CHOOSING LIFE OR DEATH: A Guide for Patients, Families, and Professionals

The wonders--and confusions--wrought by modern medicine, and some guidance through the maze for those in need of it. The federal government spends nearly $2 billion a year to keep 60,000 people on kidney dialysis. Is this unfair to those with other catastrophic and treatable diseases? A recent federal law declared the withholding of life-sustaining treatment from seriously handicapped infants to be child abuse, and stipulated that any doctor or parent who did so should be reported to the appropriate state child abuse agency. Does this mean that babies with conditions that will result in certain death in a year or so must be treated? If so, who is to pay? If prenatal testing indicates a child has Down's syndrome, spina bifada, Huntington's chorea or cystic fibrosis (tests for the last two are ""close at hand""), will, at some future time, a financially-strapped government withhold education and welfare benefits to such children on the grounds that the mother could have terminated the pregnancy? These are just a few of the problems and dilemmas created by recent medical advances that are discussed by Winslade and Ross. In successive chapters, they examine the ramifications of dialysis, life-sustaining treatment of the terminally ill, genetic screening and counseling, surrogate motherhood and embryo transfer, treatment of handicapped newborns, organ transplants and, lastly, experimental therapies. We learn that courts have generally favored requests by the terminally ill to be released from further treatment, but that the law is still reluctant to authorize a release if the patient is not competent. The new technique of embryo transfer promises to be a fertile field for lawyers. This adaptation of a common veterinary procedure calls for artificial insemination of a donor woman with the husband's sperm. The embryo is then flushed out and placed in the infertile wife's womb. But what if the embryo is not successfully flushed out? (This occurs about 15-20% of the time in animal breeding.) What is the legal status of the impregnanted donor? Of the biological father? If the transplant takes, how will the courts respond if the woman donor wants the baby? Throughout the book there is the constant question of skyrocketing medical costs, brought on partly by recent medical breakthroughs. There is also the bewildered medical consumer caught in a crossfire of ethical, legal, economic and social considerations. Winslade and Ross include these in case histories of ""composite"" patients caught up in a medical dilemma. Although these read like soap scenarios, they should help focus the problems for most readers.