Conversations on the Edge

Narratives of Ethics and Illness

Richard M. Zaner

"Each account enables the reader to feel the overwhelming emotions (and comprehend the immense difficulty) of choosing not to prolong life in situations where there is no hope of maintaining an acceptable quality of life."
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At the edge of mortality there is a place where the seriously ill or dying wait—a place where they may often feel vulnerable or alone. For over forty years, bioethicist cum philosopher Richard Zaner has been at the side of many of those people offering his incalculable gift of listening, and helping to lighten their burdens—not only with his considerable skills, but with his humanity as well.

The narratives Richard Zaner shares in Conversations on the Edge are informed by his depth of knowledge in medicine and bioethics, but are never "clinical." A genuine and caring heart beats underneath his compassionate words. Zaner has written several books in which he tells poignant stories of patients and families he has encountered; there is no question that this is his finest.

In Conversations on the Edge, Zaner reveals an authentic empathy that never borders on the sentimental. Among others, he discusses Tom, a dialysis patient who finally reveals that his inability to work—encouraged by his overprotective mother—is the source of his hostility to treatment; Jim and Sue, young parents who must face the nightmare of letting go of their premature twins, one after the other; Mrs. Oland, whose family refuses to recognize her calm acceptance of her own death; and, in the final chapter, the author's mother, whose slow demise continues to haunt Zaner's professional and personal life.

These stories are filled with pain and joy, loneliness and hope. They are about life and death, about what happens in hospital rooms—and that place at the edge—when we confront mortality. It is the rarest of glimpses into the world of patients, their families, healers, and those who struggle, like Zaner, to understand.

Table of Contents


1. Quiet Rooms for Troubled Voices

2. When You're Dead Anyway, What's To Live For?

3. Hope Against Hope

4. Don't Let Me Forget To Remember

5. Broader's Hill

6. The Cruel Clarity of It All

An Acknowledgement



"Each account enables the reader to feel the overwhelming emotions (and comprehend the immense difficulty) of choosing not to prolong life in situations where there is no hope of maintaining an acceptable quality of life."—Choice: Current Reviews for Academic Libraries

"I recommend this book to fellow clinicians. It helps to hear about our work from compassionate, empathetic, thoughtful person such as Zaner. I will not quickly forget his concept of the awesome vulnerability of my patients."—Healthcare Communication Review

"Dr. Zaner's book is a good resource for those seeking a greater understanding of the dynamics and interplay of end-of-life events and the need to be there for vulnerable patients and their families."—The Annals of Pharmacotherapy

"These moving conversations and reflections place the reader squarely at the bedside, where ethical decision making is deeply situated in the agonizing dilemmas confronted by the sick. In providing extraordinary insights into the experience of patients, family members, and those involved in their care, Zaner's book is an invaluable resource for all who are interested in clinical ethics."—S. Kay Toombs, author of The Meaning of Illness and emeritus associate professor of philosophy, Baylor University

"In an era when bioethics is increasingly defined by regulation—writing, outcomes assessment, and the exercise of authority, we get Zaner's 'Conversations on the Edge' ... a revered immersion in the nitty-gritty of medical morality, complete with the stench of wounds, the tightening grip of anguish, and the fusion of doubt and hope. Bless him!"—John Z. Sadler, MD, professor and director, Undergraduate Medical Education, Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas

"Ethical dilemmas are human problems; personal struggles over finding the right thing to do. When ethicists step into help, these problems reverberate within them as persons also. We read a lot about the ethical issues, but it takes someone of Richard Zaner’s extraordinary sensitivity and superb observational skills to take us into his thoughts and inner debates to show us the personal magnitude of ethics for all the participants. This book adds a vital dimension to the study of bioethics."—Eric J. Cassell, MD, MACP, clinical professor of public health, Weill Medical College of Cornell University

"Zaner has fearlessly reconceptualized ethics practice as a reflexive relatedness to others, achieved and enacted through narrative means, that opens self and other to truth. This book is a stunning accomplishment of daring, transformative, Jamesian respect for freedom."—Rita Charon, professor of clinical medicine and director of the Program in Narrative Medicine, Columbia University

"Zaner's work provides emotionally moving observations and reflections on what it means 'to be' a practicing clinical ethicist: to elicit and listen; to orient and explicate; and to guide and inform. And to offer phenomenological reflections on the 'accident' of illness, the meaning of being schizophrenic or afflicted with Alzheimer's. Zaner continually reflects on his own involvements in and with those who are confronting the human tragedies of illness and death, providing insights which bear on the lives of all of us, including his own."—George Psathas, emeritus professor of sociology, Boston University

"Richard Zaner’s stories of life, death, love and ethics are intriguing, poignant and moving. Taken from the daily life of a big hospital, the subjects with which they deal can be raw and confronting, but the style of their telling is always warm, personal and tender. Zaner quotes Barry Lopez: 'sometimes a person needs a story more than food'. Zaner’s own stories nourish, uplift and sustain. This is how clinical ethics should be practiced. Zaner’s book—a work of integrity and power—demonstrates the complexity and richness of ethical reflection within clinical medicine. It delineates a dimension of practice that is all too often missing from both the clinic and bioethical reflection. I believe that it will establish a model and a standard for the future practice of clinical ethics."—Paul A. Komesaroff, director, Monash Centre for the Study of Ethics in Medicine and Society, Monash University, Melbourne


Supplemental Materials


About the Author

Richard M. Zaner is Ann Geddes Stahlman Professor Emeritus of Medical Ethics and Philosophy of Medicine, Department of Medicine, at Vanderbilt University Medical Center; and author of Ethics and the Clinical Encounter, and Troubled Voices: Stories of Ethics and Illness, among others.

168 pp., 5 x 8

Jan 2004

168 pp., 5 x 8

ISBN: 978-1-62616-151-1
Jan 2004

168 pp.

ISBN: 978-1-58901-304-9
Jan 2004

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