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In Rethinking Life and Death: The Collapse of Our Traditional Values, Peter Singer argues that "the traditional western ethic has collapsed" as we enter "a period of transition in our attitude to the sanctity of life" (pp. 1). The book begins with the tale of Trisha Marshall, a twenty-eight year old woman, who in 1993 was seventeen weeks pregnant when a gunshot to her head left her in an intensive care unit, her body warm, her heart beating, a respirator supporting her breathing. However, she was brain dead.
Her boyfriend and her parents wanted the hospital to do everything possible so that the baby would be born. The ethics committee of the hospital supported the decision. For the next 100 days, Trisha Marshall continued to be supported in the ICU until her baby was delivered by cesarean birth. After a blood test showed that the boyfriend was not the father, and after three weeks in the intensive care unit, the baby went to live with Marshall's parents.
Singer uses this introduction to pose the many ethical questions that are raised because of medicine's ability to keep a "brain dead" body warm for an extended period of time. "How should we treat someone whose brain is dead, but whose body is still warm and breathing? Is a fetus the kind of being whose life we should make great efforts to preserve? If so, should these efforts be made irrespective of their cost? Shall we just ignore the other lives that might be saved with the medical resources required?
Should efforts to preserve the fetus be made only when it is clear that the mother would have wanted this? Or when the (presumed?) father or other close relatives ask for the fetus to be saved? Or do we make these efforts because the fetus has a right to life which could only be overridden by the right of the pregnant woman to control her own body--and in this case there is no living pregnant woman whose rights override those of the fetus?" (pp. 17-18).
In the chapters that follow, Singer argues that whether western society will acknowledge it or not, we have, in our actions and decisions, moved to an ethic where "quality of life" distinctions trump "sanctity of life" positions. Yet, many continue to raise the "sanctity of life" position when it is clear that our legal and ethical positions in western society have embraced the "quality of life" stance. For Singer, this paradox results in an incoherent and illogical approach to the ethical challenges presented by modern medicine.
Throughout his book, Singer presents evidence for his argument through ethical and historical analysis of brain death, abortion, physician assisted suicide and euthanasia, organ donation, and the nature of persons. For those uncomfortable with Singer's position on "infanticide," this book allows one to follow Singer's argument and his recommendations in the last chapter for a coherent approach to these "quality of life" decisions.
He closes his book with the recommendation that a new ethic should embrace five new commandments to replace the old "sanctity of life" commandments. His commandments are: 1) Recognize that the worth of human life varies; 2) Take responsibility for the consequences of our decisions (in end of life care); 3) Respect a person's desire to live or die; 4) Bring children into the world only if they are wanted; and 5) Do not discriminate on the basis of species.
When Alice Sebold, author of the best-selling novel, The Lovely Bones (see this database), was completing her freshmen year at Syracuse University, she was assaulted and raped. Years after the fact, Sebold wrote this memoir about the rape and its aftermath. The book's title, "Lucky," is explained in the prologue: the police told Sebold that she was lucky to have escaped the fate of another girl who had been murdered and dismembered in the same spot. In point of fact, Sebold, a virgin before the rape, was in a sense murdered, since life as she had known it would never be the same: "My life was over; my life had just begun" (33).
In crisp, lively prose the author takes us relentlessly through the details of her rape and the police inquiry that followed. We learn also that the narrator had suffered from a poor body self-image, loved to spend her time reading, had day-dreams of becoming a poet. We learn about her family--a mother prone to severe panic attacks and a professorial father who hid behind his books, an older sister who helped Alice take care of their mother. The family was considered by neighbors to be "weird."
After the rape, Sebold felt even more isolated and "Other." She could not bring herself to tell her family, who tip-toed around her, all of the horrendous details of the assault. She realized that all who knew her were aware she had been raped and were uneasy in her presence. Her father could not understand how she could have been raped if the assailant's knife had dropped out of reach.
In spite of everything, Alice returns to Syracuse, taking poetry workshops with Tess Gallagher and a writing workshop with Tobias Wolff. Incredibly, she spots her assailant one day on the street near the college. The author notifies the police, the assailant is later arrested, and Alice agrees to press charges and to be a witness at the trial. Neither her father nor her mother have the stomach to come to the trial, but Tess Gallagher accompanies her. The account of the trial is detailed, agonizing, and fascinating.
