BOOK REVIEWS OF
by Dr G Craig____________________________________________________
This book explores the use of sedation without hydration in the terminally ill and dying. It will challenge, inform and disturb those who consider the hospice movement to be beyond reproach.
Gillian Craig came upon the practice of sedation without hydration in a hospice
in the UK in 1990 and was shocked. She took matters up within the medical
profession and wrote a paper in the Journal of Medical Ethics that launched a
fierce debate. This book describes how the hydration debate progressed between
1994 and 2004.
When launching the debate in 1994 Raanon Gillon editor of the Journal of Medical
Ethics wrote “… Dr Gillian Craig and her commentator Eric Wilkes raise a variety
of important questions about ethical aspects of palliative
care that deserve careful reflection”. Those words remain true today. Despite
the publication of guidelines on the ethical use of artificial hydration in
terminally ill people in 1997 sedation without hydration is still widely
practiced. The question at issue remains “Has palliative medicine gone too far?”
No Water-No Life traces the origins of “comfort care only” for the dying to the
work of an American theologian Paul Ramsey in the 1970s. Key publications from
the Journal of American Ethics and other professional journals in the UK and
North America are included to illustrate the more recent professional debate.
Case reports bring the work to life, illustrate the plight of patients and
relatives and show how the medical profession deals with dissent. A chapter on
legal aspects looks at the doctrine of double effect. The book is highly topical
and takes readers to the cutting edge of medicine and law.
The book should appeal to a wide readership from health care professionals to
members of the public, clergy, lawyers and politicians. John Austin Baker, a
former Bishop of Salisbury considers that “hospital chaplaincy workers and
pastors across the board would be grateful to be able to refer to a work which
is historically informative, and medically balanced, while making no secret of
the writer’s personal convictions.”
Enterprise House (UK) Editor Craig G M. ISBN 0 9552840 0 7 (p272. Price
£18.50)
This book was published in June 2006. It covers tube feeding as a form of life
support and explores ethical dilemmas created by decisions to withdraw or
withhold tube feeding. This dark side of medical ethics is illustrated by case
reports, press reports and analysis of professional guidelines. American author
Wesley J Smith paints a worrying picture of futile care theory as practised in
the USA, yet we in the UK are following suit.
In 1999 the British Medical Association published guidelines that caused
widespread concern. The BMA strongly refuted the suggestion that non-provision
of tube feeding is a form of euthanasia, but some people took a different view.
Attempts to protect people by Act of Parliament failed. Guidance published by
the General Medical Council in 2002 was subjected to critical appraisal in the
High Court in 2004/5. The interface between medicine and the law is fraught
with difficulty.
Medical practice has become polluted with politics as governments seek to
contain the costs of healthcare. Faced with an ageing population and limited
resources the weakest go to the wall. The lives of children with learning
disabilities, mentally incapacitated adults and the frail elderly are now at
risk. Society is deeply divided about how to tackle these problems. At one
extreme are those who campaign for euthanasia - at the other are those who hold
all human life to be sacred. It remains to be seen how events will evolve in
years to come. This book is highly topical and should be of interest to all who
are involved in difficult "end-of-life decisions".
Sales and distribution. Volume 2 is available in the UK for 318.50 + £2.00 p&p
from Medical Ethics Books, PO Box 341 Enterprise House, Nothampton NN3 2WZ
(UK). Please enclose a cheque made out to Medical Ethics Books with your
order. Thank you. Postage to Europe is £3.00 and to the USA/Canada and
Worldwide £5.00 (sterling).
This book has been reviewed by
Dr Gerard Daly Review of: No Water No life
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