Whose Life is it Anyhow? by Dr Simon L Cohen (Robson Books, £16.95) Dr Tom Brogan
EUTHANASIA is a term which literally means easy or kindly death. These days, however, it has been hijacked by those who believe in "mercy-killing".
It is not uncommon in Catholic circles to come across people who believe that most doctors, unless they are practising Catholics, support what what is known as euthanasia. I hope that Whose Life is it Anyhow? will counteract this view.
Dr Cohen has spent much of his working life as physician in the intensive care unit of University College hospital in London: he is, therefore, at the sharp end of medical practice.
This very readable book describes in non-technical language the working of an intensive care unit. It also discusses various aspects of high-tech medicine and the questions of when to stop, when to withhold and when to withdraw intensive therapy and the dilemmas of resuscitation. Dr Cohen illustrates these copiously by case histories.
He emphasises that families, relatives or surrogates all play a role in intensive therapy and that medical and nursing teamwork is paramount, thus laying to rest the image of the all-knowing doctor. Other chapters are devoted to topics such as the ethics, the economics and the legal and sociological problems of intensive care; burning issues as the living will, euthanasia, and the concept of patient autonomy are discussed in some detail.
The author is a practising member of the Jewish community, and in the chapter on "Medical Ethics and Religious Belier puts forward the Judaic view as well as touching briefly on that held by Christianity and Islam.
High tech medicine has changed dramatically over the last few decades. When I was a junior doctor, very few antibiotics were available; thus the task of keeping a patient alive who would now be deemed to be in a "persistent vegetative state" was very difficult.
Nowadays, with the methods used to promote enteral feeding and the vast array of antibiotics that can keep a patient relatively free from infection, it is possible to maintain "life" almost indefinitely.
The question therefore is raised: for how long does one prolong this state?
Clough's aphorism: "Thou shalt not kill; but need'st not strive officiously to keep alive" Is often used as a guide and indeed the Church holds that "extraordinary" measures need not be taken.
Thus, in intensive care, there are complex and interlocking ethical questions with which to contend; and Dr Cohen attempts to lead one through this maze. It is possible to distinguish between ordinary and "extraordinary" .invasive nursing procedures backed by expensive modern antibiotics in preserving "life" in the persistent vegetative state.
There is a world of difference between discontinuing this extraordinary therapy and giving a patient a lethal injection.