Excellent book by an ER doc, who in mid-career studied and now teaches medical ethics. He discusses thorny issues in medicine, mostly end-of-life treatment, care, and decisions. He uses cases from his personal and professional experience including his ER practice, friends, and his own father's death.
Our (US medical culture) focus on long-term care, makes one think about "extraordinary measures" when the end of life presents itself.
Illusions of Control (ch. 3):
- A wealthy patient got the treatment she specifically requested (at home) and died - a poor patient got better treatment because it was coordinated by experts.
- Colleague (another ER doc) w/terminal cancer used his medical knowledge to take control of his treatment, and stopped short of aggressive treatment that wasn't shown to statistically improve quality or survival. He lived 3 years longer than expected, but still experienced many of the psychological downfalls of a terminal illness.
Elective Choices (ch 4): Discusses the tendency for physicians [and the medical establishment] to push "life-saving" (= no hospital death) measures. e.g. respirators.
If This is a Person (ch 6): A full chapter on persistent vegetative state (PVS) a la Terry Schiavo. Some recover (excellent case from early in his career), most don't. The current push of the healthcare industry for transplant harvest is ethically questionable. Transplants are a money-maker for hospitals (per insurance & medicare policy). Keeping people on life support is a drain.
As Night Draws Nigh (ch 8): A good death.
Uses his father's death as an example. A moving and well-thought out chapter, though I disagreed with his use of his medical knowledge. My own opinion.
