Former Scarsdale resident Jacob M. Appel’s new book, “Who Says You’re Dead: Medical and Ethical Dilemmas for the Curious & Concerned,” is full of situations and scenarios that let the reader imagine what it’s like to face ethical dilemmas and what a doctor might do in such cases. The book is divided into six parts, with multiple chapters in each. While the amount of sections and chapters may seem daunting, Dr. Appel does a great job of breaking everything up into small, digestible pieces for readers.
Appel, a graduate of Scarsdale High School class of 1992, teaches bioethics at the Icahn School of Medicine at Mount Sinai, where he is the director of ethics education in psychiatry, member of the institutional review board and an attending psychiatrist. Appel also has extensive education credentials; he completed a B.A. at Brown University with double majors in English and American literature and in history, he has seven master’s degrees: an M.A. in European history from Brown, M.A. in American history and M.Phil. from Columbia University, M.F.A. in creative writing with a focus on fiction from New York University, M.S. in bioethics from Albany Medical College, and M.F.A. in playwriting from Queens College of the City University of New York. He also holds a J.D. from Harvard Law School and an M.D. from the Columbia University College of Physicians and Surgeons.
Appel uses his educational background in history and English to weave science and the arts together, coming up with both common and rare situations with a plethora of context and history behind them, while also keeping the content of the book short and simple enough for a reader with no medical background to understand.
“Once people were aware of the book, I found that most people really enjoy it and don’t find it nearly as intimidating as they may have originally thought,” said Appel. “A lot of my work has been for the medical community or for college students and I wanted to write something that spoke to a larger audience.”
In addition to multiple professional degrees, Dr. Appel has a large number of papers, plays, articles, books and essays under his belt. He has published more than 15 books, including “Amazing Things Are Happening Here,” “The Liars’ Asylum” and “The Biology of Luck.” His opinion pieces have appeared in papers such as The New York Times, Chicago Tribune, Orlando Sentinel, Baltimore Sun, The Providence and many more.
For this new book, he said he wanted to blend his fiction and medical writing together.
Appel started thinking about the book almost 20 years ago, but did not start working on it until six years ago. One of the biggest hurdles he faced was finding a publisher that would take a chance on an unusual book; he said he was thrilled when Algonquin Books picked it up.
The book’s six sections include The Mind of a Doctor, Body Parts, Making Babies, The Good of the Many, Practical Matters, and End-of-Life Issues. All together there are 79 different scenarios and ethical dilemmas. Originally, Dr. Appel said, he had more than 100 scenarios in mind.
“My goal is to share as much bioethics knowledge as possible,” he said.
Some of the issues derived from his personal experience, with names changed, others came right from a medical textbook, and a few from famous cases that changed the medical field.
Appel first sets the scene, giving the reader the same background that doctors would have in a particular situation. Then he addresses the specific problem that the scenario raises, such as forced abortions, quality of life versus sanctity of life, the free market of medicine and a doctor’s duty to report.
After spelling out the problem, he describes the pros and cons of any given scenario, often citing actual court cases, history, scandals, laws or stories.
“I try to draw from history, from pop culture, if there are celebrities who have encountered the dilemmas, I try to mention that. I try to draw from a wide range of religious thoughts and political thoughts, social theory, so that people aren’t getting one narrow philosophical vantage point,” the author said.
Appel said he found that many books about ethics either take a narrow perspective from law or from philosophy “which, unless you went to law school or you’re an academic philosopher, it’s rather tedious.”
Appel’s book examins some out of the ordinary questions that most people will never have to face, such as “should a woman be able to consent to carrying a Neanderthal-human hybrid to term” or “should people get extreme body modifications that include drilling horns into their heads.”
Most of the scenarios, however, are familiar situations that a lot of people have to face every day — questions like “Should we turn off life support?,” “Should we help with assisted suicide” and “How much medical autonomy do certain groups, such as children or Alzheimer’s patients, get to have?”
The questions are followed up with more questions such as “What are the pros and cons? Do the pros outweigh the cons? What have people in the past done? Were they right to do that?” This approach helps readers dig deep into themselves and think about their values and beliefs.
“Everyone will face difficult, ethical challenges in medicine at some point in their lives, and having a framework speaking about them is very helpful,” said Appel. “Rather than giving them the answer I give people various ways of thinking about the issue.”
Appel’s favorite scenarios deal with genetic testing, false paternity and mistakes about one’s family life. He said those are the most interesting to him because 1% to 3% of all Americans are mistaken about their paternity, which he thinks is a trend likely to increase in the future.
Dr. Appel said he believes the book can spark a “meaningful civil discourse that is lost in much of American life now.”
“Who Says You’re Dead?: Medical and Ethical Dilemmas for the Curious & Concerned” released Oct. 8.