Legal Frontiers of Death and Dying (review)

mary of the normal and aberrant developmental patterns associated with that entity. Although the mouse is the predominant experimental species, other organisms , which provide better experimental systems or exhibit interesting genetic mutations, are described as well. The relevance to human disorders is discussed specifically at the end of each chapter, and a final chapter is devoted to the validity ofanimal models. The message that comes through clearly is that animal models are valuable resources from several perspectives, even though an exact human homologue of the animal skeletal disorder may not exist. For instance, malformations of the skeleton surely tell us something about normal development , especially with respect to the role each component of cartilage and bone plays in the spatial and temporal sequelae leading to the functional entity. One example mentioned in the text where major insights have already been gained from studies of a strain of mice exhibiting abnormal growth patterns is brachymorphism , a typical chondrodystrophy. This condition has, as the only biochemical defect, the production of undersulfated proteoglycans, owing to a limitation of the high-energy sulfate donor, PAPS. This model clearly illustrates the relevance of the high negative charge contributed by the sulfate groups to the proteoglycans of the extracellular matrix during normal growth plate development . In addition to this well-defined defect, other known defects can produce chondrodystrophy, including abnormalities of collagen, link protein, mucopolysaccharide , cell division, oxidative phosphorylation, and cell death. The necessity for a clear biochemical identification of each defect and its relationship to cartilage growth, is evident from these few examples. TL· Genetics ofthe Skeleton is an excellent reference text for anyone interested in skeletal development or abnormalities. It not only surveys the field but helps to define it. The book should be useful both for clinicians and researchers because it not only tells what mutants are available but also provides information on where to obtain relevant stocks. This latter information is contained in an appendix with a list of major genetic stockholders. Because of the rapid progress in embryo preservation and implantation, many strains are available as frozen embryos at the two- or four-cell stage of development and can be readily implanted in foster mothers. These advancements in technology obviate the need for interested investigators to invest and maintain breeding colonies, even for studies of early development. Nancy Schwartz Departments ofPediatrics, Bioatem^ry, and MoUcular Biology University of Chicago LegalFrontiers ofDeath andDying. By Norman L. Cantor. Bloomington: Indiana University Press, 1987. Pp. 208. $24.95 Sanctity of life may be "the foundation of a free society," but in matters of death and dying it has given way to "sanctity of individual free choice and self310 Book Reviews determination." Norman Cantor's Legal Frontiers of Death and Dying charts the eclipse of these two values through court decisions addressing the issue offorgoing life-sustaining medical intervention. Cantor, a senior faculty member at Rutgers University School of Law, begins by guiding us through a series of court rulings that assert the prerogative of competent patients to forgo life-sustaining therapies like dialysis, mechanical ventilation, and amputation of gangrenous limbs. Through these examples, he clearly shows the strength of self-determination as a guiding principle of decision making and the weakness of other "state interests," such as the preservation of life. Our attention is next drawn to decision making for incompetent patients. Before discussing the particular approach ofthe courts, Cantor pauses to dismiss common concerns and distinctions frequendy involved as objections to forgoing life-sustaining treatment in this group ofpatients. These include concerns about making objective quality-of-lifejudgments, as well as distinctions between omission and commission, ordinary and extraordinary procedures, nutrition and medical treatment, and finally, suicide and refusal of life-sustaining therapy. Cantor dismisses these distinctions as "myths" by showing that they either do not exist or are too simplistic to shape legal doctrine. The courts' approach to decision making for incompetent patients, to the degree that it depends on the principle of self-determination, resembles the approach for competent patients. This is particularly evident in the doctrine of "substituted judgment," which justifies decisions to forgo medical intervention based on patient preferences expressed prior to incompetence. Some courts, however, have overextended the...