally permissibleon the ballot in California. In November 1991voters in the state of Washington defeated awidely publicized referendum proposal to legalize both voluntary active euthanasia andphysician-assisted suicide. Finally, some cases ofthis kind, such as "Its Over, Debbie," describedin the journal of the Ammcan Medical Association,the "suicide machine" of Dr. jack Kevorkian,and the cancer patient "Diane" of Dr. TimothyQuill, have captured wide public and professional attention. 3 Unfonunately, the first two ofthese cases were sufficiently problematic thateven most supponers of euthanasia or assistedsuicide did not defend the physicians' actionsin them. As a result, the subsequent debate theyspawned has often shed more heat than light.My aim is to increase the light, and perhaps aswell to reduce the heat. on this important subject by formulating and evaluating the centralethical arguments for and against voluntaryactive euthanasia and physician-assisted suicide.My evaluation of the arguments leads me. withreservations to be noted, to suppon permittingboth practices. My primary aim. howe\·er. isnot to argue for euthanasia. but to identify// J.,
164CHAPTERIllEUTHANASIA AND PHYSICIAN-ASSISTED SUICIDEconfusions in some common arguments, andproblematic assumptions and claims that needmore defense or data in others. The issues areconsiderably more complex than either supponers or opponents often make out; my hopeis to advance the debate by focusing attentionon what I believe the real issues under discussion should be.In the recent bioethics literature some haveendorsed physician-assisted suicide but noteuthanasia. 4 Are they sufficiently different thatthe moral arguments for one often do not applyto the other? A paradigm case of physician-assisted suicide is a patients ending his or her lifewith a lethal dose of medication requested ofand provided by a physician for that purpose.A paradigm case of voluntary active euthanasiais a physicians administering the lethal dose,often because the patient is unable to do so. Theonly difference that need exist between thetwo is the person who actually administers thelethal dose-the physician or the patient. Ineach, the physician plays an active and necessary causal role.In physician-assisted suicide the patient actslast (for example, janet Adkins herself pushedthe button after Dr. Kevorkian hooked her up tohis suicide machine), whereas in euthanasia thephysician acts last by performing the physicalequivalent of pushing the button. In both cases,however, the choice rests fully with the patient.In both the patient acts last in the sense of retaining the right to change his or her mind untilthe point at which the lethal process becomes irreversible. How could there be a substantialmoral difference between the two based onlyon this small difference in the pan played by thephysician in the causal process resulting indeath? Of course, it might be held that the moraldifference is clear and important-in euthanasiathe physician kills the patient whereas in phystcian-assisted suicide the patient kills him- orherself. But this is misleadmg at best. In assistedsuicide the physician and patient together killthe patient. To see this. suppose a phvsician/13lsupplied a lethal dose to a patient with theknowledge and intent that the patient willwrongfully administer it to another. We wouldhave no difficulty in morality or the law recognizing this as a case of joint action to kill forwhich both are responsible.If there is no significant, intrinsic moral difference between the two, it is also difficult to seewhy public or legal policy should permit onebut not the other; worries about abuse or aboutgiving anyone dominion over the lives of othersapply equally to either. As a result, I will take thearguments evaluated below to apply to both andwill focus on euthanasia.My concern here will be with voluntary euthanasia only--that is, with the case in which aclearly competent patient makes a fully voluntary and persistent request for aid in dying. Involuntary euthanasia, in which a competentpatient explicitly refuses or opposes receivingeuthanasia, and nonvoluntary euthanasia, inwhich a patient is incompetent and unable toexpress his or her wishes about euthanasia, willbe considered here only as potential unwantedside-effects of permitting voluntary euthanasia. Iemphasize as well that I am concerned withactive euthanasia, not withholding or withdrawing life-sustaining treatment, which some commentators characterize as Mpassive euthanasia."Finally, I will be concerned with euthanasiawhere the motive of those who perform it is torespect the wishes of the patient and to providethe patient with a "good death," though one important issue is whether a change in legal policy could restrict the performance of euthanasiato only those cases.A last introductory point is that I will be examining only secular arguments about euthanasia, though of course many peoples attitudes toit are inextricable from their religious views. Thepolicy issue is only whether euthanasia shouldbe permissible, and no one who has religiousobjecnons to it should be required to take anypart m it. though of course this would not fullysansfy some opponents.
