Hard Choices

What should be done about a brain-dead patient whose respirator enables his lungs to continue functioning? What about a baby whose congenital birth defects prevent any semblance of normal brain function, and whose life will be both pain-wracked and abbreviated? Should doctors “pull the plug” on patients at the request of their families? Should the courts be involved? Who draws the line, and where?

HARD CHOICES first offers a foreword by John W. Scanlon, chief of neonatology at Columbia Hospital for Women and professor of pediatrics at the Georgetown School of Medicine. Readers who habitually skip forewords in order to jump right into the book will miss a thoughtful and well-written summary of the questions that physicians and patients must face when extraordinary technological methods become the only means by which life can be created, preserved, or prolonged.

The heart of the book is a succession of sad, sometimes horrifying stories about normal people facing abnormal crises such as incurable genetic disorders, life-threatening birth defects, or ailments whose treatments, while effective, are financially ruinous. Colen attempts to address both sides of each ethical dilemma. The author explains the positions of those families and physicians who believe that the quality of life is as important as the prolongation of life, and that decisions to prolong or terminate life properly belong to those people who are related most closely to the patient. At the same time, Colen is sympathetic to those who, because of their religious convictions, believe that euthanasia and experimental medical treatments are unacceptable.

While some readers may come away from HARD CHOICES remembering only the frightening descriptions of physical and emotional pain suffered by patients and their families, others will consider deeply the moral dilemmas raised by such experiences and will thus be better prepared to make hard choices of their own.