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Easier said than done: Moral decisions in medical uncertainty
186
Surg Neurol 1994;42: 184-6
Easier Said Than Done: Moral Decisions in Medical Uncertainty. By Milton D. Heifetz, M.D. 259 pages. $24.95. Buffalo, New York: Prometheus Books,
1992.
ISBN
O-87975-721-3.
Milton Heifetz, a multitalented person by any standard, has devoted months to the preparation of Easier Said Than Done. He left the day-to-day busy schedule of a neurosurgeon to clarify in his own mind and to help others struggling with similar problems related to medical ethics. The subject of ethics is not new but its place in philosophy, religion, and psychology was on a definite plateau. The driving force of medical ethics has increased in the published literature in this field by more than 100%. The end of World War II, the Nuremberg Trials, and the revelations of the activities of some of the Nazi physicians stimulated much discussion, in fact, awakening, among the minds of philosophers and religious leaders as well as physicians. The seminal article by an Austrian Jewish refugee psychiatrist, Dr. Leo Alexander, appearing in the New EnglandJownal of Medicine in 1949 was a clarion call, disclosing the details of the activities of the Nazi doctors. Joseph Fletcher in Charlottesville, Virginia, a minister and a profound ethical leader, went further into the fray. Since then, many distinguished minds have published on this subject, including Pelligrino and a number of other members of the Kennedy Institute of Medical Ethics at Georgetown University in Washington. Medical schools now teach ethics in the curriculum, and students in Problembased Education find that they must become “comfortable with ambiguity.” Medical ethics is not a clean, discreet subject that can be tucked into a neat file. Fortunately, the brilliant mind of Milton Heifetz has sought answers presented to society and particularly to the medical profession by the exponential progress in medical
Book Reviews
science. Once it became routine to insert intratracheal tubes in those who could not breathe on their own and it became possible to save lives otherwise lost, to prolong lives of some no longer anxious to live, and to transplant organs from one human to another, there has been no end to the problems generated by physicians who must make many profound decisions everyday. Heifett has read extensively, including the philosophies of Buddhism, Confucianism, Hinduism, and Judaism. He has distilled these, as well as Judeo-Christian thought and all the other subjects he has read, into this brief book. He has been impressed by a somewhat different group of authors and ethicists than I, and consequently, I learned much in reading this book. I would recommend it for all in the field of medical ethics who are prepared to take the time to digest the author’s thoughts-some of which will surprise the reader and are only peripherally related to medical ethics. Dr. Heifetz’s own statement in the introduction expresses in true humility his intention to be of help to others: It is not my intention to, nor can any physician deal with all the nuances that may arise when those that practice medicine are faced with the ambiguous aspects of medical ethical issues. I seek, instead, to establish the basic framework upon which ethical decisions should be based. My hope is to demonstrate how the basic ethical framework may be applied within the confines of uncertainty. Physicians can then approach ethical problems with more security, and since they are tinged with the elements of anguish, less emotional confusion.
EBEN ALEXANDER, Jr., M.D. Winston-Salem, North Carolina
Surg Neurol 1994;42: 184-6
Easier Said Than Done: Moral Decisions in Medical Uncertainty. By Milton D. Heifetz, M.D. 259 pages. $24.95. Buffalo, New York: Prometheus Books,
1992.
ISBN
O-87975-721-3.
Milton Heifetz, a multitalented person by any standard, has devoted months to the preparation of Easier Said Than Done. He left the day-to-day busy schedule of a neurosurgeon to clarify in his own mind and to help others struggling with similar problems related to medical ethics. The subject of ethics is not new but its place in philosophy, religion, and psychology was on a definite plateau. The driving force of medical ethics has increased in the published literature in this field by more than 100%. The end of World War II, the Nuremberg Trials, and the revelations of the activities of some of the Nazi physicians stimulated much discussion, in fact, awakening, among the minds of philosophers and religious leaders as well as physicians. The seminal article by an Austrian Jewish refugee psychiatrist, Dr. Leo Alexander, appearing in the New EnglandJownal of Medicine in 1949 was a clarion call, disclosing the details of the activities of the Nazi doctors. Joseph Fletcher in Charlottesville, Virginia, a minister and a profound ethical leader, went further into the fray. Since then, many distinguished minds have published on this subject, including Pelligrino and a number of other members of the Kennedy Institute of Medical Ethics at Georgetown University in Washington. Medical schools now teach ethics in the curriculum, and students in Problembased Education find that they must become “comfortable with ambiguity.” Medical ethics is not a clean, discreet subject that can be tucked into a neat file. Fortunately, the brilliant mind of Milton Heifetz has sought answers presented to society and particularly to the medical profession by the exponential progress in medical
Book Reviews
science. Once it became routine to insert intratracheal tubes in those who could not breathe on their own and it became possible to save lives otherwise lost, to prolong lives of some no longer anxious to live, and to transplant organs from one human to another, there has been no end to the problems generated by physicians who must make many profound decisions everyday. Heifett has read extensively, including the philosophies of Buddhism, Confucianism, Hinduism, and Judaism. He has distilled these, as well as Judeo-Christian thought and all the other subjects he has read, into this brief book. He has been impressed by a somewhat different group of authors and ethicists than I, and consequently, I learned much in reading this book. I would recommend it for all in the field of medical ethics who are prepared to take the time to digest the author’s thoughts-some of which will surprise the reader and are only peripherally related to medical ethics. Dr. Heifetz’s own statement in the introduction expresses in true humility his intention to be of help to others: It is not my intention to, nor can any physician deal with all the nuances that may arise when those that practice medicine are faced with the ambiguous aspects of medical ethical issues. I seek, instead, to establish the basic framework upon which ethical decisions should be based. My hope is to demonstrate how the basic ethical framework may be applied within the confines of uncertainty. Physicians can then approach ethical problems with more security, and since they are tinged with the elements of anguish, less emotional confusion.
EBEN ALEXANDER, Jr., M.D. Winston-Salem, North Carolina