32 Books THE CHILDREN ACT, by Ian McEwan 2014, NAN A. TALESE (hardcover); Anchor (paperback), ISBN 0385539703, also available in KINDLE, and audio editions oncology-times.com • n the 1970s while at the NIH, this One such is her well-publicized age, refuses therapy, transfusions, and reviewer was asked to provide ex- decision to separate conjoined twins. dies. pert commentary on the prognosis As McEwan writes, “She was the one In the final pages of the book, Justice of a young pregnant mother with who had dispatched the child from the Maye comes to grip with the conse- July 10, 2015 Iextensive osteogenic sarcoma pulmo- world, argued him out of existence in quences of her decisions: “Adam came • nary metastases. My comments played thirty-four elegant pages.” looking for her and she offered nothing only a minor part in a complex and These troubling cases, along with in religion’s place, no protection, even wrenching legal debate about patient’s her disintegrating marriage, have left though the Act was clear, her para- rights, survival of the unborn infant, Justice Maye adrift. Nonetheless, she mount consideration was his welfare. and the inter- approaches the She thought her responsibilities ended ests and desires transfusion di- at the courtroom walls.” of the husband lemma with her There is something prescient about REVIEWED BY and other close typical focused McEwan’s description of the Justice’s ROBERT C. YOUNG, MD relatives. The and crisp style. conclusions that relate to my own expe- Oncology Times Chairman, OT Editorial medical realities Quoting her men- rience with such cases. The court acts in Board seemed lost in tor Lord Justice accordance with its own interpretation the cacophony Ward (paren- of the law. The decision, no matter how of claims and thetically one of well-reasoned, falls short of optimal if counter claims McEwan’s actual it fails to consider the moral implica- and the effort of advisors), Justice tions of the decision and its long-term the court to make Maye opines: “The consequences. legal sense out of Court is a court of In that sense, courts of law seem to personal trag- law, not of morals. be a less than optimal venue for the eq- edy and chaos. Our task has been uitable resolution of these complex per- “Despite some Subsequent to find and our sonal tragedies. My view is that they are high-profile ex- duty is to apply, best left to candid and intimate conver- flaws, this short amples like those the relevant prin- sations between the principals and their of Terri Schiavo ciples of law to physicians. book by one of and Karen Ann the situation be- In this reviewer’s view, The Children our finest current Quinlan have not fore us-a situation Act is not one of McEwan’s best works. altered my view. which is unique.” Although he does delve into the mo- writers on a topic As a result, While she lis- rass of these tangled tragedies, the when one of the most accomplished tens and respects all the arguments from story is too thinly developed and the of direct relevance and honored of British novelists, Ian opposing lawyers, her decision never author does not explore the spiritual to oncologists will McEwan, tackled the subject in The seems to be in doubt. She believes that center of the conflict in any detail. Children Act, it promised to provide the welfare of the child must dominate In that sense, this book falls short of leave you with some clarity on a very complex and her verdict. She concludes that the boy, some of his most sumptuous works compelling controversy. The story is his parents, and the elders of the church like Atonement, On Chesil Beach, or the respect for the simple—the consequences are not. have made a decision that is hostile to nightmarish day of a neurosurgeon in challenges facing Fiona Maye, a 59-year-old, childless the boy’s welfare. She overrules their Saturday. British High Court judge in the Family wishes and finds for the hospital. Still, McEwan is a masterful writer judges as they try Division presides over an emergency With proper therapy and transfu- and The Children Act is packed with request from a hospital to transfuse a sions, the leukemia remits and the boy examples of his stylish prose. Here is to bring clarity and 17-year-old leukemic patient who is recovers. In the more thinly developed one describing the hospital: “They en- reason to the murky refusing transfusions for religious rea- part of the book, Justice Maye receives tered a glassed-in atrium the height sons. The boy and his family are devout two letters from the boy highlighting of the entire building. Mature native and unreasonable.” Jehovah’s Witnesses and have clear and his break from the church and his fam- trees, rather starved, pushed hopefully considered reasons for their refusal. ily and his growing attachment to the upward from the concourse. The long Artistic license has apparently allowed Justice. In her typically reasoned way, straight run up the escalator brought McEwan to ignore the possibility of he- she concludes that it would be best not them to a mezzanine where a florist matopoietic stimulants as an alternative to respond. This finally results in a face- and gift shop were ranged around a to transfusions. to-face encounter where she rejects his fountain. New Age music, airy and un- The title of the book, The Children pleas, gives him an over-exuberant kiss, modulating merged into the sound of Act, refers to the legal structure which and sends him on his way. the tinkling water. The model was of defines the court’s responsibilities. In In the third and final letter from course, the modern airport.” it the Act concludes “the child’s welfare the boy, he encloses a poem—“The We have all seen such hospitals but shall be the court’s paramount consid- Ballad of Adam Henry”—in which he likely never described them as opulently More OT Book eration.” Justice Maye is recognized by concludes with the line about hearing as Mr. McEwan. Reviews! her peers as perceptive, compassionate, the voice of Satan and “having to pay In spite of its flaws, this short book by conscientious, and skilled at bringing the fee.” Again she does not respond one of our finest current writers, on a “reasonableness to hopeless situations.” and believes “she would fade in his topic of direct relevance to oncologists, is ind the full collection of Bob While she seems organized and efficient thoughts, become a minor figure in a worthwhile read. It will leave you with FYoung’s OT book reviews online: on the surface, she ruminates over pre- the progress of his sentimental educa- respect for the challenges facing judges as bit.ly/OTCollections-Books vious cases where she had been required tion.” Her decision proves fatal as the they try to bring clarity and reason to the O to sort out other personal tragedies. boy relapses and, now at 18 years of murky and unreasonable. T.