Mortal Choices

(Critical Survey of Contemporary Fiction)

Dr. Ruth Macklin is a philosopher who has worked in the relatively new field of bioethics for the past fifteen years. Her function is to consult with physicians and health-care workers (most often in a committee) to advise them on the ethics involved in medical controversies as they apply to patients’ treatments. Macklin deals in this book with the difficult choices available to patients and their families in such cases as organ transplants, terminal illnesses, child abuse, critical infant care, and extraordinary means of sustaining life. As she does in her daily work, the author here explores the moral and ethical issues involved in these situations, often using actual case studies as concrete examples.

Macklin is a strong advocate of patients’ rights and is opposed to paternalism in medicine. She urges physicians to realize that they must always respect their clients’ autonomy, and she wants them to focus always on treating the patient, not only the illness.

Macklin is an extraordinarily rational thinker. Her book is dense with arguments and counter-arguments on almost all the vital issues facing medical practitioners today, including psychological research studies and artificial hearts. She raises provocative questions, not all of which can be answered simply or definitively. Macklin is very specific when she notices room for immediate reforms; for example, she demonstrates how a patient’s mental capacity should be determined properly and what order of priority should be given to the requests (or demands) of various family members of seriously ill patients.

Her knowledge of her own field, as well as of religious precepts and legal statutes, is vast, but she synthesizes all these materials admirably and clarifies them for the reader. Only the addition of a glossary of terms could improve this excellent, truly insightful work.