Voluntary Active Euthanasia: An Overview and DefenseTHE CENTRAL ETHICALARGUMENT FOR VOLUNTARYACTIVE EUTHANASIAThe central ethical argument for euthanasia isfamiliar. It is that the very same two fundamental ethical values supponing the consensus onpatient's rights to decide about life-sustainingtreatment also suppon the ethical permissibility of euthanasia. These values are individualself-determination or autonomy and individualwell-being. By self-determination as it bears oneuthanasia, I mean peoples interest in makingimportant decisions about their lives for themselves according to their own values or conceptions of a good life, and in being left free to acton those decisions. Self-determination is valuable because it permitS people to form and livein accordance with their own conception of agood life, at least within the bounds of justice andconsistent with others doing so as well. In exercising self-determination people take responsibility for their lives and for the kinds of personsthey become. A central aspect of human dignitylies in people's capacity to direct their lives inthis way. The value of exercising self-determination presupposes some minimum of decisionmaking capacities or competence, which thuslimitS the scope of euthanasia supponed by selfdetermination; it cannot justifiably be administered, for example, in cases of serious dementiaor treatable clinical depression.Does the value of individual self-determination extend to the time and manner of onesdeath? Most people are very concerned aboutthe nature of the last stage of their lives. Thisreflects not just a fear of experiencing substantial suffering when dying, but also a desire toretain dignity and control dunng this last periodof life. Death is today increasingly preceded by along period of significant physical and mentaldecline, due in pan to the technological interventions of modem medicine. \tany people adjust to these disabilities and find meaning andvalue in new activities and ways. Others find the165impairments and burdens in the last stage oftheir lives at some point sufficiently great tomake life no longer wonh living. For many patients near death, maintaining the quality ofone's life, avoiding great suffering, maintainingone's dignity. and insuring that others rememberus as we wish them to become of paramount imponance and outweigh merely extending one'slife. But there is no single, objectively correct answer for everyone as to when, if at all, one's lifebecomes all things considered a burden and unwanted. lf self-determination is a fundamentalvalue, then the great variability among peopleon this question makes it especially importantthat individuals control the manner, circumstances, and timing of their dying and death.The other main value that suppons euthanasia is individual well-being. It might seemthat individual well-being conflicts with a per. son's self-determination when the person requestS euthanasia. Life itself is commonly takento be a central good for persons, often valued forits own sake, as well as necessary for pursuit ofall other goods within a life. But when a competent patient decides to forgo all funher lifesustaining treatment then the patient, eitherexplicitly or implicitly, commonly decides thatthe best life possible for him or her with treatment is of sufficiently poor quality that it isworse than no funher life at all. life is no longerconsidered a benefit by the patient. but has nowbecome a burden. The same judgment underliesa request for euthanasia: continued life is seenby the patient as no longer a benefit, but now aburden. Especially in the often severely compromised and debilitated states of many critically ill or dying patients, there is no objectivestandard, but only the competent patient'sjudgment of whether continued life is no longera benefit.Of course, sometimes there are conditions,such as clinical depression, that call into question whether the patient has made a competentchoice. either to forgo life-sustaining treatmentor to seek euthanasia, and then the patients
.,i .166CHAPTERIllEuTHANASIA AND PHYSICIAN-ASSISTED SUICIDEchoice need not be evidence that continued lifeis no longer a benefit for him or her. just as withdecisions about treatment, a determination ofincompetence can warrant not honoring the patient's choice; in the case of treatment, we thentransfer decisional authority to a surrogate,though in the case of voluntary active euthanasia a determination that the patient is incompetent means that choice is not possible.The value or right of self-determination doesnot entitle patients to compel physicians to actcontrary to their own moral or professional values. Physicians are moral and professionalagents whose own self-determination or integrity should be respected as well. If perform-ing