In the quarter century since the landmark Karen Ann Quinlan case, an ethical, legal, and societal consensus supporting patients' rights to refuse life-sustaining treatment has become a cornerstone of bioethics. Patients now legally can write advance directives to govern their treatment decisions at a time of future incapacity, yet in clinical practice their wishes often are ignored.

Examining the tension between incompetent patients' prior wishes and their current best interests as well as other challenges to advance directives, Robert S. Olick offers a comprehensive argument for favoring advance instructions during the dying process. He clarifies widespread confusion about the moral and legal weight of advance directives, and he prescribes changes in law, policy, and practice that would not only ensure that directives count in the care of the dying but also would define narrow instances when directives should not be followed. Olick also presents and develops an original theory of prospective autonomy that recasts and strengthens patient and family control.

While focusing largely on philosophical issues the book devotes substantial attention to legal and policy questions and includes case studies throughout. An important resource for medical ethicists, lawyers, physicians, nurses, health care professionals, and patients' rights advocates, it champions the practical, ethical, and humane duty of taking advance directives seriously where it matters most-at the bedside of dying patients.

As elected lawmakers confront complex social problems, they inevitably make choices to single out certain populations for government-sanctioned benefits or burdens. Why some groups and not others are targeted is the central question explored in this analysis of the congressional response to two related public health crises.

Weaving case studies from the wars against AIDS and drugs with an empirical analysis of fifteen years of congressional action on these issues, Mark Donovan shows how members of Congress balance problem solving with re-election concerns, paying particular attention to their need to craft compelling rationales for their actions. His analysis shows that, counterintuitive as it may seem, most target populations with negative public images are selected to receive benefits rather than burdens.

Demonstrating that it is possible to analyze simultaneously both policy rhetoric and policy outputs, this book shows how problem frames and policy decisions evolve through the dynamic interplay of conflict participants.

A pioneer in the theory of pluralistic casuistry, the idea that there are almost as many facets to moral choices as there are cases that call for choices, Baruch Brody takes issue with conventional bioethical wisdom and challenges the rigid principalism of contemporary bioethics. His views have been seen as controversial, but they are firmly held, and convincingly argued—all of which have led him to be one of the most widely discussed and highly admired bioethicists of our time. He argues for the fundamental distinction between active and passive euthanasia, for a need to reconceptualize approaches to brain death, and for the right of providers to unilaterally discontinue life support. He shows support for the waiving of the requirement of informed consent for some research, for the widespread use of animals in research, and for the use of placebos in many international clinical trials.

When it comes to morality as it is practiced in medicine, Brody makes clear that the ethical issues are never as simple as black and white—that there are myriad factors and fine nuances that can and should challenge decision making as it is commonly practiced in difficult medical cases. In this collection, delving thoughtfully and systematically into methodology, research ethics, clinical ethics, and Jewish medical ethics, he tackles thorny life-and-death questions head-on and fearlessly. He casts a light into all the corners of end-of-life decisions—a field in which he has exemplary credentials—while illuminating a new understanding of morality and ethics.

The introduction outlines Brody's approach, defines the terminology used, and contrasts his ethical positions with much of the competing literature. Taking Issue will be invaluable to students and scholars in medical ethics, bioethics, and philosophy of medicine.

In 1965, French microbiologist André Lwoff was awarded the Nobel Prize in Physiology or Medicine for his work on lysogeny—one of the two types of viral life cycles—which resolved a contentious debate among scientists about the nature of viruses. A Tale of Two Viruses is the first study of medical virology to compare the history of two groups of medically important viruses—bacteriophages, which infect bacteria, and sarcoma agents, which cause cancer—and the importance of Lwoff’s discovery to our modern understanding of what a virus is. Although these two groups of viruses may at first glance appear to have little in common, they share uniquely parallel histories. The lysogenic cycle, unlike the lytic, enables viruses to replicate in the host cell without destroying it and to remain dormant in a cell’s genetic material indefinitely, or until induced by UV radiation. But until Lwoff’s discovery of the mechanism of lysogeny, microbiologist Félix d’Herelle and pathologist Peyton Rous, who themselves first discovered and argued for the viral identity of bacteriophages and certain types of cancer, respectively, faced opposition from contemporary researchers who would not accept their findings. By following the research trajectories of the two virus groups, Sankaran takes a novel approach to the history of the development of the field of medical virology, considering both the flux in scientific concepts over time and the broader scientific landscapes or styles that shaped those ideas and practices.

