Mortal Choices

Does a surgeon violate a patient's right of self-determination by performing a critical operation without his or her explicit consent? At what point should an incapacitated person be judged legally incompetent and involuntarily hospitalized? Macklin, who serves on the bioethical review committees of various hospitals, probes the ethical dimensions of a host of medical dilemmas in this humane and searching report. She explores the quandary of how to allocate scarce medical resourcesblood transfusions, beds in intensive-care units, slots on a dialysis unit. She also brings to light the dissension among doctors over whether the Jarvik artificial heart was too risky to implant in humans. For seriously ill patients who wish to refuse life-sustaining therapy, a sample ""living will'' is presented. The author, who teaches bioethics at Albert Einstein College of Medicine, argues that no single moral yardstick or rule of thumb can cover the welter of life choices. (June 23)