euthanasia became legally permissible, butconflicted with a panicular physician's reasonable understanding of his or her moral or professional responsibilities, the care of a patientwho requested euthanasia should be transferredto another.Most opponents do not deny that there aresome cases in which the values of patient selfdetermination and well-being suppon euthanasia. Instead, they commonly offer two kinds ofarguments against it that on their view outweighor override this suppon. The first kind of argument is that in any individual case where considerations of the patients self-determination andwell-being do suppon euthanasia, it is nevertheless always ethically wrong or impermissible.The second kind of argument grants that in someindividual cases euthanasia may not be ethicallywrong, but maintains nonetheless that public orlegal policy should never permit it. The first kindof argument focuses on features of any individualcase of euthanasia, while the second kind focuseson social or legal policy. In the next section I consider the first kind of argument.cEUTHANASIA IS THE DELIBERATEKILLING OF AN INNOCENT PERSONThe claim that any indivtdual instance ofeuthanasia is a case of delibente killing of an innocent person ts. Wllh onl · mtnor qualtfica-tions, correct. Unlike forgoing life-sustainingtreatment, commonly understood as allowing todie, euthanasia is clearly killing, defined as depriving of life or causing the death of a livingbeing. While providing morphine for pain relief at doses where the risk of respiratory depression and an earlier death may be a foreseenbut unintended side effect of treating the patient's pain, in a case of euthanasia the patientsdeath is deliberate or intended even if in boththe physicians ultimate end may be respectingthe patients wishes. If the deliberate killing of aninnocent person is wrong, euthanasia would benearly always impermissible.In the context of medicine, the ethical prohibition against deliberately killing the innocent de·rtves some of its plausibility from thebelief that nothing in the currently acceptedpractice of medicine is deliberate killing. Thus,in commenting on the "It's Over, Debbie" case,four prominent physicians and bioethicistscould entitle their paper "Doctors Must NotKill. "5 The belief that doctors do not in fact killrequires the corollary belief that forgoing lifesustaining treatment, whether by not startingor by stopping treatment, is allowing to die, notkilling. Common though this view is, 1 shallargue that it is confused and mistaken.Why is the common view mistaken? Consider the case of a patient terminally ill with ALSdisease. She is completely respirator dependentwith no hope of ever being weaned. She is unquestionably competent but finds her conditionintolerable and persistently requests to be removed from the respirator and allowed to die.Most people and physicians would agree thatthe patient's physician should respect the patients wishes and remove her from the respirator, though this will certainly cause the patient'sdeath. The common understanding is that thephysician thereby allows the patient to die. Butis that correct?Suppose the patient has a greedy and hostile son who mistakenly believes that his motherwill never decide to stop her life-sustainingtreatment and that even if she dtd her phystcian115
Voluntary Active Euthanasia: An Overview and Defensecwould not remove her from the respirator.Afraid that his inheritance will be dissipated bya long and expensive hospitalization, he entershis mother's room while she is. sedated, extubates her, and she dies. Shonly thereafter themedical staff discovers what he has done andconfronts the son. He replies, "I didn't kill her,I merely allowed her to die. It was her ALS disease that caused her death." I think this wouldrightly be dismissed as transparent sophistrythe son went into his mother's room and deliberately killed her. But, of course, the sonperformed just the same physical actions, didjust the same thing, that the physician wouldhave done. lf that is so, then doesn't the physician also kill the patient when he extubates her?I underline immediately that there are imponant ethical differences between what thephysician and the greedy son do. First, thephysician acts with the patient's consentwhereas the son does not. Second, the physicianaets with a good motive-to respect the patientswishes and self-determination-whereas theson acts with a bad motive-to protect his owninheritance. Third, the physician acts in a socialrole through which he is legally authorized tocarry out the patient's wishes regarding treatment whereas the son has no such authorization. These and perhaps other ethicallyimponant differences show that what the physician did was morally justified whereas what theson did was morally wrong. What they do notshow. however. is that the son killed while thephysician allowed to die. One can either kill orallow to die with or without consent, with agood or bad motive, within or outside of a socialrole that authorizes one to do so.The difference between killing and allowingto die that I have been implicitly appealing tohere is roughly that between acts and omissions ·resulting in death. 