May 23, 2006

A Book that Actually Helps in Making Decisions with the Mentally Disabled

New England Journal really likes Making Medical Decisions for the Profoundly Mentally Disabled, a book by Norman Cantor that we published in our book series:
When was the last time you opened a book and realized that what you were reading could actually help you to improve the lives of persons to whom you owe special care? Norman Cantor, a professor of law at Rutgers University, has written such a book.

Surrogate decision making for profoundly mentally disabled persons is central to the conceptual organization of this book. Cantor precisely addresses the concerns of people - family caregivers, guardians, health care professionals, lawyers, and bioethicists - who must make carefully considered choices about medical care and other substantive matters that can affect the most personal and intimate interests of persons who are profoundly mentally disabled. The population of concern in this book is specified as those "people whose cognitive functioning places them in the bottom of the ranges applicable to the mentally retarded." How best to make medical decisions for persons who are profoundly mentally disabled has long been perceived as something of an intractable problem. In part, this problem has been intensified because in the United States today, respect for a patient's autonomy has become the paramount value; we live in a culture where we give the highest priority to personal choice. Yet Cantor has developed a framework - a road map - that, in effect, serves to liberate even those who are so mentally impaired that they may not be able to make any medical decisions for themselves. Cantor's carefully crafted framework is based on critically reasoned moral arguments, examination of established policies and procedures, and a discerning appraisal of U.S. constitutional law.

Cantor does not shy away from examining sensitive issues relevant to sterilization, abortion, organ and tissue donation, and participation in research protocols that will not benefit the research subject. He recounts the historical context of these issues and reexamines and clarifies their contemporary meaning for the purposes of improving the lives of profoundly mentally disabled persons. This book is both sensible and compassionate. A few months ago, I heard the American philosopher Martha Nussbaum on National Public Radio responding to the question "What is ethics?" with the following words: "Ethics is about what matters, and how we should behave." In this book, Cantor has elucidated what matters and has developed a carefully reasoned methodology that serves to guide us as to how we should behave.

More about our Basic Bioethics book series at The MIT Press available here.

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