This book distills the essence of child psychoanalysis from the practice and thought of its founder Anna Freud, who for over 50 years has been at the forefront of this controversial field. Children are the most refractory of all subjects to treat analytically. Here, for the first time, is a primer on the difficult technique as practiced at the Hampstead Clinic in London, which was founded by Anna Freud and is today the leading child analytic center in the world. She and her colleagues expose their wealth of experience to systematic review, which yields up rich insights not only into child psychoanalysis and psychotherapy but also into basic child development. In addition, their findings have relevance to the understanding of emotional disturbance at all ages.

The book follows the treatment situation through all its stages, from the first session to termination and follow-up. It focuses on the interaction between therapist and child in the treatment room, illustrating the points with copious clinical vignettes. One point examined is the structure of treatment with respect to such matters as scheduling sessions and handling interruptions. Another element that comes under scrutiny is the development of the child's relationship to the therapist, which subsumes such factors as establishing an alliance, transference, and resistance. The child's repertoire of expressions, both verbal and nonverbal, is explored, as is the therapist's armamentarium of interpretations and interventions. Woven throughout the description of these elements is incisive commentary by Anna Freud. Her commonsense approach gives the book unique value, lifting it to a rare level of human wisdom.

When sickness strikes, people around the world pray for healing. Many of the faithful claim that prayer has cured them of blindness, deafness, and metastasized cancers, and some believe they have been resurrected from the dead. Can, and should, science test such claims? A number of scientists say no, concerned that empirical studies of prayer will be misused to advance religious agendas. And some religious practitioners agree with this restraint, worrying that scientific testing could undermine faith.

In Candy Gunther Brown’s view, science cannot prove prayer’s healing power, but what scientists can and should do is study prayer’s measurable effects on health. If prayer produces benefits, even indirectly (and findings suggest that it does), then more careful attention to prayer practices could impact global health, particularly in places without access to conventional medicine.

Drawing on data from Pentecostal and Charismatic Christians, Brown reverses a number of stereotypes about believers in faith-healing. Among them is the idea that poorer, less educated people are more likely to believe in the healing power of prayer and therefore less likely to see doctors. Brown finds instead that people across socioeconomic backgrounds use prayer alongside conventional medicine rather than as a substitute. Dissecting medical records from before and after prayer, surveys of prayer recipients, prospective clinical trials, and multiyear follow-up observations and interviews, she shows that the widespread perception of prayer’s healing power has demonstrable social effects, and that in some cases those effects produce improvements in health that can be scientifically verified.

An Independent Publisher Book Awards Gold Medal Winner
A Progressive Book of the Year
A TechCrunch Favorite Read of the Year

“Deeply researched and thoughtful.”
—Nature

“An extended exercise in myth busting.”
—Outside

“A critique of both popular and scientific understandings of the hormone, and how they have been used to explain, or even defend, inequalities of power.”
—The Observer

Testosterone is a familiar villain, a ready culprit for everything from stock market crashes to the overrepresentation of men in prisons. But your testosterone level doesn’t actually predict your appetite for risk, sex drive, or athletic prowess. It isn’t the biological essence of manliness—in fact, it isn’t even a male sex hormone. So what is it, and how did we come to endow it with such superhuman powers?

T’s story begins when scientists first went looking for the chemical essence of masculinity. Over time, it provided a handy rationale for countless behaviors—from the boorish to the enviable. Testosterone focuses on what T does in six domains: reproduction, aggression, risk-taking, power, sports, and parenting, addressing heated debates like whether high-testosterone athletes have a natural advantage as well as disagreements over what it means to be a man or woman.

“This subtle, important book forces rethinking not just about one particular hormone but about the way the scientific process is embedded in social context.”
—Robert M. Sapolsky, author of Behave

“A beautifully written and important book. The authors present strong and persuasive arguments that demythologize and defetishize T as a molecule containing quasi-magical properties, or as exclusively related to masculinity and males.”
—Los Angeles Review of Books

“Provides fruitful ground for understanding what it means to be human, not as isolated physical bodies but as dynamic social beings.”
—Science

The field of bioethics was deeply influenced by religious thinkers as it emerged in the 1960s and early 1970s. Since that time, however, a seemingly neutral political liberalism has pervaded the public sphere, resulting in a deep suspicion of those bringing religious values to bear on questions of bioethics and public policy.