6 Both the physician and thegreedy son act in a manner intended to causedeath, do cause death. and so both kill. One reason this conclusion is resisted is that on a different understanding of the distincuon betweenkilling and allowing to die. what the physicianlift167does is allow to die. In this account, the mothersAI.S is a legal disease whose normal progressionis being held back or blocked by the life-sustaining respiratory treatment. Removing this artificial intervention is then viewed as standingaside and allowing the patient to die of her underlying disease. I have argued elsewhere thatthis alternative account is deeply problematic, inpan because it commits us to accepting thatwhat the greedy son does is to allow to die, notkill. 1 Here, 1want to note two other reasons whythe conclusion that stopping life suppon iskilling is resisted.The first reason is that killing is often understood, especially within medicine, as unjustified causing of death; in medicine it is thoughtto be done only accidentally or negligently. It isalso increasingly widely accepted that a physician is ethically justified in stopping life supponin a case like that of the AI.S patient. But if thesetwo beliefs are correct, then what the physiciandoes cannot be killing, and so must be allowingto die. Killing patients is not, to put it flippantly,understood to be pan of physicians' job description. What is mistaken in this line of reasoning is the assumption that all killings areunjustified causings of death. Instead, somekillings are ethically justified, including manyinstances of stopping life suppon.Another reason for resisting the conclusionthat stopping life suppon is often killing is thatit is psychologically uncomfonable. Suppose thephysician had stopped the ALS patient's respirator and had made the son's claim, "I didn't killher, I merely allowed her to die. It was her ALSdisease that caused her death." The clue to thepsychological role here is how naturally the"merely" modifies "allowed her to die." Thecharacterization as allowing to die is meant toshift felt responsibility away from the agentthe physician-and to the lethal disease process.Other language common in death and dyingcontexts plays a similar role; ·'letting naturetakes its course" or "stopping prolongmg thedying process·· both seem to shift responstbilityfrom the phystct::m who stops life suppon to the
168CHAPTERIllEuTHANASIA AND PHYSICIAN-ASSISTED SUIODEfatal disease process. However psychologicallyhelpful these conceptualizations may be in making the difficult responsibility of a physician'srole in the patients death bearable, they nevertheless are confusions. Both physicians and family members can instead be helped tounderstand that it is the patients decision andconsent to stopping treatment that limits theirresponsibility for the patient's death and thatshifts the responsibility to the patient.Many who accept the difference betweenkilling and allowing to die as the distinction between acts and omissions resulting in deathhave gone on to argue that killing is not in itselfmorally different from allowing to die. 8 1n thisaccount, very roughly, one kills when one performs an action that causes the death of a person(we are in a boat, you cannot swim, I push youoverboard, and you drown}, and one allows todie when one has the ability and opportunityto prevent the death of another, knows this, andomits doing so, with the result that the persondies (we are in a boat. you cannot swim, youfall overboard, I don't throw you an available lifering, and you drown). Those who see no moraldifference between killing and allowing to dietypically employ the strategy of comparing casesthat differ in these and no other potentiallymorally important respects. This wilt allow people to consider whether the mere difference thatone is a case of killing and the other of allowingto die matters morally, or whether instead it isother features that make most cases of killingworse than most instances of allowing to die.Here is such a pair of cases:Case 1. A very gravely ill patient is broughtto a hospital emergency room and sent up torhe ICU. The patient begins to develop respiratory failure that IS likely to require intubation very soon. At that point the patientsfamily members and long-standing physician arrive at the IQJ and inform the ICUstaff that there had been extensive discussion about future care