1. McSteen, Kerstin MS, CNS, APRN-BC, PCM.

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L.A. Jansen. Pennsylvania: Rowman & Littlefield Publishing Group, 2006. $21.95. ISBN 074253510X. 164 pp.


Death in the Clinic is one of several books in the Practicing Bioethics series, which provides practical approaches to addressing ethical issues that clinicians, administrators, and policymakers confront regularly. In this series of essays, ethical issues involving dying patients and death are explored through multiple perspectives: the public meaning of death, confronting issues of dying in the clinical setting, and ethical dilemmas encountered after a patient's death. Topics include the following: whether death is bad and, if so, why and to whom; defining death in the face of ever-expanding medical technology; the impact of palliative care as a specialty; the challenge of autonomous decision making in the mentally ill patient; creative adaptation in aging and dying; and the use of newly deceased patients for medical training.


There is a logical flow to the essays, yet the book need not be read in any particular order; there is an appendix with abstracts of the chapters to guide the reader to a particular topic of interest. The essays are well written and insightful. The ideas presented are challenging but clear, and I found that they informed my own practice. For instance, in "Against the Right to Die," J. David Velleman argues against the establishment of an institutional right to die. Despite the emphasis that society places on the value of autonomy, the common argument favoring euthanasia, Velleman contends that by offering an "option to die," the persons' autonomy is actually harmed.


Once a person is given the choice between life and death, he will rightly be perceived as the agent of his own survival[horizontal ellipsis].The problem with this perception is that if others regard you as choosing a state of affairs, they will hold you responsible for it; and if they hold you responsible for a state of affairs, they can ask you to justify it. Hence if people ever come to regard you as existing by choice, they may expect you to justify your continued existence.


Velleman's compelling interpretation of autonomy has helped me articulate my "gut feelings" about euthanasia, and this is just one example of how this range of essays encourages our thinking about recurring practice issues.


This book would be an excellent resource for clinicians involved with ethics committees and for clinical nurse specialists and other advanced practice nursing graduate students, especially if practicing in a field that works frequently with dying patients, such as oncology, critical care, or palliative care.