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Review of End of Life-Care Ethics and Law
John DanaherThe relationship between philosophical ethics and medical practice weighed heavily on mind after reading this book. As I worked my way through the chapters, I found myself constantly recalling something that Frances Kamm once said when asked about the practical value of ethics:. .. people come to philosophy for practical guidance, certainly in bioethics. We now even have philosophers on medical wards, wearing beepers, who get asked by doctors 'Come advise me whether I should pull the plug on this person's ventilator'. I have never done that. I tried teaching at the medical school at NYU, but they were more interested in answers to specific real-life cases and I was more interested in theoretical issues that related to questions of practical import. " 1 Kamm's comment reveals certain tensions inherent in the discipline of medical ethics. In particular, tensions between the drive for theoretical sophistication and purity, on the one hand, and the drive for practical significance on the other. Academic monographs, of course, tend toward the former, while textbooks arguably tend toward the latter. But the tensions are always present and there is an important question as to whether ethics can, in the words of James Rachels, provide the answers for which people are looking. The book under review manifests these tensions rather exquisitely. Ostensibly, this is a textbook which aims to be of great practical significance. Written for healthcare professionals dealing with end-of-life care, the book is structured around eight modules, dealing with a range of practical topics such as " The Ethics of Breaking Bad News " and " The Ethics of Managing Pain ". One imagines the goal therefore must be to equip medical centres, hospitals and hospices with their own " philosophers with beepers " , ready, able and willing to advise on all manner of end-of-life care decisions. But one would be wrong, for this book does not aim to provide direct guidance to healthcare professionals. Instead, it aims " not to tell people what to do, but to offer tools for thinking about difficult problems " (14). Pedagogically speaking, this is an appropriate aim. And the educational philosophy behind the book specifically proclaims that the job of ethics and ethicists is to negotiate disagreements, not to resolve uncertainty (14). But one is left wondering whether this would be satisfying to the students participating in these modules. Would they be pleased to learn that there are arguments for and against breaking bad news to patients (81-105) and the decision of whether to inform a patient will depend on how one weighs competing ethical considerations? Would they, like Kamm's students back in NYU, not long for answers to real-life cases?
