Seven in ten Americans over the age of age of sixty who require medical decisions in the final days of their life lack the capacity to make them. For many of us, our biggest, life-and-death decisions—literally—will therefore be made by someone else. They will decide whether we live or die; between long life and quality of life; whether we receive heroic interventions in our final hours; and whether we die in a hospital or at home. They will determine whether our wishes are honored and choose between fidelity to our interests and what is best for themselves or others. Yet despite their critical role, we know remarkably little about how our loved ones decide for us.
             
Speaking for the Dying tells their story, drawing on daily observations over more than two years in two intensive care units in a diverse urban hospital. From bedsides, hallways, and conference rooms, you will hear, in their own words, how physicians really talk to families and how they respond. You will see how decision makers are selected, the interventions they weigh in on, the information they seek and evaluate, the values and memories they draw on, the criteria they weigh, the outcomes they choose, the conflicts they become embroiled in, and the challenges they face. Observations also provide insight into why some decision makers authorize one aggressive intervention after the next while others do not—even on behalf of patients with similar problems and prospects. And they expose the limited role of advance directives in structuring the process decision makers follow or the outcomes that result.
           
Research has consistently found that choosing life or death for another is one of the most difficult decisions anyone can face, sometimes haunting families for decades. This book shines a bright light on a role few of us will escape and offers steps that patients and loved ones, health care providers, lawyers, and policymakers could undertake before it is too late.
 

Since the late 1960s, Oregon has been at the forefront of environmental protection in the United States. The state generally, and Portland in particular, continue to have strong “green” credentials well into the twenty-first century. Within this forty year period of progress, however, the health of the Willamette River has been a consistent blot on the record. Willamette River water pollution has not gone away—the problem has, in fact, gotten much more complex. James Hillegas-Elting’s book, Speaking for the River, provides a historical look at this dilemma.

Willamette River cleanup efforts between 1926 and 1975 centered on a struggle between abatement advocates and the two primary polluters in the watershed, the City of Portland and the pulp and paper industry. Beginning in 1926, clean streams advocates created ad hoc groups of public health experts, sanitary engineers, conservationists, sportsmen, and others to pressure Portland officials and industry representatives to cease polluting the river. By the late 1960s, these grassroots initiatives found political footholds at the state level. As governor between 1967 and 1975, Tom McCall took the issue of environmental protection personally, providing the charisma and leadership that was needed to finally make substantive progress toward cleaning the Willamette.

Speaking for the River is the first book to describe the historical roots of Willamette River pollution, providing important context for understanding the political, fiscal, and technological antecedents to the present-day conundrum. Hillegas-Elting’s contribution to the academic literature on environmental and urban history in Oregon will be welcomed by policy makers, environmentalists, and concerned citizens alike.