Summary:

Auden wrote this poem in memory of his own physician, Dr. David Protetch. He begins, "Most people believe / dying is something they do, / not their physician . . . " Auden, whose father was a physician, knows better. His father had warned him about doctors who are too aggressive or too concerned with money. Fortunately, he found a consultant who thought as his father did, perhaps because he (Dr. Protetch) had himself "been a victim / of medical engineers / and their arrogance, / when they atom-bombed / your sick pituitary / and over-killed it."

While prescribing for Auden’s minor complaints, Protetch himself was "mortally sick." Because of this, Auden felt that he could trust his doctor to tell him the truth about his medical condition: "if I were dying, / to say so, not insult me / with soothing fictions." Thus, Auden praises Protetch for having been, "what all / doctors should be, but few are . . . " [78 lines]

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Henry Moss is a medical geneticist specializing in Hickman syndrome, a fictitious disease resembling progeria. Children with Hickman syndrome experience premature aging and invariably die before the age of twenty. The physician meets Thomas Benhamouda, a teenager who genetically has Hickman syndrome but astonishingly has no physical manifestations of the disease. Dr. Moss identifies a protein that "corrects" Hickman syndrome in the blood of Thomas and proceeds to synthesize it.

Dr. Moss violates medical ethics by administering the experimental enzyme to his favorite Hickman patient, William Durbin, a dying 14-year-old boy. It is a last-ditch effort to save William's life even though the substance has not been tested for safety or efficacy in human beings. Dr. Moss also injects himself with the enzyme. He realizes the tremendous potential the drug has not only in curing Hickman syndrome but also in extending longevity in normal individuals. He is well aware of the great financial rewards he might reap from his discovery.

After a series of injections, William's deteriorating health stabilizes and even improves but he dies in his home. Dr. Moss has failed to save the doomed boy but in the process of breaking the rules and risking his career has learned how to understand and appreciate his own life as well as reconnect with his family.

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This long poem in 20 sections seeks to explore, dissect, and create a language for the experience of hemophilia. "Blood pools in a joint / The limb locks . . . " The poet first dissects words like "trans / fusion" and "hema / toma," and showers the reader with images (like splatters of blood?).

In section 5 he states his purpose in the familiar jargon of educational objectives and later, in section 10, he utilizes spacing and line breaks to convert standard admonitions into poetry; for example, "These child- / ren should / not / be / punished, and / their / play with / other / children / should / be super- / vised . . . " Isolated phrases and sentences appear--some from the hospital and some from the "outside" world.

In some phrases the worlds of outside and inside mix, as in "Arterial sunrise, capillary dusk." Section 13 consists of laboratory reports. The poem breathes in and out, between syllables and long lines, between prosaic statements and poetic images. Finally, the poet finds words for the endless rhythm of hemophilia, "Gratitude and / fear--Your relentless / rhythm--I move to / it still . . . "

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Surrounded by Family and Friends is a collection of six life-sized fabric and thread wall hangings that explore the relationships between dying persons and those human or animal companions they are about to leave behind. Scherer’s drawing tools are her scissors and sewing machine; she sculpts in fabric--a warm, tactile and inviting medium.

In "At Night," a dying man, though weak, is alert, conscious, and comfortable. His direct eye contact with the viewer draws us into the family grouping of standing daughter or wife with eyes downcast on one side of the bed, and a seated elderly woman and middle aged man on the other side looking at her. The artist met and did a pencil sketch study of her protagonist 21 days after he had rejected further dialysis and other treatments. Scherer documents in her notes, "He wanted his doctor to see the drawing--proof that he was still here, doing it right, dying his way. He told his wife, ’The doctor should see this! I did it MY way!’ We agreed to write those words on the drawing." (Project on Death in America newsletter, 2002: (10) p. 7)

"Open Window" shows an elderly woman in bed with a window open to a breeze that gently stirs her long gray hair splayed out around her head like a crown. Although the woman is fragile and bedridden, the hair is striking, gray with age, but thick and vital. Her cat stands sentry beside her, greeting the viewer with a steady gaze.

In "Child" a seated mother is kissing the head of the dying child on her lap. The supportive medical technology is barely visible. A teddy bear, colorful patterned quilt, and a clean gauze-like curtain communicate the essence of palliative care.

Two standing figures tenderly touch and comfort themselves and a third who is dying in bed. "Three Men" is exceptional for its unselfconscious display of the loving relationship between the subjects. They might be brothers or friends, lovers, or professional caregivers. Intergenerational and non-traditional families from culturally diverse groups apply to all six of these works.

"In Her Room" appears to be a husband and wife, though the actual relationship doesn’t really matter. Directly gazing at the viewer, the calm subjects invite us into the comfort and intimacy of this moment. The "husband" might well be the caregiver. He sits close to the woman’s bed, his hand wrapped firmly around her outstretched arm.