As a theological ethicist and progressive Catholic, Lisa Sowle Cahill does not want to cede the "religious perspective" to fundamentalists and the pro-life movement, nor does she want to submit to the gospel of a political liberalism that champions individual autonomy as holy writ. In Theological Bioethics, Cahill calls for progressive religious thinkers and believers to join in the effort to reclaim the best of their traditions through jointly engaging political forces at both community and national levels.

In Cahill's eyes, just access to health care must be the number one priority for this type of "participatory bioethics." She describes a new understanding of theological bioethics that must go beyond decrying injustice, beyond opposing social practices that commercialize human beings, beyond painting a vision of a more egalitarian future. Such a participatory bioethics, she argues, must also take account of and take part in a global social network of mobilization for change; it must seek out those in solidarity, those involved in a common calling to create a more just social, political, and economic system.

During the past two decades Cahill has made profound contributions to theological ethics and bioethics. This is a magisterial and programmatic statement that will alter how the religiously inclined understand their role in the great bioethics debates of today and tomorrow that yearn for clear thinking and prophetic wisdom.

“They Never Want to Tell You” transcends the negative metaphors and clichés of life-threatening disease to give voice to the culture of cancer and to the behavior and attitudes of those who function within that culture—as patients, medical professionals, family, and friends.

In these extraordinary narratives, children coping with cancer reveal their most personal experiences, and they speak with a candor that breaks through the cultural taboos ostensibly designed to protect us from the disease. The rich, compassionate, and honest words of these children give expression to concerns that adults who are struggling with cancer find nearly impossible to articulate. Free of social conventions and cognitive distortions, each story presents a powerful variation on the theme of survival in the face of the continuing uncertainties of life-threatening disease.

David Bearison, a developmental psychologist and psychotherapist, is keenly aware of the psychological impact of cancer on children, particularly as survival times for childhood cancers lengthen and complex treatments intensify concern about the emotional—not merely physical—well-being of children. Bearison has culled from scores of interviews the most salient moments that represent these individual children in their shared struggle with disease. In these pages the children express their wildest hopes and worst fears about cancer. They speak of the absolute necessity of full disclosure, the problems of relating to friends and family, the difficult adjustment to hair loss, their feelings of punishment, grief, and spirituality, and many other issues. In the course of these stories the children reveal not only their will to survive and their extraordinary capacity to understand themselves and their condition, but their altruistic desire to share that understanding with other children as well as with adults who have cancer. “They Never Want to Tell You” is rich and rewarding reading for cancer patients, their families, and health-care professionals alike.

Waiting lists in psychiatric clinics and increasing numbers of patients in long-term psychotherapy have highlighted the need for shorter methods of treatment. Existing forms of short-term psychotherapy tend to be vague and uncertain, lacking as they do a clearly formulated rationale and methodology.

The bold and challenging technique for brief psychotherapy designed around the factor of time itself, which James Mann introduces here, is a method he hopes will revolutionize current practice. The significance of time in human life is examined in terms of the development of time sense as well as its unconscious meaning and the ways these are experienced in both the categorical and existential senses. The author shows how the interplay between the regressive pressures of the child’s sense of infinite time and the adult reality of categorical time determine the patient’s unconscious expectations of psychotherapy.

Torture doctors invent and oversee techniques to inflict pain and suffering without leaving scars. Their knowledge of the body and its breaking points and their credible authority over death certificates and medical records make them powerful and elusive perpetrators of the crime of torture. In The Torture Doctors, Steven H. Miles fearlessly explores who these physicians are, what they do, how they escape justice, and what can be done to hold them accountable.

At least one hundred countries employ torture doctors, including both dictatorships and democracies. While torture doctors mostly act with impunity—protected by governments, medical associations, and licensing boards—Miles shows that a movement has begun to hold these doctors accountable and to return them to their proper role as promoters of health and human rights. Miles’s groundbreaking portrayal exposes the thinking and psychology of these doctors, and his investigation points to how the international human rights community and the medical community can come together to end these atrocities.

Proposals to reform the health care system typically focus on either increasing private insurance or expanding government-sponsored plans. Guaranteeing that everyone is insured, however, does not create a system with the quality of care patients want, the flexibility clinicians need, and the internal dynamics to continually improve the value of health care.

