Author Description

Filled with critically ill patients, equipped with the sophisticated and expensive technologies that are the miracles of modern medicine, American intensive care units are testing grounds for the most fundamental issues of contemporary medical ethics. The doctors and nurses who staff ICUs daily confront these difficult questions: Under what circumstances, if any, is it acceptable to withhold treatment? Who should get the last bed when there are too few? How should these decisions be made and by what criteria? In riveting case studies collected between 1985 and 1989, Robert Zussman describes how medical decisions in ICUs are considered and reconsidered, made and remade, negotiated and renegotiated. He concentrates on the practice of medical ethics, on the ways in which right and wrong are interpreted and used in the ward--how definitions of right and wrong emerge from the social situations of patients, families, doctors, and nurses and from the workings of hospitals and the courts.^ From this superb fieldwork--observing medical staff on their rounds; interviewing staff, patients, and families; and systematically reviewing hospital records--Zussman reveals the existence of deep conflicts of opinion on how to allocate treatment and resources. He shows that these perspectives depart from the formal principles of medical ethics. He argues that courts and hospital administrators, with their new insistence on taking the rights of patients seriously, have reshaped the way life and death decisions are made. At the same time, Zussman examines doctors' frequent resistance to the precepts of medical ethics: doctors, he shows, often override patients' wishes, justifying their decisions in the name of the patients' best interests while maintaining control over the decision-making process.^ In Zussman's hands, the study of medical ethics becomes a means of examining the logic and limits of professional discretion and a source of insights into the social and economic forces empowering patients and administrators at the expense of physicians. His book is a strong, often moving portrait of the way careful planning is undermined by the unpredictability of illness and the persistence of self-interest, by high principle and curious compromise.