First, Do No Harm: A Book by LIsa Belkin that Addresses Medical Ethics

First, Do No Harm, was written by Lisa Belkin, a reporter researching and writing for more than ten years for the New York Times covering many different avenues of news such as television and business to health care and hospitals. Taking a more personal, though still professionally objective interest in health care and hospital ethics, she published this book which gets to the heart of these issues asking the tough questions.

Dealing with the raw reality of the questions facing both families, doctors, and other hospital staff about the life and death of particular patients, this book could be considered a primary source for those seeking to understand the mindsets of everyone involved and the emotion that those involved cannot escape being affected by. Though written in a more entertaining, nonacademic way like a textbook or encyclopedia would be, it is clear and easy to understand containing as much factual information as it does present the reader with questions.

As this book follows four cases at Hermann, it intends to continuously ask the question “What is life worth?” and “What is life worth living?” Has medicine come to a point in history where it simply does too much prolonging of the inevitable death of the patient? If so, how do you know when enough is enough? This is the moral dilemma the book is written around, and the purpose of this book is to find out if there is an answer, and if so, what the answer is.

Belkin attempts to tackle these questions through the true stories of four major cases at Hermann Hospital in Houston, Texas. The first case is about a young teenage boy named Patrick Dismuke, born in 1973. Shortly after birth Patrick was found to be having problems with his stomach. It was found out that the baby was born with Hirschsprung’s Disease, which is a disorder of the digestive tract.

His case eventually became one of the most severe cases, but somehow they managed to keep him alive until he was fifteen years old, and the boy made medical history as he broke the record on how long he was supposed to live. The book begins during another one of Patrick’s visits to the hospital where Hermann’s Ethics Committee was meeting to discuss whether or not to make him DNR which means Do Not Resuscitate in order to end his prolonged suffering which would only lead to death.

The second case is about Armando Dimas, a twenty-five year old Mexican illegal alien, with a gun shot wound that traveled up his spine to right below his brain stem paralyzing him from the ears down. Not only is he immobile, but he also cannot talk, and will never be able to get any better. This man is explicitly given the choice to die.

The third case is about a tiny little preemie baby named Taylor Poarch, whose parents, after losing her twin on the second day of birth, request Taylor be taken off the ventilator to end her suffering. Being on the ventilator for two months, and with very little chance of survival, the parents ask for a meeting with the Ethics Committee so the decision can be voted on since the resident doctor disagreed with their request.

The fourth case is the most difficult and controversial for the Ethics Committee to make a decision regarding a full-term baby with severe Spina bifida. In this case, the parents may have been given too much information, and a choice too early as to the ultimate fate of their child. Spina bifida, being a non-terminal disability, would impair the child’s quality of living to a high degree due to the severity. The question for this family is: Would their son, Landon Sparks, have a life worth living?

As this book follows each case from an objective, third person perspective of the initial conditions, treatments, and patient responses, as well as the emotions of all the staff, families, and patients, and the decisions that have to be made as a result, the book also gives where appropriate the factual history of Hermann Hospital, the way the hospital operates, the economic issues facing the hospital, and a history of medical practice in the 19th century and how that has changed with new medical and technological discoveries and inventions.

Being a reporter for ten years, Belkin achieves her goal of objectivity while causing the reader to go back and forth in thier mind about all the circumstances around each case, including the historical context in which this is taking place, and the decisions that are being made. Thinking is what Belkin is trying to provoke here, in this written achievement.

This book gives the reader the understanding and knowledge needed in order to develop one’s own well-rounded educated thoughts and opinions on this matter. It does not try to force a particular view through persuasive writing. There is more emphasis on the idea that there is no solid answers to these questions. Belkin presents many different personalities, approaches, and thoughts on this topic through her characters bringing different slants for the reader to consider.

Medical ethics in America touches each and every person living in the United States. Not only is this book relevant, it is also worth reading by any literate citizen. The language she uses is not insulting to the educated person, and it is not too hard for the uneducated making it easy to follow and understand. It gets right to the heart of the important issues we all have a stake in. We all have the potential concern of someday ending up on a ventilator that is only prolonging the inevitable, or possibly having to make decisions about our parents or grandparents.

In relation to Religious Ethics, this book never considered this type of veiw point when making their decisions. This particular hospital was a secular, though private, institution and narrowing it down to religious ethics would have been inappropriate for the staff and everyone else involved giving rise to more conflict. The closest this book comes to the study of relgigious ethics is that it causes the reader to rethink their opinions, and perhaps consider this aspect themselves and apply it to individual situations.

Although this book was wonderful from cover to cover, I did find myself enjoying some cases more than others, such as Patrick and Taylor’s case. These were the first two brought up in the book, and I found myself empathizing with them the most throughout the book despite how the other cases can be just as interesting and informative. When I first started reading this book, I didn’t quite understand the organization or structure of the book since it didn’t have typical chapters or a table of contents that many books do. Instead, this one was separated into months, and what cases were being dealt with each month. As I caught onto this organization I found it easy to follow. This is quite a different, yet very effective method Belkin uses.

I am very glad to have read this book. It was fast, easy reading, and I learned a lot about the inner-workings of hospitals that I would have never known. I also learned a lot about the different diseases the patients had and how they were treated. And of course I learned in great depth the difficulty of the Ethics Committee to make life and death decisions for their patients or with their families. Medical ethics has proven to be a very complicated subject with no easy answers if any at all.

Are we playing God? Years ago such questions were unheard of because there were very few cures available and not nearly as much technology available. At that time the concern was that medicine couldn’t do enough for people, and now it may be doing too much. Where do you draw the line?

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