"Bigger than Each Other" is a composition of a couple seated on a couch holding hands, fingers entwined. The woman--with tubing supplying nasal air/oxygen--is enveloped in the body of her husband (partner? Physician?). Although physically present to each other in an embrace, they appear to be lost in their separate thoughts.

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Grace Rhodes (Lisa Eichhorn) is an unmarried New York advertising executive. Around forty years old, she decides that she wants a child and has no more time to find the right man. She becomes a client of Cryogenetics Sperm Bank and conceives by donor insemination.

As soon as she is pregnant, she becomes obsessed with learning more about the sperm donor, and her friend, Elaine, helps her by taking on a temp job at the sperm bank and breaking into their files, discovering the identity of Grace's donor, a photographer named Peter Kessler (Stanley Tucci). He is single, having an affair with a married woman, and his landscape photographs never include human figures because, he says, "people mess up the composition."

Grace visits Peter's upstate New York studio. They meet, become friends, and then begin dating. Grace tells him she is pregnant and that he is the child's donor father. He is outraged and throws her out. Months pass, and Peter arrives in New York to apologize to Grace, who is now heavily pregnant. He gives her a photograph he had taken, of her. The film ends ambiguously, but suggests that they will become a couple and parent the child together.

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Holy Fire's setting is America at the end of the 21st century. A gerontocracy is firmly in place and in many older persons are reaping the benefits of life-extending technology. Mia Ziemann, the protagonist of this "cybersuspense" novel, is a 94 year-old medical economist who has a life-altering visit with a dying ex-lover. Could she become the person she had wanted to become so many decades ago--someone much more adventuresome?

In order to do so, she needs to undergo an experimental treatment--NTDCD (Neo-telemeric Dissipative Cellular Detoxification)--that does not just halt the aging process, but reverses it. NTDCD involves numerous ordeals including clogging her digestive tract with a sterilizing putty, filling her lungs with a sterilizing oxygenating fluid, replacing her cerebrospinal fluid (producing profound unconsciousness), being fetally submerged in a gelatinous tank of support fluids where the bacteria in her body are removed, and then receiving DNA treatments. If she survives the treatment the question remains whether or not she'll be able to survive as a young person in a world that favors the old.

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In this memoir, subtitled "One Woman's Search for the Perfect Sperm Donor," lesbian author and academic Harlyn Aizley confronts her approaching fortieth birthday by deciding to have a child. She and her partner, Faith, begin the process of choosing its biological father. The first major decision: a known or unknown sperm donor? Eventually they choose an unknown one, from a sperm bank with an identity-release program that will allow their child the option of meeting her biological father after she turns eighteen.

Aizley narrates, in absorbing and often very funny detail, the eight months it takes her to conceive, and then the nine months of pregnancy culminating in the birth of a daughter. Sad but telling counterpoints to this narrative are the terrorist attacks in September 2001, which occur during Aizley's pregnancy, and the experience of her mother, who dies three months after the baby's birth, of ovarian cancer.

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Emiko a child survivor of Hiroshima, is now a documentary filmmaker. She has horrific memories of August 1945 when she lost her parents and little brother, and of the years of painful operations and homesickness in America where she was sent to restore her mutilated face. She is hoping to interview Anton Böll, a scientist who had fled Germany to work on the Manhattan project.

Böll contends that he had been unaware of human rights abuses; he left Europe because the Nazi regime had cramped his scientific style. As a consequence, his mother was imprisoned and killed. During the war, he met his Austrian-born Jewish wife, Sophie, at a displaced persons camp in Canada. Sophie had lost her whole family, but she does not speak of them and he does not ask.

Briefly they knew happiness, but soon Böll left for work on the bomb and on to Hiroshima in its aftermath. Their marriage would never be the same. For the rest of his life, Böll justified his involvement as a "dream" turned "nightmare" emerging from the imperative demands of a virtuous science. When Emiko approaches him, he hesitates. He does not want to risk blame. But his dying wife knows that absolution for unacknowledged guilt is what he craves.

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A philosopher and a clinical ethicist conduct an analysis of the practice of assisted suicide. They begin with the premise that health care providers may at times be assisting with suicide now, whether or not it is legal and whether or not the ethical dimensions have been solved. They contend that assisting a suicide might be morally right, but only when the patient’s choice is rational and free.

Referring to an earlier publication by Prado (Last Choice: Preemptive Suicide in Advanced Age, 1990; 2nd ed. 1998), they devote a chapter to each of three criteria used to determine the "rationality" of a choice for suicide, and another chapter to the "slippery slope" argument. A final chapter summarizes their contribution to this topic.

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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.

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