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Culture of Death: The Assault on Medical Ethics in America By Wesley J. Smith
Encounter (2001), $23.95

It had to happen. For years, ethicists wrote books deploring the fact that patients were not allowed to choose to die naturally. They told horror stories of prolonged suffering against families' wishes. Now this book arrives, written by a consumer advocate, a colleague of Ralph Nader, who asserts that doctors and ethicists are in league to promote a "culture of death." He tells horror stories of families being pressured to prematurely disconnect their loved ones from life support or to withdraw nutrition, thus hastening the end.

The medical profession must be getting closer to the middle of the ethical road if we are now facing attacks from both sides. Since, as Smith admits, the principle of patient autonomy is the accepted guiding principle in medical ethics and, under the law, the patient (or the family, if the patient is unable to express his wishes) has the right to decide about feeding tubes and breathing machines, as a doctor I must carry out the patient's wishes or find another physician for him or face him in court. Smith insists that this standard of practice doesn't adequately protect patients.

These are painful and morally treacherous decisions, particularly if no one knows what the now-unconscious patient would have wanted. Each of us has our own definition of a meaningful life, which frequently changes as we become increasingly disabled. I agree with Smith that most people do want their loved ones kept alive at all costs--especially since in many cases the families are neither paying for nor providing the care, why not?

But families facing a loved one who can no longer move independently, talk, eat, or interact with them might not be comforted by such high-minded thoughts. They see the patient grimace as yet another intravenous line is inserted for more antibiotics. They are forced to choose between sedation and physical restraints because words cannot penetrate the patient's confusion. Or finally, after months of false optimism, misreading open eyes for consciousness and groans for speech, the reality of love already lost seeps through their layers of defenses along the seams, like a flood seeks out the cracks in a dam.

In one sense, Smith is right. Doctors do live in a culture where death is common and imperfect technology dooms thousands to a twilight zone of grave disability. The rest of society does its best to ignore these realities. If Smith's polemic convinces more people to think about these issues, that good might balance the harm it will cause by scaring those who are the most emotionally vulnerable.--Toni Martin


Close to Shore By Michael Capuzzo
Broadway (2001), $24.95

Nonfiction narratives in which a relatively small moment in history is writ large, their earnest authors spinning out skeins of research to make readers feel like instant experts--will we ever tire of them? They're like a dream of school, but without bells and homework, so that afterwards you need only remember little bits. And, yes, I think we will tire of them.

The genre, launched with Longitude, has spawned dozens of books on irrepressible explorers and ill-fated undertakings. That the past would become such a pop phenomenon--so many codpieces, so many gaslights--is really something, but it can't last.

Close to Shore rides that wave, a prime example of right place, right time. To tell this tale of great white shark attacks at New Jersey resorts in the summer of 1916, its author spent the requisite time in libraries, collecting facts. It paid off, more or less, in deft if dutiful descriptions of Gibson Girls and early ichthyologists and Carcharodon carcharias that keep the pages turning, but only just. As mild as the play of sunlight on an early-summer afternoon, the text cross-cuts between human characters, most of them doomed, and the sojourns of one ravenous fish.

The shark chapters are the most interesting, offering easy science ("it came out of the womb four to five feet long, fifty to eighty-five pounds, hunting") and striking undersea imagery. Steering clear of anthropomorphism, an admirable feat given the risk, Capuzzo evokes a creature whose motives and feats are at once exquisitely simple and at the very fringes of our comprehension.

It is when the author turns his attention to humans that we start to feel the strain of a story better suited to a magazine article being drawn out to book-length. We are to understand that 1916 was an "age of innocence," that American beach-goers had just begun to shed their Victorian hangups and swim, that just as news of WWI dawned slowly on unbelieving ears, the public no more accepted the existence of man-eating sharks than of unicorns. Capuzzo, a New Jerseyite himself, writes with empathy of the era's swimmers and the doctors to whom their mangled bodies were remanded. But reading these passages too often feels like hacking one's way through cotton candy: "In the terra firma of Louisa's parlor on Spruce Street," we learn of a minor character with "a life inscribed by a constellation of virtues, certainties as fixed and brilliant as the stars."

Still, Close to Shore is a thinking reader's Jaws, with the same spine-chilling moral: that we are not alone, and seldom safe.--Anneli Rufus


The Street Of Clocks By Thomas Lux
Houghton Mifflin (2001), $22

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