Jose is a patient who exhibits all the classical symptoms of autism. The caregivers in his institution treat him dismissively, as though he is stupid. Sacks notices, however, that, given a pencil, Jose draws not only with amazing accuracy, but with a quality of liveliness in his representations that betokens close, insightful, and even empathetic observation and awareness. As he encourages Jose to draw, he finds his drawings diagnostically helpful, and powerful evidence of an active interior life to which they provide a valuable link.
In this tightly organized study of the relationship between creativity and manic-depressive disease and its variants, the author asks and attempts to address some interesting questions. Is there sufficient evidence in the histories of well-known artists and their families to demonstrate a genetic linking of creativity and depressive disorders? Are there phases in classic bipolar cycles that are particularly conducive to bursts of, or sustained, creative productivity? Does treatment (be it chemical or psychotherapeutic) of his or her psychiatric symptoms blunt the ability of the artist to work successfully?
In an attempt to answer these and other intriguing questions, Jamison explores in some detail the personal, family and creative histories of writers long suspected of being depressed with or without alcohol or having periods of mania. She opens by defining for the novice the parameters of the disorders in question, examines some of her subjects' family history of "madness," and discusses evidence for relationships among the waxing and waning of depressive disorders and creative productivity.
This thorough and fascinating treatment of the politics of anatomy studies in 19th-century America provides a variety of perspectives on the vexed question of how appropriately to study human anatomy while also maintaining respect for the human body and honoring the various, deeply held community beliefs, and attitudes toward treatment of the dead. Sappol seeks, as he puts it, to "complicate the cultural history of medicine in late-eighteenth- and nineteenth-century America. . . by telling it from an anatomical perspective."
That statement of his objectives hardly suggests the startling range of approaches to the topic he takes in the book's nine chapters. These cover such issues as the legacies of belief about the "personhood" of the dead human body; the status of anatomy as both a legitimate and valuable study and also as an "icon of science"; the relationship of dissection and anatomy study to medical status and professionalization; the political tensions engendered by the "traffic in dead bodies" that most often expropriated corpses from marginalized communities; and the relationship of anatomy studies to sexual commerce and sensationalist fiction.
This gripping narrative traces the history of the efforts to eradicate smallpox in the 1970s, the top-level decisions to keep a few vials of it for emergency purposes in American and Soviet freezers, and the reemergence of smallpox not only as a health threat, but as a potential bioweapon of unequaled destructive power. Preston details maverick natural cases that surfaced after worldwide eradication efforts, how it was discovered that undocumented reserves of smallpox were not only being kept, but researched and possibly "weaponized," and how hotly, in the US, teams of scientists and military intelligence personnel debated funding new smallpox research in the US with a view to developing a new vaccine as a defense.
The ethical issues in those debates are unprecedented in the scope of the possible public health threat and the variables that might make traditional vaccination ineffective against the weaponized virus. As in his previous books on biological threats, The Hot Zone and The Cobra Event (see annotation), Preston follows the work and lives of several key scientists and includes scenes from interviews with a variety of persons involved in confronting the political, ethical, and medical dilemmas posed by smallpox research and efforts to track and control it.
The subtitle of this memoir is "Meditations upon Returning." Richard John Neuhaus is a Catholic priest and scholar, director of the Institute on Religion in Contemporary Life in New York City and described on the book cover as "one of the foremost authorities on religion in the contemporary world." The book is a meditation on his near-brush with death as a result of colon cancer.
As Fr. Neuhaus describes it, he underwent two colonoscopies to ascertain the cause of persistent abdominal symptoms, but in both cases his colon was pronounced completely normal. However, shortly thereafter, he developed extreme abdominal pain and was taken to the hospital, where emergency surgery was performed and a colon cancer the size of a "big apple" was removed. During the first procedure, the surgeon nicked his patient’s spleen, so a second emergent procedure was required to control hemorrhaging.
The two procedures left Fr. Neuhaus very near death, but he gradually recovered over a period of several months. When introducing the story of his illness, the author comments, "several lawyers have told me my case would make a terrific malpractice suit." (p. 79) But he says he won’t sue, because it would "somehow sully my gratitude for being returned from the jaws of death." (p. 80) In fact, he has considerable praise for his surgeon.
The narrative of Fr. Neuhaus’s illness occupies a relatively small proportion of this memoir. The first three of seven chapters consist of the author’s reflections on the meaning of suffering and death, and especially the existential question of "Why me, now?" (His answer is "Why not?) In chapter five Fr. Neuhaus describes a near-death experience that changed his life, a scene in which he heard two "presences" tell him, "Everything is ready now." In much of the rest of the book, the author examines and rejects the possibility that the experience was a dream or an hallucination. He is convinced that he witnessed the "door" to a more glorious life after death, and this has, in some sense, profoundly changed his present life.
