Book reviews 161 J Med Ethics: first published as 10.1136/jme.13.3.161-a on 1 September 1987. Downloaded from between women in terms of probability the thinking of ten American ofrisk to an unborn child and offer a test physicians. This article was written in The - which, to be effective in population an attempt to begin to examine publicly Understanding terms, will lead to being offered the responsibility ofphysicians towards termination of an abnormal fetus. Such the hopelessly ill patient. The article screening would generally be for deals with the ethical dilemmas of Derek Humphry and Anne Wickett, Down's Syndrome and would only be whether life should be sustained at all 353 pages, London, £15, The Bodley performed after agreement of the costs or whether its quality should be Head, 1986 mother to abort an affected fetus. To taken into account. It perceives four respond to a woman's request for such general levels of care which should be The uncomfortable paradox of modern tests may be morally acceptable, but to considered and discussed with the medical advance is that technology can sow seeds of doubt in the mind of a patient ranging from emergency often create much suffering particularly pregnant mother who hitherto had no resuscitation to general nursing care in a terminally ill, elderly patient who worries, and to offer her the death ofher which simply makes the patient would much prefer 'to go to sleep now' baby as the sole solution may be comfortable. The article considers both as in the reported last words of92-year- ethically unacceptable. the competent and incompetent patient old Lord Stockton, Harold MacMillan. There is no evidence put forward as and argues for a sensible approach to To go gently into that good night is the to who these high-risk women are, nor patients and relatives who, if at all preferred way of death for most of us of the proportion of women in these possible, have the right to be involved in but the dilemma of modern medicine groups likely to find this method of any decision-making. Further, it affirms is that the ethical insistence on the prevention morally or ethically the limited usefulness of 'The Living sanctity of life often means for aged acceptable. It would have been Will' as a real assistance to the physician patients who might have slipped away interesting to have examined the trying to ascertain the best course of peaceably only a generation ago, that acceptability and efficacy of such treatment for the dying patient. death is a technological battle to keep programmes elsewhere. In addition, The second section of the book is a patients alive - no matter what the one would have expected a health compilation of questions and answers quality of life is. The medical and economist to have looked more closely on legal aspects of allowing patients to ethical commitment to preserving life at the issues of likely cost-effectiveness die. Here the book moves from the ideal even against a suffering incurable of such a screening policy. The or theoretical to the pragmatic. This patient's wishes is the subject of Theby copyright. application of currently accepted begins to put into perspective what Right to Die by Derek Humphry and criteria for monitoring a screening courses of action are possible, when the Anne Wickett. programme would have been patient's wishes should be heeded and This wide-ranging and closely argued illuminating. the doctor's responsibilities when study, subtitled Understanding Despite these reservations, the dealing with the hopelessly ill person. Euthanasia, traces the historical author reflects a body of current The final section of this book takes perspective of 'mercy-killing' and the opinion, concerned to make things the questions a stage further by giving roots of the religious and cultural work, to provide 'good' community an up-to-date resume of right to die and concept of the sanctity of life. care, though possibly at the expense of living will legislation and case law State The authors make no secret of their families and the community, and to by State. What becomes apparent from position and argue fluently that involve statutory and voluntary sectors this is the sheer complexity and variance euthanasia is the compassionate http://jme.bmj.com/ more in working together. The in legislation in the . Since response where terminally ill but problems have been realistically 1976 some 36 States have enacted living competent people request help to die. It analysed but a lot more effort must be will laws. Although these share is inhumane, they argue, to keep people directed to finding convincing and common features no two are precisely technically alive when they are in a ethically acceptable solutions. identical. This is further complicated hopeless condition, when they are by the fact that where a State has no suffering and when they have made it DEIRDRE CUNNINGHAM or case law about the clear they wish to die. Department of Community Medicine, legislation right to die. . . 'the law of other States may Derek Humphry, an English on September 24, 2021 by guest. Protected Paddington and North Kensington exert influence and may indicate journalist who now lives in America, Health Authority, London general trends, but it is not binding'. writes from first-hand experience in This book is a fascinating vignette on that in 1978 he wrote Jean's Way, an how the United States is dealing with account ofhow he helped his terminally The Physician and the one of the most important ethical ill wife to die. He was investigated by Hopelessly Ill Patient: considerations of the medical the Director of Public Prosecutions as profession; the right of anyone to self- to his role in his wife's death but he was Legal, Medical and determination at the most profound not prosecuted. Now with Anne Ethical Guidelines level. It is generally accepted that in a Wickett, his co-author, he has founded developed society ethical principles will the which urges the Society for the Right to Die, 92 pages, be enshrined in legislation. However, rights of people to be helped to die, New York, $5.00, Society for the Right reading this book gives one a sad either in a passive or even in an active to Die, 1985 reminder of the chaos which ensues way, when medical help can only when a medical profession is beset by prolong what they consider to be 'dying' This volume is divided into three rampant and costly litigation. and not living. sections. The first, short section is a However, the study gives a fair and reprint ofan article which was originally RODERICK COSH objective view of the many arguments published in The New England Jrournal Chaplain's assistant, against euthanasia, as an Orwellian ofMedicine in 1984 and is a synthesis of The Royal Marsden Hospital, London 