In Total Cure, Hal Luft presents a comprehensive new proposal, SecureChoice, which does all that while providing affordable health insurance for every American. SecureChoice is a plan that restructures payment for medical care, harnessing the flexibility and responsiveness of the market by aligning the incentives of clinicians, hospitals, and insurers with those of the patient. It uses the accountability of government to ensure transparency, competition, and equity.

SecureChoice has two major components. A universal pool covers the major risks of hospitalization and chronic illness, which account for almost two-thirds of all costs. Everyone would be in the pool, irrespective of employment, income, or health status. The second component emphasizes choice, flexibility, and responsibility. People will be able to choose any physician to serve as their “medical home,” to keep track of their health records, provide much of their care, and suggest referrals. Clinicians will have the information and incentives to continually enhance quality. SecureChoice also facilitates improvements in areas ranging from malpractice to pharmaceuticals and establishes new roles for key stakeholders such as health insurers.

This exciting medical detective story of the search for the cause of beriberi—an account of the 26 years of research for a method of isolating the vitamin, the determination of its molecular structure, and the development of methods for its synthesis—is a remarkable first-person account of an important chapter of medical history. The book summarizes all that has been learned about beriberi since the beginning of medicine. It chronicles the unceasing efforts of the author to eradicate the scourge of beriberi among the rice-eating peoples of the world.

Beriberi is of evident interest to specialists in the fields of nutrition and public health; it appeals also to those confronted with practical problems in applied medicine or science; and it is a compelling story of an exciting and admirable human adventure for the general reader. The author has directed his book especially to students in Asia who are becoming increasingly responsible for the welfare of their countries.

The timeless human desire to be more beautiful, intelligent, healthy, athletic, or young has given rise in our time to technologies of human enhancement. Athletes use drugs to increase their strength or stamina; cosmetic surgery is widely used to improve physical appearance; millions of men take drugs like Viagra to enhance sexual performance. And today researchers are exploring technologies such as cell regeneration and implantable devices that interact directly with the brain. Some condemn these developments as a new kind of cheating—not just in sports but in life itself—promising rewards without effort and depriving us most of all of what it means to be authentic human beings. “Transhumanists,” on the other hand, reject what they see as a rationalizing of human limits, as if being human means being content forever with underachieving bodies and brains. To be human, they insist, is to be restless with possibilities, always eager to transcend biological limits.

As the debate grows in urgency, how should theology respond? Christian theologians recognize truth on both sides of the argument, pointing out how the yearnings of the transhumanists—if not their technological methods—find deep affinities in Christian belief. In this volume, Ronald Cole-Turner has joined seasoned scholars and younger, emerging voices together to bring fresh insight into the technologies that are already reshaping the future of Christian life and hope.

Three decades after the first heart transplant surgery stunned the world, organs including eyes, lungs, livers, kidneys, and hearts are transplanted every day. But despite its increasingly routine nature-or perhaps because of it-transplantation offers enormous ethical challenges. A medical ethicist who has been involved in the organ transplant debate for many years, Robert M. Veatch explores a variety of questions that continue to vex the transplantation community, offering his own solutions in many cases.

Ranging from the most fundamental questions to recently emerging issues, Transplantation Ethics is the first complete and systematic account of the ethical and policy controversies surrounding organ transplants. Veatch structures his discussion around three major topics: the definition of death, the procurement of organs, and the allocation of organs. He lobbies for an allocation system-administered by nonphysicians-that considers both efficiency and equity, that takes into consideration the patient's age and previous transplant history, and that operates on a national rather than a regional level.

Rich with case studies and written in an accessible style, this comprehensive reference is intended for a broad cross section of people interested in the ethics of transplantation from either the medical or public policy perspective: patients and their relatives, transplantation professionals, other health care professionals and administrators, social workers, members of organ procurement organizations, and government officials involved in the regulation of transplants.

Although the history of organ transplant has its roots in ancient Christian mythology, it is only in the past fifty years that body parts from a dead person have successfully been procured and transplanted into a living person. After fourteen years, the three main issues that Robert Veatch first outlined in his seminal study Transplantation Ethics still remain: deciding when human beings are dead; deciding when it is ethical to procure organs; and deciding how to allocate organs, once procured.

However, much has changed. Enormous strides have been made in immunosuppression. Alternatives to the donation model are debated much more openly—living donors are used more widely and hand and face transplants have become more common, raising issues of personal identity. In this second edition of Transplantation Ethics, coauthored by Lainie F. Ross, transplant professionals and advocates will find a comprehensive update of this critical work on transplantation policies.