When literature and cultural studies professor Michael Bérubé's son James was born in 1991, he was diagnosed with Down Syndrome. Negotiating various medical, social, and educational environments and the identities each assigns their son, Bérubé and Janet Lyon (his wife, a literature professor and former cardiac-ICU nurse), become effective advocates for Jamie and embark on a course of questions about the social systems that produce disabled identities and administer to those human differences termed significant ones. Bérubé engages these questions with a mixture of family experience (his own, and that of other families with disabilities), historical research, critical theory, and sophisticated critical analysis.
This masterful collection of essays was written by Gawande while he was a general surgery resident. The book consists of fourteen essays divided into three sections: Fallibility, Mystery, and Uncertainty. Although some of the essays fall clearly within the boundaries of the section title (such as "When Doctors Make Mistakes" and "When Good Doctors Go Bad" in the Fallibility section), others cross boundaries or don’t fall as squarely in these general themes ("Nine Thousand Surgeons," an anthropological essay on the cult and culture of a major surgical convention, is also located in the Fallibility section). Nevertheless, the many pleasures of the individual essays, the range of topics explored in depth, and the accuracy of the medicine portrayed are the true strengths of this work.
The book begins Dragnet-style with an Author’s Note: "The stories here are true." (p. 1) And it is this attention to fidelity that makes the essays so compelling. Because even when the truths are hard--the terrible acknowledgment by the medical neophyte about lack of skill and knowledge, the mistakes in judgment at all levels of doctoring, the nature of power relations and their effects on medical pedagogy and on the doctor-patient relationship, the gnawing uncertainties about so many medical decisions--the author confronts the issues head on with refreshing rigor, grace and honesty.
Many of the essays reference scientific and medical research (historical and current) as part of the exploration of the topic. This information is imbedded within the essay, hence avoiding a dry recitation of statistical evidence. Typically, the reader’s interest in an essay is immediately piqued by a story about a particular patient. For example, the story of an airway emergency in a trauma patient, her oxygen saturation decreasing by the second as Gawande and the emergency room attending struggle to secure an airway, surgical or otherwise, sets the scene for "When Doctors Make Mistakes."
This leads to a meditation on not only the culture of the Morbidity and Mortality Conference, with its strange mix of third-person case narrative and personal acceptance of responsibility by the attending physician (see Bosk, Charles, Forgive and Remember: Managing Medical Failure, U. Chicago Press, 1981 for an in depth analysis of this culture), but also a positive examination of the leadership role that anesthesiologists have played in improving patient safety via research, simulator training and systems improvement.
Gawande’s journalistic verve takes him beyond the confines of his own hospital and training to interview patients and physicians on topics as diverse as incapacitating blushing ("Crimson Tide"), chronic pain ("The Pain Perplex"), malpractice and incompetence ("When Good Doctors Go Bad") and herniorraphy ("The Computer and the Hernia Factory"). In addition, he visits his own post-operative patients at home ("The Man Who Couldn’t Stop Eating" and "The Case of the Red Leg") which gives a longer view of postoperative recovery and a broader exposure to patients’ perspectives.
Some of the most telling moments come with the introduction of his children’s medical problems into the text. These range from the relatively straightforward (a broken arm, but a chance to comment on detection of child abuse in the emergency room) to the downright parental nightmare scary (severe congenital cardiac defect in their oldest child and a life-threatening respiratory infection in their prematurely born youngest).
These last two experiences are introduced to provide an angle on issues of choice. Choice of a fully trained, attending physician rather than a fellow to provide follow-up cardiac care for their oldest, and the choice to opt out of the decision-making process for whether to intubate the trachea of the youngest and hence leave the medical decisions up to the care team.
Born in Newnan, Georgia, and raised in Jackson, Florida, Cary Henderson was the first member of his family to go to college. He eventually earned a Ph.D. from Duke University and with his family, settled into an academic career as a history professor at James Madison University. In 1985, at the age of fifty-five, he was diagnosed with Alzheimer's disease.
As his ability to read and write deteriorated, Henderson began using a pocket recorder to tape what he called "the anecdotal career of an Alzheimer's patient" in order to help others "understand the world that they are now forced to live in" (4). His recorded journal spans the fall of 1991 to the summer of 1992. His wife and daughter began the long process of editing his tapes and were ultimately joined in the project by Nancy Andrews, award-winning photographer from The Washington Post, who provided images of Henderson to accompany his words.