December 15, 2008

Strange Bedfellows: How Medical Jurisprudence has Influenced Medical Ethics and Medical Practice

By admin

The relationship between law and bioethics and the influence of both on medical research and clinical practice is a topic that is often mentioned but rarely subjected to sustained critical analysis. This book considers a number of issues in medicine in which the influence of the law has been most profound and positive including:

  • informed consent;
  • advance directives;
  • constitutional liberties and privacy;
  • standards for pain management and end-of-life care.

The book provides important background material on significant legal and philosophical concepts, terms and principle necessary to an understanding of the legal process and ethical analysis. This work establishes the role of law in medicine and bioethics as being positive and its continuing involvement in the rights of research subjects and patients as a necessity.

Customer Review: Most Biased Textbook I Have Ever Read–Skip It!

This is the worst, most biased textbook I have ever read. I have been in college for 15 years and have taught 10 college courses. I am presently working on my 6th degree, a doctorate in philosophy and also have a law degree. I have seen lots of school and been around lots of books. I have never been more frustrated with an author’s lack of intellectual honesty. As I see it, intellectual honesty means either 1) being as unbiased as possible, or 2) giving the whole story. Rich does neither. I will give you several examples of this.

In the discussions on abortion, after repeatedly giving only one side to the history of abortion, Rich says this: “The Catholic Church’s growing militancy in defense of existing abortion laws in the United States” caused a new debate, and they joined forces with the National Right to Life Committee where “the two groups fought against the growing support for abortion with lurid and graphic images of aborted fetuses, a tactic that continues to characterize the so-called pro-life movement” (108). You gotta be kidding!! This is a textbook? This is more biased than most editorials I have read. On 111, he is describing the history of the abortion laws up to the Casey decision and comments on the “confirmation of the ultra-conservative justice, Clarence Thomas…” Again, a textbook saying this? When discussing the “right to die” cases on p.133, Rich again uses several adjectives to distort the facts. He talks about the Missouri court taking a “highly-controversial” step of second-guessing the trial court’s assessment of the facts. (I don’t know what planet he is on. Appellate courts do this all the time. Maybe they shouldn’t, but they do. I worked in a Superior Court for 3 years and saw it repeatedly.) Then, he says that the Missouri court’s ruling is “profoundly disturbing.” When he gets to the Cruzan case at the United States Supreme Court (p.134), he spends roughly 1/5 the time on the majority opinion (the one that is the law of the land) compared to the dissents. These are dissents that are “strong.” Frankly, I read them and thought that they were not well written, as whole. Earlier in the chapter, when he addressed doctors who force-fed a patient, he vilifies them and in no way respects their attempts to determine what is right: “Regrettably, however, as we have already seen in other cases, the core ethical value and legal principle underlying these ringing assertions–respect for the autonomy of the individual–continued to be compromised through an open and notorious collaboration of paternalistic physicians and patronizing judges” (130). Can you believe that? This is a textbook and he is addressing a case involving people struggling to do their best in a very difficult situation, and because they disagree with them, they are “notorious” and “patronizing.” Finally, he takes a shot at the whole state of Missouri: “If states such as Missouri are so determined to demonstrate their reverence for the sanctity of all human life, why have they not instituted measures that would trigger their involvement in each and every attempt on the part of a patient or surrogate to prevent the administration of life sustaining measures? The cynical answer…is that the elected officials are unwilling to expend the significant political (not to mention economic) capital that would be required to insinuate the state into life and death decision-making across the board. They will simply accept what role the state can secure through the offices of non-elected appellate judges” (p.136). Can you believe this garbage is in a textbook?

I hope that these quotations are sufficient to make my point. There are *several* other such shameful characterizations in the book. Lastly, I want to note that the book is sloppy in a couple places. In one place (I forgot to write down the page), he uses “loathe” when he means “loath.” And on p.136 he talks of Justices “Brennan and Stephens.” There is no Justice “Stephens” on the Supreme Court. It is John Paul “Stevens.” These little things indicate the manner in which this book is written.

I gave it two stars because it is well written in certain areas–such as his discussion of SUPPORT and other informed consent issues. That, however, cannot overcome the overall unfair presentation of the issues.

If your class is using this book and the teacher is forcing you to get it, go to the library. Don’t waste your money on the $70. If you do buy it, go sell it afterwards and get hold of Jerry Menikoff’s excellent “Law and Bioethics: An Introduction”
or Roger Dworkin’s Book “Limits:The Role of the Law in Bioethical Decision Making.”

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