162 Book reviews J Med Ethics: first published as 10.1136/jme.13.3.161-a on 1 September 1987. Downloaded from nightmare, as the thin edge of the This book should be compulsory two main aims. One is to survey the wedge, as in the Nazi experience, as a reading for all those engaged in, or main controversial problem areas in threat to the trust between patients and considering a career in, neonatal medical ethics around the time of the doctors and as evidenced by the moral medicine. It is well written and full of commencement of life: abortion; dilemma of doctors themselves. understanding and feeling for the artificial insemination; ethics ofembryo The ethical dimensions of mercy- babies who can express no opinion, for research and experimentation; prenatal killing are profound and the authors their parents who do not have a much diagnosis; genetic engineering; cloning, rightly label the still almost taboo bigger say in the matter and for the and in vitro fertilisation. The book subject 'one of the last serious moral doctors who have to make life-and- provides a useful survey of the moral issues for modern society to decide on'. death decisions in an atmosphere of problems in these areas, ostensibly from It is certainly an idea viewed with American legislation which may compel a Christian viewpoint. It is an area abhorrence by many, but the euthanasia them to carry out intensive treatment which receives little attention in the movement has grown rapidly in the against their consciences and against the medical-student curriculum although USA where 40 States now have 'living interests of the babies. we will soon be in the position ofhaving will' legislation which effectively What they describe with immense to make immediate decisions on such authorises the maker's family and sympathy and understanding is the dilemmas, whether as physicians or as doctors not to take 'extraordinary' absolute horror of American medicine, parents. I thus found this book of great measures to prolong life when death which I am afraid is already creeping benefit since it opened my eyes to such seems inevitable and the illness into our own practice. controversies and provided me with an incurable. In Britain, the pro- They have admiration for the information base on which to formulate euthanasia movement has grown magnificent technology which is my own opinions. steadily under the auspices of the increasing almost every day but which The book's second aim is to argue for Society but it is runs far ahead of the consideration of a mechanism whereby the consensus of the Netherlands which has taken the what its application means to so many. It society on these issues can be obtained most radical steps in providing a legal may be best to quote verbatim a and applied. In order that an framework with strict guidelines for paragraph which will give the reader a appropriate decision may be reached doctors who have to treat patients who good impression of the substance and Gareth Davies hopes 'that even those have asked for life-preserving treatment tone of the whole book: who disagree with my stance on various to be withheld at a certain point. The points will look beyond such by copyright. Dutch legislation goes further even than 'However, hand in hand with this disagreement to the underlying withholding treatment. There, a progress run its side-effects, principles'. This makes an important physician who meets strict criteria, can threatening to trip it and send it point: there is a need for patients, and give a lethal injection to a dying person crashing into a nightmarish domain for society at large, to become more who has requested death and the where, as in George Orwell's 1984, involved in medical decision-making, physician will not be punished. things become the opposite ofwhat they particularly, perhaps, with regard to It seems unlikely that the British were intended to be. In the intensive general principles. There is no escape medical profession or the public are yet care nursery, where the dramas of from the ramifications of biomedical ready to go that far but this book is a neonatology unfold, equipment technology and the many issues raised valuable contribution to the debate. designed to be therapeutic can turn into in the book should provoke the reader machinery for torture. Saving life can http://jme.bmj.com/ GORDON into reflecting on his or her own ethics WENDY FISHER mean prolonged dying. Babies are and practices. Furthermore the point is Barrister, 27 Burgh Street, "saved" only to be confined to London NI made that many people prefer their institutions as total care patients, while doctors to make choices for them in their families are destroyed by the areas such as abortion and prenatal A Time to be Bom, a "rescue". The burden of choice is as screening. I found this rather great as its potential.' disconcerting in its implication that Time to Die doctors have some particular divine Rasa Gustaitis and Ernle W D Young, The book should be on the shelves in right to preside over human life and that on September 24, 2021 by guest. Protected 267 pages, USA, $18.95, Addison- every neonatal intensive-care unit and they will always arrive at the 'right' Wesley, 1986 should be frequently read and not just answer. catalogued. Overall, I enjoyed reading this This book was written by two non- May we be spared the horrors of fascinating book, which deals with medical authors, one of whom, intensive neonatal care inflicted on issues that are less than comfortable and Gustaitis, is a professionl journalist and American babies! conveys some of the dilemmas and the other a chaplain and senior lecturer quandaries facing personnel involved in in medical ethics in the Stanford JOHN LORBER making decisions about human life University medical school. They were Emeritus Professor ofPaediatrics, around the time of its inception. The given the free run of the neonatal, University ofSheffield text was refreshingly free from the intensive-care nursery at Stanford prententious jargon which sometimes University and had detailed frequent disfigures studies of this sort. The only discussions with the medical and Brave New People disappointment is that the book was not nursing staff, as well as with the parents able to deal with developments in of very small babies. They lived on the D G Davies, 221 pages, Leicester, medical ethics over the past couple of premises and absorbed the whole £4.95, Inter-Varsity Press, 1984 years since it was published in 1984. In atmosphere of the problems created by, particular in the field of research on and sometimes solved by neonatal This book, written by a professor of embryos a discussion of the Warnock intensive care. anatomy who is a devout Christian, has committee report would have been