Summary:

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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This is a story of a day in the life of 12-year-old Albert Abrams in Brownsville, Brooklyn, during the Depression summer of 1934. Albert’s father is an irascible middle-aged general practitioner whose practice is getting smaller and smaller. Most of his patients can’t pay; and many have left Dr. Abrams to go to younger doctors, or to specialists. Albert’s mother is a refined literary-type lady who never complains about their life in the deteriorating neighborhood, even though all of their middle-class friends have moved elsewhere.

Albert is a brilliant young man ("the highest IQ in the school"), but his greatest desire is to be "one of the boys." He is small, skinny, and poor at sports. The other kids make fun of him because of his "rich" father. The novel describes a long day of verbal and physical harassment; its highlights are a critical punchball game between the white kids, mostly Jewish, and black kids of Longview Avenue, and a fistfight in which Albert actually "beats" one of his perennial nemeses. In the evening there is a fire in which Yussel Melnick, an old Talmudic scholar, is burned to death.

Peeking out from behind his son’s story is the image of Dr. Abrams, a man who once was the star of his medical school class, but whose career long ago failed to "take off" because of his bluntness, bad-temper, and general difficulty getting along with other professionals. He is portrayed as a man truly committed to his patients, but also prone to yelling at them and hounding them for payment. As the day progresses, it becomes evident that Dr. Abrams has been losing his grip; he has episodes of confusion and appears to be on the verge of a nervous breakdown. In the end, stimulated by love for his son, he rouses himself from suicidal ruminations.

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This collection of over ninety photographs and their stories celebrates an "unsung army of great healers," caregivers of persons with AIDS. Herself infected with the HIV virus, mother and AIDS activist Mary Fisher chronicles painful, private, and precious moments of interaction between patients, families, lovers, friends, and "professionals," in home, hospital, clinic, and other settings (a women’s prison on Riker’s Island, a homeless shelter in Boston, a nursery in West Palm Beach). Interspersed with the photographs and commentary are excerpts from Fisher’s letters and addresses including her show-stopping televised speech at the 1992 Republican National Convention.

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Dmitry Ionych Startsev is a physician in a provincial town. He is frequently entertained by the Turkins, the town's most cultivated residents. He falls in love with their daughter, Yekaterina, who teases the doctor by asking him to meet her in the cemetery at 11 PM and then not showing up. Finally, she rejects his suit coldly, saying that she must go to Moscow and study at the conservatory.

Four years later, Startsev has gotten corpulent, built a big practice, become affluent, and lost all interest in romance. Yekaterina returns and tries to rekindle their affair, but Startsev becomes irritated and says to himself, "What a jolly good thing I didn't marry her!" In the end, he just becomes fatter and more irritable, and he shouts at his patients.

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In payment for the doctor's saving his life, a young man gives Dr. Koshelkov an antique bronze candelabra. The candelabra features "two female figures in the costume of Eve and in attitudes for the description of which I have neither the courage nor the fitting temperament." While the doctor finds the piece obscene, the young man chides him for not appreciating fine art. Finally, the doctor accepts the candelabra, but decides to give it to Uhov the lawyer, to whom he is indebted.

Uhov, in turn, judges the naked figures to be too raunchy: "I should be ashamed for my servants to see it." Yet, he is pressured to accept the gift. The same night he foists off the candelabra to Shashkin, the comic actor, who subsequently sells it. Two days later, the original young patient rushes into Dr. Koshelkov's office with the original candelabra, proclaiming that his mother had just discovered it in a shop. "Happily for you we have succeeded in picking up the pair to your candelabra!"

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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.

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Max Vigne, the most junior member of a survey group mapping the Himalayas in the 1860s, writes letters to his young wife Clara in England. She has prepared in advance of his journey a series of postdated letters which he keeps in his trunk. When these have been read, Clara sends numbered letter packets which arrive sporadically, out of sequence, if at all, over the months of the expedition. Max struggles to describe and to edit his daily experiences on the mountains which are extraordinary, often terrifying, and disorienting for him.

Separated by time, distance, and experiences, they are slowly and irrevocably estranged. Max discovers that his real scientific passion is alpine botany, and he must decide how to tell Clara that he will not be returning to England after the Survey ends. The exchange of letters ingeniously maps out the complexities between Max's love for his wife and his passion for scientific knowledge, and the wide expanse between them.

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One day some people were visiting Chekhov and they wanted to talk about him, about his genius. The author was embarrassed. He asked them, "Do you like chocolates?" Although the visitors were reticent at first, Anton P. Chekhov encouraged them to speak. Soon everyone was talking about his or her preference in chocolates, relishing the fine points of "almonds and Brazil nuts" and "the flavor of shredded coconut." Later, in the coach on the way home, the people felt that their conversation with Chekhov was very successful. [30 lines]

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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.

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Summary:

Giovanni (Nanni Moretti) is a psychoanalyst. He has a beautiful wife, Paola (Laura Morante), and an adolescent son and daughter, Andrea and Irene. One Sunday morning, Giovanni gets a call from one of his patients, newly diagnosed with cancer and frantic. Instead of spending the day with his family, Giovanni attends to his patient. Andrea goes diving with friends, there is an accident, and he is killed.

The rest of the film examines the family’s bereavement. Giovanni finds his work increasingly difficult, and by the end of the film he has decided that he can no longer be a psychotherapist.

A love letter addressed to Andrea arrives from a girl called Arianna: it turns out Andrea had a secret girlfriend. Both parents become obsessed, in different ways, with contacting Arianna. Eventually she visits them, while hitchhiking with her new boyfriend, and the family drive all night along the Mediterranean coast, taking Arianna and the boy to France. Next morning, on the beach at Nice, in saying goodbye to Arianna, they seem to have made progress in continuing their life as a family without their lost son.

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