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'Tough Choices' by Daniel Sokol - Reviewed by Aidan O'Brien

17/12/18. Tough Choices is a fascinating collection of case studies and vignettes, drawn from Daniel Sokol’s experience on the front line of medical ethics and law.

Each chapter presents the reader with a new ethical dilemma: should doctors lie to their patients? Should they lie to each other? What are the limits of a parent’s right to determine their child’s best interests? What are the limits of informed consent?

If these questions seem to invite simple answers, the reader is soon disabused. Sokol’s clinical distillation of each question soon reveals its hidden depth and complexity.

Many of the chapters recount tragic real life events, such as the high-profile cases of Charlie Gard and Alfie Evans. The global controversy they attracted is testament to their emotive power. Sokol manages to deconstruct these case studies with dispassionate logic, whilst still maintaining a compassionate tone.

As a Barrister specialising in medical law and an established medical ethicist, Sokol is well placed to guide the reader through this myriad of moral and legal quandaries. His observations from wards around the world are interwoven with salutary lessons from the courtroom. The author’s experiences allow him to survey the relationship between medicine, ethics and law with authority.

Many readers, including those who deal with medical experts regularly, will be surprised to learn how little attention can be given to ethical issues in healthcare. For those working on busy wards, it can be difficult to identify an ethical crossroads, never mind knowing which way to turn. This book highlights just how ubiquitous ethical dilemmas are in medicine and how little recognition is given to this fact during medical training or on hospital wards. It provides a timely clarion call for better education, enhanced focus and specialist support to allow clinicians to practise more ethical medicine.

Perhaps this book’s greatest achievement is that it teaches the reader how to think like an ethicist. It equips the reader with the skills needed to untangle the most knotty of moral problems.

Tough Choices is not just an essential read for any lawyers wishing to better understand the confluence of law, medicine and ethics, but will improve anyone’s powers of critical reasoning. Written with humour, warmth and clarity, it grapples with life-and-death issues and yet leaves the reader feeling intellectually fortified and uplifted.

This review was written by Aidan O’Brien, a Barrister specialising in clinical negligence litigation and medical regulation. He has a Masters in Healthcare Law and Ethics.

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