Gutmann (The Spirit of Compromise, coauthor) and Moreno (Impromptu Man), who both served on President Obama’s bioethics commission, vividly explore the complexity of the ethical principles underlying scientific advances and emerging medical treatments. The opening chapters lay historic and cultural foundations, showing how debates over medical practices became more contentious as Americans became less automatically trusting of medical practitioners. Gutmann and Moreno then trace the evolving ethical debate by taking on wide-ranging questions, from the concrete—unequal availability of healthcare—to the abstract—the evolving definition of parenthood amid the proliferation of reproductive technologies. They also introduce the different ethical philosophies in play, the best-known of which is utilitarianism, but ensure the discussion remains immediate through real-life examples. These include the case of Brittany Maynard, a 29-year-old terminally ill cancer patient, whose “youth and vigorous advocacy” for her right to a physician-assisted death the authors credit with bringing new attention to the issue. Part cultural history, part philosophical enquiry, and part gentle polemic, this valuable survey should become prescribed reading for America’s healthcare practitioners. (Aug.)
"A remarkable, highly readable journey through the development of modern thinking about bioethics, from syphilis experiments on black men in Tuskegee, and Brittany Maynard’s desire to die rather than live with uncurable cancer, to wondrous medical advances that pose excruciating trade-offs."
"Amy Gutmann and Jonathan Moreno’s groundbreaking Everybody Wants to Go to Heaven But Nobody Wants to Die should be required reading for anyone with a heartbeat who wants to understand the ethical and practical contradictions of our cultural obsession with prolonging life at all costs."
"A tour de force. Readable and understandable to lay audiences, sophisticated and comprehensive for all, fair-minded in approach but also taking positions, this book gives a thorough history, with important examples, of all the areas of research and action that raise serious ethical questions. Everybody will face some of the challenges raised in this book. And everyone would benefit immensely from reading it."
"The age-old debate about health care—what we owe each other as we all become sick—has rarely been able to transcend the superficial and frustratingly binary arguments of the politics that has held a meaningful discussion hostage. This superb book is a refreshing departure."
In surveying the limitless ethical dilemmas created by modern medicine, University of Pennsylvania colleagues Gutman (The Spirit of Compromise) and Moreno (Ethics in Clinical Practice), both of whom served on President Obama's bioethics commission, trace the field from just after World War II, when the rapid advances in medicine and science that continue today began in earnest. Bioethics is inextricably linked, as they see it, to the politics of health care, and the book's overarching ethical question is how responsible we should be collectively for the well-being of others. The authors see providing basic affordable health care to everyone as a moral obligation but recognize the political and ideological barriers. They discuss specific areas that present individuals and society with ongoing ethical problems, including how we die, patients' rights and privacy, new reproductive technologies, human and animal experimentation, organ transplantation, the use of stem cells, and cloning. In each case they offer concrete examples of some difficult choices and how they are being addressed. The answers are seldom simple. VERDICT Targeting a general audience, this title provides a clear and compassionate presentation of complicated topics and how important it is to confront them. [See Prepub Alert, 2/4/19.]—Richard Maxwell, Porter Adventist Hosp. Lib., Denver
An analysis of how bioethics continue to affect modern American medicine.
"All stages of our lives are caught up in challenging ethical questions raised by modern medicine, health care, public health, and life science research," write University of Pennsylvania president Gutmann (Identity in Democracy, 2003, etc.) and Moreno (Ethics/Univ. of Pennsylvania; Undue Risk: Secret State Experiments on Humans, 2016, etc.) in this astute examination of bioethics as it applies to America's collective health. As a primer to their insightful discussion, the authors share relevant personal stories. Gutmann discusses her beloved grandmother's conundrum involving a crucial medical decision, and Moreno discusses the blatant lack of clinical truth telling and "therapeutic privilege" at work during his mother's ordeal with cancer. These poignant memories illuminate the greater problem of ethics in medicine. The authors' three-part study begins with a comprehensive history of patient care as it progressed from an atmosphere of unquestioned physician opinion to more current viewpoints, where second opinions and collaborative clinical evaluations are more the norm. Gutmann and Moreno lucidly outline the differences between earlier eras in medicine, when a doctor's "implicit permission to mislead, if not to lie outright" was openly accepted, and contemporary medicine, where healthier food "choice architecture" and mental health system reforms are just two examples of the radical shift in perception and patient self-empowerment. The authors are unafraid to address more disputable, "slippery slope" issues, many of which remain targeted by polarized political systems. They also respectfully discuss the idea of universal health care, organ donor matching and transplantation, physician-assisted suicide, the surging interest in genetic manipulation, and the deep ethical issues surrounding the neuroscience field. While the authors agree that great strides have been made through more focused attention on ethical clinical care, America falls critically short on achieving a system that is both affordable and accessible.
An academic, illuminating assessment of the past, present, and future forms of responsible public health care.