Vigil By Alan Shapiro (review)

three audiences. Philosophically, I am frustrated by the authors' decision not to give a theoretical justification for why they chose these ten benchmarks and not others. The theoretical underpinnings of this project are also incomplete. For example , the authors do not explore what "normal functioning" entails. Depending on how this is defined will have wide impact on the degree of health care services that would be required to achieve "normal function" as well as to determine whether medicine or another institution is better adept at addressing the inequalities that derive from it. I am also frustrated by the authors' decision to give each benchmark equal weight, although this is partially corrected by the fact that there are two benchmarks to address some issues such as universal access and equitable financing, but only one benchmark to address other issues such as public accountability and degree of consumer choice. The benchmarks are then subdivided into a varying number of subdivisions , and each subdivision is counted equally. For example, under public accountability , the authorsjudge the value of the four reform proposals on the basis of whether they include 1) explicit and public procedures for evaluating services, 2) explicit democratic procedures for resource allocation, 3) fair grievances procedures , and 4) adequate privacy protection. The authors fail to explain how fairness in one subsection can be compared or balanced against lack of fairness in another subsection. Finally, I am frustrated by the authors' method of assigning each bill a numerical rating with respect to each benchmark since the authors do not provide objective criteria on which to base their numerical ratings. These numerical values make the project seem more precise and objective than it is. Despite these criticisms, the book offers insight into what fair health care reform should include. Their analysis of real health care reform legislation and its strengths and weaknesses provides additional insight into what will be needed ifwe are going to reform health care in the United States where insurance companies and other large health care organizations have a vested interest in maintaining the status quo. The authors also succeed in giving one the sense that health care reform in the U.S. will occur, but it will be piece-meal and incremental, and that much of the impetus will have to come from a discontented public. Lainie Friedman Ross Dept. of Pediatrics, University of Chicago Vigil. By Alan Shapiro, 136 p., 1937, Cloth $18.95. The illumination of the process of dying is increasingly common, too often used as a means of shocking us into seeking better alternatives in end of life care. This is not the case in this uncommon book in which Alan Shapiro, a poet, lyrically captures the grandeur and texture of his sister's life against the backdrop of her dying in a hospice in Houston. The characters in the drama are all too familiar: suffering patient, grieving parents, disconsolate siblings, exhausted husband, innocent child, and frustrated oncologist. Shapiro has a keen eye for the subtleties of human relationship, and, as each person appears, the author flashes back to events 606 Book Reviews that define the relationship between Beth, his sister, and the visitor at the bedside. The poet does not spare himself in assessing the depth of his intimacy with her and the agony of his loss. And there are good times. Her birthday party is a true celebration and recognition of a unique person and joyously lived life; a family estrangement overcome because of her marriage to a man of a different race; a deepening of intimacy as brothers and sister reach out to each other in new ways in the presence of ravaging cancer. This is not a book preoccupied with suffering and dying, however, although both are present. It is an elegiac lament for the shortness of an exuberantly lived life, for the pain and love intrinsic to human connection, as well as a healing balm of affirmation, devotion and reflection for Beth, himself, and their families in the midst of mind-numbing tragedy. Through the author's poetic sensibilities, the devastation of a family watching a loved one die is transformed into a commentary on the human condition as it struggles...