BOOK REVIEWS OFby 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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