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Doody's Review ServiceReviewer: Sarah E. Hetue Hill, MA (Saint Louis University)
Description: University of Virginia professor Lois Shepherd uses the Terry Schiavo case as the terminus a quo for a substantial scrutiny of the medical, legal, and ethical issues surrounding end-of-life decision making and for an alternative framework based on an ethic of respect and care.
Purpose: The author begins by sifting through the various media accounts of the Schiavo case and other literature to find the most credible facts to provide answers to both what happened and why the case proceeded in the manner in which it did. She also examines the case for what it can teach us with regard to end-of-life decision making in the areas of culture, ethics, and the law.
Audience: The book is intended for anyone with a vested interest in end-of-life decision making including lawyers, ethicists, policymakers, disability rights activists, and various healthcare professionals, particularly those who most often assist families with goals-of-care discussions such as hospice and palliative care physicians and nurses.
Features: A thorough overview of the medical and legal issues surrounding the Terry Schiavo case begins the book, including an overview of the permanent vegetative state and other disorders of consciousness. The book also addresses issues involved in the withdrawal of life support including an assessment of standards of evidence, the shortcomings of living wills, and the weaknesses and strengths of surrogate decision making. A chapter examines quality of life arguments and discusses rights, respect, and care. Artificial and nutrition and hydration are reframed rather uniquely in the perspective of the cared-for instead of the caregiver. The last chapter provides a brief outline of the author's reframing of the issue from a rights approach to one that emphasizes care and respect, particularly for those who are considered vulnerable such as the terminally ill or profoundly disabled.
Assessment: The author seeks to move beyond the polemic dichotomy of arguments for the right to life versus the right to refuse treatment. Compared to other books written on this case, this one offers a thoughtful, frank, and balanced look at the case itself and the larger issue of end-of-life decision making. The broadening of the scope of the issues from a simple rights approach to the alternative approach of respect and care has fruitful implications. The bibliography is useful, providing the legal materials and other articles on end-of-life decision making. However, it would have been useful had the author offered those interested in a similar reframing of the issues further reading in either the notes or bibliography by some of the authors who have delved deeply into developing care ethics, such as Nel Noddings or Carol Gilligan.