Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making

What do you do with a book that in spite of disagree with the vantage point of the author, you have to admit that the points he raises and the stand he takes has some validity? That an author can cause the reader to stop and think about firmly held belief systems, is indicative of a good writer in my opinion. The author of this bioethical treatise is not a physician. He is a sociologist, and he is giving the historical background to the immense changes in how the American public views its medical establishment. In the process of becoming involved in ethics in the medical world, Rothman had to come in close contact with those he was writing about...physicians. I get the feeling that he was and to a point still in awe of the great men and the great minds he has been exposed to. Occasionally, the book seemed to be biased in favor of the physicians. A book such as this cannot be written without showing the author's own biases; author's can only admit that they harbor particular biases towards those they are writing about. In many issues Rothman comes down solidly on behalf of the physicians, whether or not they brought about the changes in the public's attitudes towards those who work in medicine. Rothman bemoans the fact that the public has involved lawyers, bioethicists, and politicians in what used to be the private domain of physicians. Yet he writes and explains the history behind this lowering of pedestals for doctors and medical researchers...all the while trying to explain why physicians felt their patients should rely 'on those who know and understand' (read that to mean physicians think most patients and families are too stupid to understand basic concepts). This book actually gives a good and vitally important background into the movements for individual rights and the exposure of unethical experimentation and medical treatment which led to the creation of new standards for medical care and research, as well as the installment of Internal Research Boards (IRBs) which are suppose to act as brakes on over-ambitious and unethical practices. Unfortunately, it is all too clear in recent media reports that even IRBs in universities and hospitals are not enough to protect the American public from research by those not interested in protecting the patients and alleviating pain, but rather shows more concern for keeping the grant money coming, fame, and doing science merely for the sake of doing science ('because we can!) John Hopkins obviously hasn't changed its attitudes over 30 some odd years towards the rights of the individual, since they are continuing to attract attention and controversy because of unethical research. This book is definitely a must-read for anyone interested in bioethics. Even if the reader does not agree with the author, the book provides a different, and somewhat valid reflection of the medical establishment's views towards the infringement of their previously existing rights in determining patient care and the moral stan

This book makes a real contribution to the understanding of bioethics in the US, explaining how we got from the paternalistic consciousness in health care that allowed pre-WW II human experimentation on vulnerable subjects such as the one at Tuskegee, to the present day's ethics committees with its emphasis on patient autonomy. I would recommend it to anyone interested in bioethics.