A Case of Need: A Novel (37 page)

I
N MEDICINE TODAY
, there are four great moral questions involving the conduct of medical practice. One is abortion. Another is euthanasia, the killing of a patient with a terminal and incurable illness. A third concerns the social responsibility of the doctors to administer care to as many people as possible. A fourth concerns the definition of death.

The interesting thing is that all these problems are new. They are products of our technology, moral and legal problems which have sprung up within the last decade or so.

Hospital abortion, for example, must now be regarded as a relatively inexpensive and safe procedure, carrying a mortality rate roughly similar to a tooth extraction. This was not always true, but in the modern context it is, and we must therefore deal with it.

Euthanasia was once much less serious a problem. When doctors had fewer “supportive” aids, artificial respirators, and knowledge of electrolyte balances, patients with terminal illnesses tended to die quickly. Now, medicine faces the fact that a person can be kept technically alive for an indefinite period, though he can never be cured. Thus the doctor must decide whether supportive therapy should be instituted and for how long. This is a problem because doctors have traditionally felt that they should keep their patients alive as long as possible, using every available technique. Now, the morality—and even the humanity—of such an approach must be questioned.

There is a corollary: whether the patient facing an incurable disease has the right to refuse supportive therapy; whether a patient facing weeks or months of terminal pain has a right to demand an easy and painless death; whether a patient who has put himself in a doctor’s hands still retains ultimate life-and-death control over his own existence.

Social responsibility in its modern terms—responsibility to a community, not an individual—is something rather new to medicine. Formerly patients who were indigent were treated by kind doctors, or not at all; now, there is a growing feeling that medical care is a right, not a privilege. There is also a growing number of patients who were once charity cases but are now covered by health insurance or Medicare. The physician is today being forced to reconsider his role, not in terms of those patients who can afford to seek his help, but in terms of all the people in the community. Related to this is the increased medical emphasis on preventive care.

The definition of death is a problem with a single cause: organ transplants. As surgeons become more skilled in transplanting parts from the dead to the living, the question of when a man is dead becomes crucial, because transplantable organs should be removed as rapidly as possible from a dead man. The old, crude indicators—no pulse, no breathing—have been replaced by no EKG activity, or a flat EEG, but the question is still unresolved, and may not be for many years to come.

There is another problem involving medical ethics, and that concerns the doctor and the drug companies. This is currently being fought over in a four-way tug-of-war involving patient, doctor, government, and drug manufacturer. The issues, and the eventual outcome, are still unclear.

Michael Crichton (1942–2008) was a writer and filmmaker, best known as the author of
Jurassic Park
and the creator of
ER
. He was born in Chicago, Illinois, and raised in Roslyn, New York, along with his three siblings.

Crichton graduated
summa cum laude
from Harvard College and received his MD from Harvard Medical School. As an undergraduate, he taught courses in anthropology at Cambridge University. He also taught writing at the Massachusetts Institute of Technology.

While at Harvard Medical School, Crichton wrote book reviews for the
Harvard Crimson
and novels under the pseudonyms John Lange and Jeffery Hudson, among them
A Case of Need
, which won the Edgar Award for Best Mystery in 1969. In contrast to the carefully researched techno-thrillers that ultimately brought him to fame, the Lange and Hudson books are high-octane novels of suspense and action. Written with remarkable speed and gusto, these novels provided Crichton with both the means to study at Harvard Medical School and the freedom to remain anonymous in case his writing career ended before he obtained his medical degree.

The Andromeda Strain
(1969), his first bestseller, was published under his own name. The movie rights for
The Andromeda Strain
were bought in February of his senior year at Harvard Medical School.

Crichton also pursued an early interest in computer modeling, and his multiple-discriminant analysis of Egyptian crania, carried out on an IBM 7090, was published by the Peabody Museum in 1966.

After graduation, Crichton was a postdoctoral fellow at the Salk Institute for Biological Studies, where he researched public policy with Dr. Jacob Bronowski. He continued to write and published three books in 1970: his first nonfiction book,
Five Patients
, and two more John Lange titles,
Grave Descend
and
Drug of Choice.
He also wrote
Dealing or The Berkeley-to-Boston Forty-Brick Lost-Bag Blues
with his brother Douglas, and it was later published under the pseudonym Michael Douglas.

After deciding to quit medicine and pursue writing full-time, he moved to Los Angeles in 1970, at the age of twenty-eight. In addition to books, he wrote screenplays and pursued directing as well. His directorial feature film
Westworld
(1973), involving an innovative twist on theme parks, was the first to employ computer-generated special effects.

Crichton continued his technical publications, writing an essay on medical obfuscation published by the
New England Journal of Medicine
in 1975 and a study of host factors in pituitary chromophobe adenoma published in
Metabolism
in 1980.

He maintained a lifelong interest in computers and his pioneering use of computer programs for film production earned him an Academy Award for Technical Achievement in 1995. Crichton also won an Emmy, a Peabody, and a Writers Guild of America Award for
ER
. In 2002, a newly discovered dinosaur of the ankylosaur group was named for him:
Crichtonsaurus bohlini
.

His groundbreaking, fast-paced narrative combined with meticulous scientific research made him one of the most popular writers in the world. His novels have been translated into thirty-eight languages, and thirteen have been made into films. Known for his techno-thrillers, he has sold more than 200 million books. He also published four nonfiction books, including an illustrated study of artist Jasper Johns, and two screenplays,
Twister
and
Westworld
.

Crichton remains the only person to have a number one book, film, and television series in the same year.

He is survived by his wife, Sherri; his daughter, Taylor; and his son, John Michael.

Crichton and his younger brother, Douglas, co-authors of
Dealing or The Berkeley-to-Boston Forty-Brick Lost-Bag Blues
, which was published under the pseudonym Michael Douglas.

Telegram from Harvard College announcing Crichton’s acceptance, May 4, 1960. (Courtesy of the Office of the General Counsel of Harvard University.)

Lowell House Harvard yearbook photo, 1961. (Courtesy of Harvard Yearbook Publications and Harvard University Archives.)

Crichton as an anthropology major at Harvard College.

“Peabody Papers.” (Reprinted from “A Multiple Discriminant Analysis of Egyptian and African Negro Crania” in
Craniometry and Multivirate Analysis
, Papers of the Peabody Museum of Archaeology and Ethnology, Vol. 57, No. 1, 1966, courtesy of the Peabody Museum of Archaeology and Ethnology, Harvard University.)