According to the poet Elias Canetti, “All the things one has forgotten / scream for help in dreams.” To the ancient Egyptians they were prophecies, and in world folklore they have often marked visitations from the dead. For Freud they were expressions of “wish fulfillment,” and for Jung, symbolic representations of mythical archetypes. Although there is still much disagreement about the significance and function of dreams, they seem to serve as a barometer of current mind and body states.

In this volume, Deirdre Barrett brings together the study of dreams and the psychology of trauma. She has called on a distinguished group of psychiatrists, psychologists, and social workers—among them Rosalind Cartwright, Robert J. Lifton, and Oliver Sacks—to consider how trauma shapes dreaming and what the dreaming mind might reveal about trauma. The book focuses on catastrophic events, such as combat, political torture, natural disasters, and rape. The lasting effects of childhood trauma, such as sexual abuse or severe burns, on personality formation, the nature of memories of early trauma, and the development of defenses related to amnesia and dissociation are all considered. The book also takes up trauma and adult dreams, including Vietnam veterans and Post-Traumatic Stress Disorder, Holocaust survivors and perpetrators, rape victims, and firestorm survivors. Finally, this volume concludes with a look at the potential “traumas of normal life,” such as divorce, bereavement, and life-threatening illness, and the role of dreams in working through normal grief and loss.

Taken together, these diverse perspectives illuminate the universal and the particular effects of traumatic experience. For physicians and clinicians, determining the etiology of nightmares offers valuable diagnostic and therapeutic insights for individual treatment. This book provides a way of juxtaposing the research in the separate fields of trauma and dreams, and learning from their discoveries.

Drawing on his own experience, and on literature, philosophy, and medicine, Daniel Callahan offers great insight into how to deal with the rewards of modern medicine without upsetting our perception of death. He examines how we view death and the care of the critically ill or dying, and he suggests ways of understanding death that can lead to a peaceful acceptance. Callahan's thoughtful perspective notably enhances the legal and moral discussions about end-of-life issues.

Originally published in 1993 by Simon and Schuster.

Lying on the couch, the patient must tell all. And yet, as the psychoanalyst well knows, the patient is endlessly unable--unwilling--to speak the truth. This perversity at the heart of psychoanalysis, a fine focus on intimate truths even as the lines between truth and lies are being redrawn, is also at the center of this book of essays by the renowned historian of psychoanalysis John Forrester. Continuing the work begun in Dispatches from the Freud Wars, Truth Games offers a rich philosophical and historical perspective on the mechanics, moral dilemmas, and rippling implications of psychoanalysis.

Lacan observed that the psychoanalyst's patient is, even when lying, operating in the dimension of truth. Beginning with Lacan's reading of Freud's case history of the Rat Man, Forrester pursues the logic and consequences of this assertion through Freud's relationship with Lacan into the general realm of psychoanalysis and out into the larger questions of anthropology, economics, and metaphysics that underpin the practice. His search takes him into the parallels between money and speech through an exploration of the metaphors of circulation, exchange, indebtedness, and trust that so easily glide from one domain to the other.

Original, witty, incisive, these essays provide a new understanding of the uses and abuses and the ultimate significance of truth telling and lying, trust and confidence as they operate in psychoanalysis--and in the intimate world of the self and society that it seeks to know.

Twenty-Two Years presents the results of a unique longitudinal study of the first 22 years in the lives of more than 200 young people with varying degrees of mental retardation. By following their paths through available services, job histories, leisure activities, friendships, and marriages, the authors provide objective information about the quality of life of young people with mental retardation.

The book makes a unique contribution by determining what factors in childhood predict who will and who will not require mental retardation services and, for those who disappear from services, why some fare better than others. Most important, the results help answer a question that haunts parents: "What will happen when my child grows up?"

This study expands on an internationally acclaimed clinical and epidemiological study of children with mental retardation published in 1970. It provides prevalence rates by severity of mental retardation, gender, social class, and family stability, and shows how these change over time.

The authors confirm the central role of biomedical factors in the etiology of severe mental retardation. For the etiology of mild mental retardation, the book examines the relative contributions of biomedical and intergenerational genetic factors as well as psychosocial adversity. The book should be of interest to a broad range of clinicians, researchers, and students, as well as the families of people with mental retardation, and it will serve as a model for future epidemiological and follow-up research.