Vital Choices: Life and Death and the Health Care System

Mark W. Cortiula is an assistant professor at Nipissing University in
North Bay.

As the aging Canadian population places a strain on increasingly scarce
health-care resources, there arises a need to explore alternatives to
the traditional delivery of medical care. William Molloy, a geriatrician
at McMaster University, asks thoughtful questions about aging and death
that health-care planners, physicians, and individuals would be well
advised to consider.

Although Molloy tends to exaggerate the extent of the health-care
crisis, his cost-benefit analysis of hospital care for the terminally
ill and aged effectively demonstrates that health-care dollars could be
more usefully spent. Molloy supports the advance directive as a means of
ensuring the best allocation of resources as well as a means of giving
individuals the opportunity to make informed health-care choices while
competent. His book provides a step-by-step guide on the construction of
living wills.

While Molloy reveals a solid understanding of the ethical and legal
dilemmas that surround advance directives, he skirts the central issue
of what to do about patients who might be inclined to change their minds
about the nature of desired medical care once a terminal condition was
diagnosed. In addition, there are alternatives to advance directives
that can be promoted to reform to the Canadian health-care system; the
advent of multiservice agencies and the promotion of home as opposed to
institutional care are measures that will result in revenue savings that
can be redirected elsewhere in the system.

These issues aside, Vital Choices will appeal to those interested in
understanding the complex issues surrounding aging and death in Canadian
society.