This is an excellent and provocative discussion that should be of interest to auto/biographers; patients; physicians who write [about their patients or about their clinical experiences] as well as physicians who do not write; bioethicists; literary scholars; scholars in cultural studies, ethnography, science studies, disability studies and other fields. While not wishing to impose unnecessary restrictions on writers, Couser is concerned that those who write about the sick or disadvantaged have a special obligation to represent their subjects in a way that "resist[s] objectification" and resists exploitation. Furthermore, he argues, authors have an obligation to their readers to articulate the negotiations that took place with their subjects in order to publish.

Perhaps the most important chapters for medical humanities are chapters 4, 5, and 6. In Chapter 4, "Adoption, Disability, and Surrogacy: the Ethics of Parental Life Writing in the Broken Cord," Couser argues that the way in which Michael Dorris represents his adopted [Native-American, mentally impaired] son transforms the boy into a case history, the embodiment of cultural damage [as it is reflected in the high incidence of alcoholism among Native-Americans] and Otherness.

The discussion of Oliver Sacks’s work in Chapter 5--"Beyond the Clinic: Oliver Sacks and the Ethics of Neuroanthropology"--expands significantly Couser’s critique of Sacks in Recovering Bodies: Illness, Disability, and Life Writing (see annotation). Couser traces the articulation of Sacks’s "personal medical ethic" (86)--attending to the person and the meaning of illness to the person--and its expression or lack thereof in his writing and filmmaking. He elucidates in considerable detail those instances where Sacks reduces people to things because he chooses them and identifies them (with medical authority) as model cases, or because he presents people as puzzles to be solved by a medical detective who is himself.

On the other hand, Couser credits Sacks for acknowledging that disability "may bind people together in communities that have distinctive values and customs" (99) and that conventional notions of illness and health must be questioned. There are interesting observations contrasting the Sacks films with some of his writing; Couser notes that in certain films, some of the patients clearly understand their position and are active agents in the filmmaking process.

Chapter 6, "Life Writing as Death Writing: Disability and Euthanography," explores the ethics and complexities of this writing. As Couser explains, "issues of autonomy and authority are crucial" in this genre and the writers in these cases are "complicit in the death they narrate" (125). Further, these texts, Couser posits, provide an opportunity for the reader to search out what is not said, what is not taken into account in the narrative; he suggests that such narratives and an active reading process are important in the euthanasia debate, as well as for providing new perspectives on living with disability.

Couser supports the notion that biomedicine and life writing have an obligation not just to respect autonomy, but to actively promote it. Individuals, he argues, exist in relations with others and that "relational self" must be "nurtured in its existential context" (163). "If the subtext, the subliminal message, of medicine today is all too likely to be ’cure, correct, or eliminate’, the subtext of robust disability narratives is life without cure, but not without care" (164).