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 How and why your rights as a patient are eroding as the professional autonomy of physicians has declined and the power of bureaucratic overseers has grown. The ``enemies'' of the title may be an overstatement, but Macklin (Bioethics/Albert Einstein University; Mortal Choices, 1987) has chosen the term not for precision but to emphasize the adversarial roles that may be played by, among others, hospital administrators, risk managers, insurance companies, government regulators, attorneys, judges, and even physicians. She points out that, theoretically at least, physicians are guided by two principles: beneficence, which directs them to do good; and respect for autonomy, which recognizes the right of patients to take part in treatment decisions. But although these principles may coincide, they also may conflict; furthermore, physicians' personal values may conflict with those of patients, and pressures from various hospital and governmental bureaucracies may interfere with physicians' roles as their patients' advocates, putting the doctors into the position of ``enemies.'' Macklin presents specific cases that serve as models of representative situations. Among them are cases that examine do- not-resuscitate policies; the rights of Jehovah's Witnesses to refuse life-saving blood transfusions; the conflicts between the rights of pregnant women and those of fetuses; the refusal of doctors to treat certain patients; the rights of patients competing for scarce resources; and the right to die. Many of the cases are familiar, but what is unique is the author's marvelously clear ethical analysis following each one, as she presents conflicting positions fairly and tells where she stands and why. Highly recommended for anyone concerned about the care of patients and the protection of their rights. (For a fuller discussion of physicians' obligations toward patients, see Marc A. Rodwin's Medicine, Money, and Morals, reviewed below.)

Pub Date: May 1st, 1993
ISBN: 0-19-507200-6
Page count: 320pp
Publisher: Oxford Univ.
Review Posted Online:
Kirkus Reviews Issue: March 15th, 1993