FIRST, DO NO HARM

When should life-support be withdrawn? What level of medical care is appropriate for whom? These and other tough questions— too tough (or too hot) for one person to handle—are faced by ethics committees that now are as commonplace in hospitals as respirators and government regulations. Here, New York Times reporter Belkin tells how one such group deals with questions like these. Belkin spent three years observing the ethics committee's meetings at Hermann Hospital in Houston, Texas, talking to doctors, committee members, patients and their families. Nearly all gave permission for their real names to be used, which says something about Belkin's empathy and discretion. Besides describing the dynamics of meetings and delving into the background of some members, the author focuses on a few patients whose plight the committee is asked to consider: Patrick, a 15- year-old with a chronic, incurable disorder of the digestive tract; Taylor, born at 25 weeks and weighing only 24 ounces; Armando, a young man with a bullet in his brain that has paralyzed him from the neck down; and Landon, a baby born with severe spina bifida. Decisions must be made, and Belkin shows how the committee makes them, demonstrating that there are never easy answers and sometimes no right ones. There are no perfectly happy endings, either: Patrick and Taylor die; Armando and Landon live, but the quality of their lives is debatable. Nevertheless, the narrative is not depressing, as the individual stories are always absorbing and Belkin relates them with warmth and understanding. A behind-the-scenes account that's hard to put down and difficult to forget.