Journal of Social Work Values & Ethics

Komesaroff, P.A. (2008). Experiments in Love and Death: Medicine, Postmodernism, Microethics and the Body. Melbourne: Melbourne University Press.

Review by Stephen M. Marson. Ph.D.

Recently, I was asked to write a book review for Human Body Size and the Laws of Scaling: Physiological, Performance, Growth, Longevity and Ecological Ramifications by Thomas Samaras. This review will be published in Cambridge Press’ Public Health Nutrition and it is fitting that the review of Samaras’ book will be published approximately the same time as Komesaroff’s work. Why?  After reading the first two chapters of Komesaroff’s Experiments in Love and Death: Medicine, Postmodernism, Microethics and the Body, it became abundantly apparent that Komesaroff lays out the philosophical underpinnings for Samaras’ review of empirical studies.  Thus, I found it providential that I had an opportunity to read these fine works sequentially.  

Although Komesaroff states that his primary audience includes physicians, nurses, and caregivers, it is obvious to me that he can extend his audience to undergraduate philosophy students and Ph.D. students with an emphasis in public health, sociology, psychology, and social work. Professors who teach within the social sciences will find this book intriguing – especially those who teach ethics and theory construction.  Within the first two chapters, Komesaroff completes a comprehensive review of ethical frameworks and successfully links them to the practice of medicine.  In the classical tradition of ethical theory books, Komesaroff moves from broad concepts to traditional theory to the application of theory in general to the application of ethical theory to clinical practice and case illustrations with analysis. The book is very orderly, so that students and practitioners can follow it.  However, a strong academic background in philosophy (particularly ethical theory) is the prerequisite for comprehending this book.  Most American colleges do not mandate a strong philosophy curriculum.    

I have very little knowledge of medical education outside the USA, but it is clear to me that the Komesaroff vision of medical practice is not shared with the American Medical Association or most of its members.  By the time I started on the fifth chapter, I made a note indicating that his basic concepts for physician/patient interaction were recognizable.  Although it is not immediately apparent, Komesaroff’s discussion of the application of ethical theory within medical practice employs the systems framework with which most social workers have intimate familiarity.  In reflecting on his work on a much deeper level than I normally would, I realized that Komesaroff was presenting the major tenets articulated by Pincus and Minahan in their 1973 paradigm shift text entitled Social Work Practice: Model and Method.  Although Komesaroff does not employ social work jargon within his discourse, it is apparent that his vision of the practice of medicine would be shared with the typical MSW social worker.  In this respect, Experiments in Love and Death can be an inspiring exercise for social workers.

Because of the educational system in the USA, American social workers would find the first two chapters somewhat slow and laborious.  Starting with “Animal Experimentations” in chapter 3, interest would be piqued and would continue for the rest of the book. Because of their grounding in basic philosophy, social workers educated elsewhere (particularly Europe and Canada) would find the first two chapters much less problematic. 

Two dimensions of this book are particularly noteworthy.  First is the emotional response.   Once I completed the first two chapters, I found myself responding with sadness and a level of depression.   In fact, after I put the book down, my daughter queried, “What’s wrong?”  I explained that the case scenarios were depressing.  I noted to her that my emotional response suggested that the author was a master of the written word.  In fact, the emotional response created the motivation to continue to read.  However, for me, I found that I was reading Komesaroff’s work in short bursts.  The case illustrations are emotionally draining.

Second, a dominant theme exists throughout the case illustrations.  In social work jargon, we call it the “right to self determination.”  Komesaroff does not offer a label for his actions, but it is clear that he totally embraces this centerpiece of social work values.  In most of the case scenarios, the patient dies.  Komesaroff’s emphasis is on the process of the patient’s perceptions and needs.  As the physician, he offers patients the soundest medical intervention to pursue.   However, when the patient rejects the seemingly best medical alternative, Komesaroff listens to the patient with an empathic ear.  In my experience in working with physicians, he responds to his dying patients in an unprecedented manner.  He issues support and acceptance for their decision NOT to pursue his recommended medical treatment.  The manner in which he lays out his interaction with patients is uncommon within my health care experience.  The fact is, Komesaroff’s interaction with patients is identical to the manner in which we expect social workers to interact with their clients.   Experiments in Love and Death is extraordinary reading.   As stated earlier, the book can be quite depressing, but on the other hand, it is also uplifting.  In this respect, Komesaroff’s work is quite a rich paradox.

In general, Experiments in Love and Death: Medicine, Postmodernism, Microethics and the Body is a well-written, emotionally charged book that addresses the application of ethical theory in the practice of medicine and health care.  It is an important addition to any academic library that supports a curriculum in philosophy, medicine, nursing, sociology, and social work.  I recommend it without reservation.