Through the Valley of Shadows: Living Wills, Intensive Care, and Making Medicine Human

Oxford University Press
Free sample

Hospital intensive care units have changed when and how we die--and not always for the better. The ICU is a new world, one in which once-fatal diseases can be cured and medical treatments greatly enhance our chances of full recovery. But, paradoxically, these places of physical healing can exact a terrible toll, and by focusing on technology rather than humanity, they too often rob the dying of their dignity. By some accounts, the expensive medical treatments provided in ICUs also threaten to bankrupt the nation. In an attempt to give patients a voice in the ICU when they might not otherwise have one, the living will was introduced in 1969, in response to several notorious cases. These documents were meant to keep physicians from ignoring patients' and families' wishes in stressful situations. Unfortunately, despite their aspirations, living wills contain static statements about hypothetical preferences that rarely apply in practice. And they created a process that isn't faithful to who we are as human beings. Further confusing difficult and painful situations, living wills leave patients with the impression that actual communication with their physicians has taken place, when in fact their deepest desires and values remain unaddressed. In this provocative and empathetic book, medical researcher and ICU physician Samuel Morris Brown uses stories from his clinical practice to outline a new way of thinking about life-threatening illness. Brown's approach acknowledges the conflicting emotions we have when talking about the possibility of death and proposes strategies by which patients, their families, and medical practitioners can better address human needs before, during, and after serious illness. Arguing that any solution to the problems of the inhumanity of intensive care must take advantage of new research on the ways human beings process information and make choices, Brown imagines a truly humane ICU. His manifesto for reform advocates wholeness and healing for people facing life-threatening illness.
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About the author

Samuel Morris Brown is Assistant Professor of Pulmonary and Critical Care Medicine and Medical Ethics and Humanities, University of Utah School of Medicine and founder and director of the Center for Humanizing Critical Care at Intermountain Medical Center. A practicing intensive care physician, researcher and award-winning historian of ideas, Dr. Brown writes at the intersections of medicine, ethics, and culture.
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Additional Information

Publisher
Oxford University Press
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Published on
Apr 1, 2016
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Pages
288
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ISBN
9780199392971
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Language
English
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Genres
Medical / Ethics
Medical / Pain Medicine
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Content Protection
This content is DRM protected.
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Available on Android devices
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Eligible for Family Library

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For readers of Being Mortal and Modern Death, an ICU and Palliative Care specialist offers a framework for a better way to exit life that will change our medical culture at the deepest level


In medical school, no one teaches you how to let a patient die.

Jessica Zitter became a doctor because she wanted to be a hero. She elected to specialize in critical care—to become an ICU physician—and imagined herself swooping in to rescue patients from the brink of death. But then during her first code she found herself cracking the ribs of a patient so old and frail it was unimaginable he would ever come back to life. She began to question her choice.

Extreme Measures charts Zitter’s journey from wanting to be one kind of hero to becoming another—a doctor who prioritizes the patient’s values and preferences in an environment where the default choice is the extreme use of technology. In our current medical culture, the old and the ill are put on what she terms the End-of-Life  Conveyor belt. They are intubated, catheterized, and even shelved away in care facilities to suffer their final days alone, confused, and often in pain. In her work Zitter has learned what patients fear more than death itself: the prospect of dying badly. She builds bridges between patients and caregivers, formulates plans to allay patients’ pain and anxiety, and enlists the support of loved ones so that life can end well, even beautifully.

Filled with rich patient stories that make a compelling medical narrative, Extreme Measures enlarges the national conversation as it thoughtfully and compassionately examines an experience that defines being human.
A compelling new interpretation of early Mormonism, Samuel Brown's In Heaven as It Is On Earth views this religion through the lens of founder Joseph Smith's profound preoccupation with the specter of death. Revisiting historical documents and scripture from this novel perspective, Brown offers new insight into the origin and meaning of some of Mormonism's earliest beliefs and practices. The world of early Mormonism was besieged by death--infant mortality, violence, and disease were rampant. A prolonged battle with typhoid fever, punctuated by painful surgeries including a threatened leg amputation, and the sudden loss of his beloved brother Alvin cast a long shadow over Smith's own life. Smith embraced and was deeply influenced by the culture of "holy dying"--with its emphasis on deathbed salvation, melodramatic bereavement, and belief in the Providential nature of untimely death--that sought to cope with the widespread mortality of the period. Seen in this light, Smith's treasure quest, search for Native origins, distinctive approach to scripture, and belief in a post-mortal community all acquire new meaning, as do early Mormonism's Masonic-sounding temple rites and novel family system. Taken together, the varied themes of early Mormonism can be interpreted as a campaign to extinguish death forever. By focusing on Mormon conceptions of death, Brown recasts the story of first-generation Mormonism, showing a religious movement and its founder at once vibrant and fragile, intrepid and unsettled, human and otherworldly. A lively narrative history, In Heaven as It Is on Earth illuminates not only the foundational beliefs of early Mormonism but also the larger issues of family and death in American religious history.
From the era of slavery to the present day, the first full history of black America’s shocking mistreatment as unwilling and unwitting experimental subjects at the hands of the medical establishment.

