WINTER 2006 | Letters

Stepping Out

As the spouse of a Northeastern law graduate, whose idea of "work-life balance" is making it home for dinner by 7 p.m., occasionally not working weekends and getting perhaps six hours of sleep per night, I found "Dancing on the Glass Ceiling" (summer 2005) revealing. The article implies that women, especially mothers, are the only ones interested in achieving this "balance" on behalf of families —and making the necessary compromises and sacrifices. When the work of raising children and maintaining the home environment is done solely or principally by women, everyone suffers—the mothers, the children and the fathers (even if the latter do not recognize it). I believe we need more equality for men and women in both the home and the workplace, and I would like to see more serious discussion about how couples can pull back from the 24/7 work ethic madness that seems ever more prevalent and start demanding more balance for both men and women.

Dana Markiewicz
Los Angeles

Life-and-Death Decisions

Eileen McCluskey decried the emphasis of modern bioethics on individual autonomy and the concomitant "loss of focus on the common good and the sense of community" ("Live and Let Die," summer 2005). There is a good reason for that emphasis. Communities don't suffer and die, individuals do. No one else can go with you into that good night.

The monumentality of bedside decisions for a patient dwarfs diffuse socio-economic considerations. I have participated in or reviewed hundreds of medical-ethical hospital consults since 1992, and have never seen a decision to withdraw life support from a patient primarily to save society money. Nor do I want to.

Not until 1980 did the American Medical Association's "Principles of Medical Ethics" first mention patients' rights. Patient autonomy is often the universal solvent for sticky ethical dilemmas to which there is no one, right answer. Terry Schiavo's case was not a tragedy caused by autonomy. Far from it. Her wish—"I don't want to be kept alive on a machine"—as established in court was carried out only after many years because of a failure to honor her autonomous wishes. Others were more interested in projecting their own dogmatic values upon the silent patient. Let the community decide? I hope not.

McCluskey also accepts the claim that Terry Schiavo suffered from bulimia. However, that claim was contradicted by her autopsy. The medical examiner of Pasco and Pinellas counties issued a report on June 13, 2005. It concluded that "the main piece of evidence supporting a diagnosis of bulimia nervosa is suspect or, at least, can be explained by her clinical condition at the time of her blood draw."

Schiavo is neither an example of bulimia nor excessive patient autonomy. If anything, it is a cautionary tale to reflect upon our aspirations at the end of life, and then communicate those autonomous wishes to those most able to ensure that they are followed.

Casey Frank '91
Denver
Casey Frank has been a member of the medical ethics committee and the ethics consult service at the University of Colorado Hospital for many years.

Short and Sweet

Great magazine! Professional, informative!

Richard Hooper M'67
Harrison, Maine