wtth the patient whenhe was unquesuonably competent. Give h1sgra\·c and tcrmmal 1llness. as well as hisstate of debilitation, the patient had firmlyrejected being placed on a respirator underany circumstances, and the family andphysician produce the patients advance directive to that effect. The ICU staff do not intubate the patient, who dies of respiratoryfailure.Case 2. The same as Case 1 except that thefamily and physician are slightly delayed intraffic and arrive shonly after the patient hasbeen intubated and placed on the respirator.The lCU staff exrubate the patient, who diesof respiratory failure.In Case 1 the patient is allowed to die, inCase 2 he is killed, but it is hard to see why whatis done in Case 2 is significantly differentmorally than what is done in Case 1. It must beother factors that make most killings worse thanmost allowings to die, and if so, euthanasia cannot be wrong simply because it is killing insteadof allowing to die.Suppose both my arguments are mistaken.Suppose that killing is worse than allowing todie and that withdrawing life suppon is notkUling, although euthanasia is. Euthanasia stillneed not for that reason be morally wrong. Tosee this, we need to determine the basic principle for the moral evaluation of killing persons.What is it that makes paradigm cases of wrongful killing wrongful? One very plausible answeris that killing denies the victim something thathe or she values greatly--continued life or a future. Moreover. since continued life is necessaryfor pursuing any of a person·s plans and purposes, killing brings the frustration of aU ofthese plans and desires as well. In a nutshell,wrongful killing deprives a person of a valuedfuture. and of all the person wanted andplanned to do in that future.A natural expression of this account of thewrongness of killing is that people have a moralright not to be killedY But in this account of thewrongness of killing. the right not to be k11led.like other rights. should be waivable when theperson makes a competent decision th:n con·unued life 1s no longer wanted or a good. but !S117
Voluntary Active Euthanasia: An Overview and Defenseinstead worse than no funher life at all. In thisview, euthanasia is properly understood as acase of a person having waived his or her rightnot to be killed.This rights view of the wrongness of kUlingis not, of course, universally shared. Many people's moral views about killing have their originsin religious views that human life comes fromGod and cannot be justifiably destroyed ortaken away, either by the person whose life it isor by another. But in a pluralistic society likeour own with a strong commitment to freedomof religion, public policy should not begrounded in religious beliefs which many in thatsociety reject. I tum now to the general evaluation of public policy on euthanasia.WOULD THE BAD CONSEQUENCESOF EUTHANASIA OUTWEIGHTHE GOOD?].·'.cThe argument against euthanasia at the policylevel is stronger than at the level of individualcases, though even here I believe the case is ultimately unpersuasive, or at best indecisive. Thepolicy level is the place where the main issueslie, however, and where moral considerationsthat might override arguments in favor of euthanasia will be found, if they are found anywhere. It is important to note two kinds ofdisagreement about the consequences for publicpolicy of permitting euthanasia. First, there isempirical or factual disagreement about whatthe consequences would be. This disagreementis greatly exacerbated by the lack of firm data onthe issue. Second, since on any reasonable assessment there would be both good and badconsequences, there are moral disagreementsabout the relative imponance of different effects.In addition to these two sources of disagreement. there is also no single. well-specified policy proposal for legalizing euthanasia on whichpolicy assessments can focus. But without suchspecification. and espectally without explicitprocedures for protecting against well-intentioned mtsuse and ill-intentioned abuse. the169consequences for policy are largely speculative.Despite these difficulties, a preliminary accountof the main likely good and bad consequences ispossible. This should help clarify where betterdata or more moral analysis and argument areneeded, as well as where policy safeguards mustbe developed.Potential Good Consequencesof Permitting EuthanasiaWhat are the likely good consequences? First,if euthanasia were permitted it would be possible to respect the self-determination of compe.:tent patients who want it, but now cannot get itbecause of its illegality. We simply do not knowhow many such patients and people there are.In the Netherlands, with a population of about14.5 million (in 1987), estimates in a recentstudy were that about 1,900 cases of