Medical Apartheid is the first and only comprehensive history of medical experimentation on African Americans. Starting with the earliest encounters between black Americans and Western medical researchers and the racist pseudoscience that resulted, it details the ways both slaves and freedmen were used in hospitals for experiments conducted without their knowledge—a tradition that continues today within some black populations. It reveals how blacks have historically been prey to grave-robbing as well as unauthorized autopsies and dissections. Moving into the twentieth century, it shows how the pseudoscience of eugenics and social Darwinism was used to justify experimental exploitation and shoddy medical treatment of blacks, and the view that they were biologically inferior, oversexed, and unfit for adult responsibilities. Shocking new details about the government’s notorious Tuskegee experiment are revealed, as are similar, less-well-known medical atrocities conducted by the government, the armed forces, prisons, and private institutions.

The product of years of prodigious research into medical journals and experimental reports long undisturbed, Medical Apartheid reveals the hidden underbelly of scientific research and makes possible, for the first time, an understanding of the roots of the African American health deficit. At last, it provides the fullest possible context for comprehending the behavioral fallout that has caused black Americans to view researchers—and indeed the whole medical establishment—with such deep distrust. No one concerned with issues of public health and racial justice can afford not to read Medical Apartheid, a masterful book that will stir up both controversy and long-needed debate.
In this heartfelt memoir from one of the youngest recipients of the transorbital lobotamy, Howard Dully shares the story of a painfully dysfunctional childhood, a misspent youth, his struggle to claim the life that was taken from him, and his redemption.

At twelve, Howard Dully was guilty of the same crimes as other boys his age: he was moody and messy, rambunctious with his brothers, contrary just to prove a point, and perpetually at odds with his parents. Yet somehow, this normal boy became one of the youngest people on whom Dr. Walter Freeman performed his barbaric transorbital—or ice pick—lobotomy.

Abandoned by his family within a year of the surgery, Howard spent his teen years in mental institutions, his twenties in jail, and his thirties in a bottle. It wasn’t until he was in his forties that Howard began to pull his life together. But even as he began to live the “normal” life he had been denied, Howard struggled with one question: Why?

There were only three people who would know the truth: Freeman, the man who performed the procedure; Lou, his cold and demanding stepmother who brought Howard to the doctor’s attention; and his father, Rodney. Of the three, only Rodney, the man who hadn’t intervened on his son’s behalf, was still living. Time was running out. Stable and happy for the first time in decades, Howard began to search for answers.

Through his research, Howard met other lobotomy patients and their families, talked with one of Freeman’s sons about his father’s controversial life’s work, and confronted Rodney about his complicity. And, in the archive where the doctor’s files are stored, he finally came face to face with the truth.

Revealing what happened to a child no one—not his father, not the medical community, not the state—was willing to protect, My Lobotomy exposes a shameful chapter in the history of the treatment of mental illness. Yet, ultimately, this is a powerful and moving chronicle of the life of one man.

Listen to a short interview with Michael Sandel Host: Chris Gondek - Producer: Heron & Crane Breakthroughs in genetics present us with a promise and a predicament. The promise is that we will soon be able to treat and prevent a host of debilitating diseases. The predicament is that our newfound genetic knowledge may enable us to manipulate our nature--to enhance our genetic traits and those of our children. Although most people find at least some forms of genetic engineering disquieting, it is not easy to articulate why. What is wrong with re-engineering our nature? The Case against Perfection explores these and other moral quandaries connected with the quest to perfect ourselves and our children. Michael Sandel argues that the pursuit of perfection is flawed for reasons that go beyond safety and fairness. The drive to enhance human nature through genetic technologies is objectionable because it represents a bid for mastery and dominion that fails to appreciate the gifted character of human powers and achievements. Carrying us beyond familiar terms of political discourse, this book contends that the genetic revolution will change the way philosophers discuss ethics and will force spiritual questions back onto the political agenda. In order to grapple with the ethics of enhancement, we need to confront questions largely lost from view in the modern world. Since these questions verge on theology, modern philosophers and political theorists tend to shrink from them. But our new powers of biotechnology make these questions unavoidable. Addressing them is the task of this book, by one of America's preeminent moral and political thinkers.
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