A Wretched Book Review!
First, Do No Harm
by Lisa Belkin
This book was accidentally sent to my castlemate instead of another book she had purchased and she was going to send it back but I said, “No – it sounds interesting. I’ll read it.” I was expecting one of those action-packed “Life in the E.R.” type books, but this is actually a book about medical ethics and it uses a handful of case studies to analyze the ethical dilemmas that doctors/hospitals face on a regular basis. At first I was disappointed that it wasn’t filled with ghastly stories of tragedy and mayhem, but in the end I found this book much more thought-provoking and illuminating than your average work of medical non-fiction.
Here are some examples of the dilemmas this book explores:
1. Is it a good idea to try to keep extremely premature babies alive? Not the month or two preemies that have a good chance to survive, but the severely premature babies born at 5-6 months gestation. In some countries, such as Sweden, they don’t bother with trying to ventilate and coax survival from babies born this premature. They just let nature take its course and let them die. Which sounds cruel… but is it crueler than forcing oxygen into lungs that are not developed enough to work on their own, thereby causing extensive damage and scarring that will result in either death or severe pulmonary disease for the rest of the infant’s life? And will most likely cause a chain reaction of organ failures, from kidneys to liver, etc., that will result in severe illness, possibly multiple resuscitations, prolonged suffering, and lifelong debility? And the kid will probably die eventually at some point in the months it spends in the hospital. And it’s going to cost you hundreds of thousands of dollars in the process – which, sadly, is a consideration that has to be made in American hospitals. And if you’re uninsured, should the hospital have to eat those costs, and thereby be forced to pass on the expense to other patients in the form of higher fees for services?
2. What should happen to illegal immigrants who suffer debilitating injuries, such as the Mexican man in this book who is shot in the neck, resulting in paralysis so severe he can’t even hold his head up, and must be strapped to an expensive rotating bed (to prevent bedsores), attached to a ventilator, and receive several thousands of dollars worth of care per day, from medications to suctioning of his lung secretions? Do you send them back to Mexico and let them worry about it (as a Chicago hospital recently did), or do you just turn them over to their families and let the families worry about what to do if the power goes out and they can’t run the ventilator that keeps their loved one alive? And again, who picks up the tab?
3. At what point do you decide that enough treatment has been done and it’s time to simply allow a patient to die instead of continuing lifesaving procedures that may only prolong death for a matter of weeks and may cause great suffering to the patient? The case study in this book is the most poignant of them all: a 16-year-old boy named Patrick who was born with an intestinal disease that resulted in most of his intestinal tract being removed at a young age. He was given intravenous nourishment most of his life, which resulted in constant fungal infections in his body, which in turn required constant application of anti-fungal drugs (which made him ill), and caused his veins to deteriorate to the point where he had to have an IV surgically inserted directly into his heart. And now this poor kid, who had spent much of his life in the hospital and is beloved by the nurses and doctors there, finds out that the IV line into his heart is plugged and his only chance for survival is another surgery to implant another IV… and he probably won’t survive it… and the doctors think it’s pretty much hopeless. But if you do nothing, he can no longer receive adequate nutrients through his fragile veins, so you’re subjecting him to a death by slow starvation… because our stupid culture doesn’t believe in Euthanasia for humans, only animals. What do you do? And who makes that decision? At what age is someone able to make their own decisions instead of allowing their parents or doctors to do so for them?
So, yeah, lots of interesting thought-provoking dilemmas in here, and no clear cut answers. I was thinking to myself as I read it, see, this is life as it is really lived. Life is not clear-cut like Republicans want you to think it is. There are no “right” or “wrong” answers in situations like these. Is it the responsibility of a doctor to save a life, regardless of the suffering that may result? Is it “wrong” to allow a premature baby born with severe spina bifida to die from infection, rather than perform surgery that may extend his life… even if he may have limited brain function, and will never be able to walk or even sit up? And who makes the judgment of what a “life worth living” is, anyway? I may think a life as someone paralyzed from the chin down is not worth living… but the man who suffered that injury said that his life after the injury was far more enjoyable than his life beforehand because he was closer to his family and he appreciated his life so much more.
I’ll be thinking about this one for awhile yet. 4/5
(Incidentally, I only gave it a 4 star because there were some slow parts in it – mainly discussing the Ethics Committee that meets at the hospital to discuss the cases.)
More medical books can be perused at The Library Eclectica’s Monstrous Medicine aisle.

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