voluntaryactive euthanasia or physician-assisted suicideoccur annually. No straightforward extrapolation to the United States is possible for manyreasons, among them, that we do not know howmany people here who want euthanasia now getit, despite its illegality. Even with better data onthe number of persons who want euthanasia butcannot get it, significant moral disagreementwould remain about how much weight shouldbe given to any instance of failure to respect apersons self-determination in this way.One important factor substantially affectingthe number of persons who would seek euthanasia is the extent to which an alternative isavailable. The widespread acceptance in the law,social policy, and medical practice of the right ofa competent patient to forgo life-sustainingtreatment suggests that the number of competent persons in the United States who wouldwant euthanasia if it were permitted is probablyrelatively small.A second good consequence of making euthanasia legally permissible benefits a muchlarger group. Polls have shown that a maJority ofthe American public believes that people shouldhave a right to obtain euthanasia if they wantit. 10 No doubt the vast ma 1omy of those who
170cCHAPTER IllEuTHANASIA AND PHYSICIAN-ASSISTEDsuppon this right to euthanasia will never in factcome to want euthanasia for themselves. Nevertheless, making it legally permissible wouldreassure many people that if they ever do wanteuthanasia they would be able to obtain it. Thisreassurance would supplement the broader control of the process of dying given by the right todecide about life-sustaining treatment. Havingfire insurance on one's house benefits all whohave it. not just those whose houses actuallybum down, by reassuring them that in the unlikely event of their house burning down, theywill receive the money needed to rebuild it.Ukewise, the legalization of euthanasia can bethought of as a kind of insurance policy againstbeing forced to endure a protracted dyingprocess that one has come to find burdensomeand unwanted, especially when there is no lifesustaining treatment to forgo. The strong concern about losing control of their care expressedby many people who face serious illness likely toend in death suggests that they give substantialimportance to the legalization of euthanasia asa means of maintaining this control.A third good consequence of the legalizationof euthanasia concerns patients whose dying isfilled with severe and umelievable pain or suffering. "When there is a life-sustaining treatmentthat, if foregone, will lead relatively quickly todeath, then doing so can bring an end to thesepatients' suffering without recourse to euthanasia. For patients receiving no such treatment.however, euthanasia may be the only releasefrom their otherwise prolonged suffering andagony. This argume
Voluntary Active Euthanasia: An Overview and Defense Dan W. Brock Dan W. Brock, Ph.D., is a professor of philosophy and biomedical ethics at Brown University. He is also the director of the Center for Biomedical Ethics at Brown. In this essay, Brock sur veys a wide range of arguments used
to Dan Brock, the author of several different articles regarding active euthanasia for the Hastings Center claims that active euthanasia is actually a safer option for patients. Through active euthanasia, the physician would have until the very last moment t
Supported by The Humane Society of the United States. Presented at the 2003 Ohio Veterinary Medical Association Annual Conference. Address correspondence to Dr. Rogelberg. Objective—To examine the effects of euthanasia rates, euthanasia practices, and human resource practices on the turnover rate among employees with euthanasia responsibilities
Voluntary active euthanasia, on the other hand, is illegal in most countries and the obje ct of conflicting and polarised moral debates. Physician assisted suicide involves an affirmative act, writing a prescription or providing the lethal drug. Voluntary active euthan asia requires
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providing adequate training so that euthanasia pro-cedures may be competently applied. Another may be to change work duties as needed to provide relief when it becomes apparent that such duties are caus-ing emotional distress. Euthanasia, regardless of the circumstances, impacts a person's emotional state.
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Por Alfredo López Austin * I. Necesidad conceptual Soy historiador; mi objeto de estudio es el pensamiento de las sociedades de tradición mesoamericana, con énfasis en las antiguas, anteriores al dominio colonial europeo. Como historiador no encuentro que mi trabajo se diferencie del propio del antropólogo; más bien, ignoro si existe alguna conveniencia en establecer un límite entre .
