Challenges and choices

Tough choices: living and dying in the 21st century; Maureen A. McTeer; Irwin Law, Toronto; 1999; $24.95 (paper) 211 pp. ISBN 1-55221-040-5

FIGURE 1 The title of lawyer Maureen McTeer's Tough Choices: Living and Dying in the 21st Century is ambitious, if not very precise. You have to turn to the back cover to discover that the book is about everything from "research on human embryos to genetic testing and reproductive technologies; from genetically modified foods to patents and organ transplants; from living wills to assisted suicide and euthanasia." That's a lot of territory to cover in 132 pages of text. McTeer writes that what began as a "narrow legal text kept growing and changing into a book for laypeople and lawyers alike. ... I hope this book will be a starting point for the many Canadians who, until now, have felt these issues too distant and new to join their discussion."

Figure 1.

Unfortunately, this goal has proved elusive. Tough Choices holds little appeal for the layperson (I can't speak for lawyers), and that is a shame. Although many of the issues McTeer tackles are important and interesting, she doesn't seem to have a knack for communicating them clearly. The writing is often awkward and confusing, the sections are frequently poorly organized and the index is almost completely useless.

McTeer is at her most convincing when she discusses genetic testing and the need to keep the results of such testing private. She argues that people can suffer discrimination by virtue of their genetic profiles and recommends that such information be treated differently from other personal medical information: "[W]e must be assured that, if we seek genetic testing, or if we or our newborns undergo this kind of testing, we will also maintain control over the resulting information. All provincial privacy legislation needs to be amended so that this principle is clear and enforceable."

Various passages on developments in reproductive technology and the legal status of human life before birth are also thought-provoking. McTeer notes that, in Canadian law, legal rights begin at birth: where there is an irreconcilable conflict between the interests of the fetus and the rights of the pregnant woman, our courts have chosen to protect the woman. She argues that, since there is no such conflict in the case of embryos created through in-vitro fertilization (IVF), these (unimplanted) embryos should be placed "within a zone of legal protection that spares them from abusive research, while simultaneously safeguarding women's reproductive rights in the context of contraception and abortion." FIGURE 2

Figure 2.

Generally, though, this book is an awkward hybrid of fact and opinion. Too often, just when an opportunity for thoughtful discussion appears, McTeer preempts the exploration of an issue with her own strongly held opinion. For example, early in her account of reproductive technology she insists that new laws "should guarantee that those suffering from medical infertility be provided access to those technologies through the public health care system." In other words, if the technology exists, people should be able to have "genetically linked children" without regard to ability to pay. This is a controversial view, given the potential burden on the health care system and general disagreement about just how "medically necessary" it is to treat infertility. Moreover, McTeer makes no attempt to reconcile her view on the "rights" of the infertile with her next, very brief section on the health risks associated with the multiple births that sometimes result from fertility treatments.

Occasionally, ideas are injected into the text without contextualization, as if the reader is completely familiar with the issue. At other times, McTeer makes recommendations without the support of a practical discussion. For example, she expounds on the risks of "reproductive incest," which she describes as a risk created by reproductive technologies that allow for the "deliberate creation of human beings while legally denying them the possibility of ever knowing the identity of their blood relatives." She suggests setting a "legally enforced" limit on the maximum number of live births allowed for one donor. The goal - to prevent the "potentially devastating health and human situations" that can result from the inadvertent pairing of close blood relatives - is laudable. But the mind boggles at how to legally limit sperm donation.

Extrapolating from what has been learned about the psychological needs of adopted children, McTeer believes that, at maturity, people conceived through IVF should have the option of meeting their biological parents. McTeer quickly moves on to another topic, but the reader is left imagining scenarios: 20 years later, the university student sperm donor meets his 64 children!

In her chapter on organ donation, McTeer lists as an option the long discredited idea that medical personnel be "legally mandated to ask all competent patients 'in their last illness' ... to donate their organs and tissue for transplant. A fine or loss of funding to the hospital could be imposed for failure to do so." There is no indication that McTeer means to ridicule this suggestion. She appears to be genuinely blind to the conflict of interest involved.

"Compact and provocative" is how Senator Wilbert J. Keon, in his Foreword, describes Tough Choices. This is probably a fair assessment, as is his observation that this book tackles fascinating and complex issues. Unfortunately, while the book may be provocative it is not always satisfying, and the quality of the writing offers little to entice the reader. Instead, reading it feels like a chore.