EVERYBODY WANTS TO GO TO HEAVEN BUT NOBODY WANTS TO DIE

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.