Finding Meaning At the Edge 

Vandy ethics professor considers life in crisis

Vandy ethics professor considers life in crisis

We move through the routines of our lives—coffee with breakfast, washing up after dinner—almost on autopilot. But once in a while, some word, some event, some image wakes us up and makes us pay attention to our own extraordinary human connections. In Conversations on the Edge: Narratives of Ethics and Illness (Georgetown University Press, 150 pp., $21.95), Richard M. Zaner, a medical ethicist retired from Vanderbilt, tells stories that might just wake a reader up.

Zaner includes tales about a young couple withdrawing life support from critically ill newborn twins, a man refusing dialysis, a husband making decisions about the end of his wife's long life, a patient facing the onset of Alzheimer's, the death of a teenager in a car accident, and finally the death of Zaner's own mother. These tales are compelling merely as human dramas, but Zaner is after more than a good story. In the context of lived existence rather than academic abstraction, he considers the kinds of questions that arise in the midst of terrible accidents, extreme old age and desperate illness.

These stories bring to painful awareness the mechanics of medical decision-making, and Zaner tells them with an eye for the crucial details of highly technical care. This is not a book version of ER, however: it is almost in passing that we glimpse the machinery of intensive care units and the legalese of advance directives, and Zaner doesn't give even fleeting sight of the health care costs that powerfully impact the decisions of many families. Such issues have substantial implications for society, but they're outside the purview of this book. Instead, Zaner focuses on the necessity of compassion, on the importance of human stories: "If grief, in the telling of it and listening to it, is relearning how to be in the world, it is also the beginning of rebuilding the world that's been shattered by loss. If so, it is clear that the language of feeling, of emotion, must come to be in and from the stories we tell, the anecdotes that tell who and what we are."

For Zaner, what matters most in the lives of people on the edge is, ultimately, dignity. In recounting the story of a dialysis patient, Zaner fittingly concludes that gestures of kinship—"seeing each other, touching hands, feeling that rough skin on my palm, talking together"—are the most meaningful, perhaps even magical, because they affirm the worth of both patient and friend. They are "affirmations of each other as worthwhile, worth the time. You make a difference. You matter, Tom."

Zaner clearly respects, even reveres, the personhood of patients, people who are more than simply medical problems that must be solved. That reverence should serve as a powerful reminder to medical professionals—as well as to lawyers, therapists and other professionals in whom people trust their well-being—that power should be exercised with respectful care. However, to focus too intently on the setting of these tales in life's extremities is to miss the possibilities they have for illuminating life lived from its center. As people make choices in the midst of vulnerability, entrust themselves to others, or wield power over the vulnerable, they reveal something important about choosing, trusting and exercising power. By looking at the edge in the lives of others, perhaps we can see the center for living our own lives.

Zaner will read from and sign his book at Davis-Kidd Booksellers on Nov. 3 at 6 p.m.

—Jess O. Hale Jr.

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