BOOK REVIEW / FICTION : Can Death Be Humane and Cost-Effective? : IN THE NAME OF MERCY By Nicholas Delbanco ; Warner 310 pages, $21.95


Nicholas Delbanco has taken on a provocative theme in his new novel, "In the Name of Mercy."

He has seen the conflict between a doctor's Hippocratic obligation to heal, to do no harm, to leave the ending of a life to God and the contrary belief, acclaimed by Dr. Jack Kevorkian, that there is mercy in hastening the death of an incurable patient in pain.

It is certainly a timely issue, given that today's medical profession is so technically advanced that it can, at great expense, prolong life unnaturally.

Delbanco lays his tale of healing and death at the Trueman-Andrews hospital and hospice in Bellehaven, Mich.

This enterprise is part of the empire of financier J. Harley Andrews, who has acquired it from the founder, Richard Trueman. The hospital and its adjoining hospice for terminal patients are a stage for the struggle between those who believe in the right to life and those who believe in the right to a timely death.

Our expectations are raised that the two physicians in charge of the hospital will dramatize these conflicting points of view.

Dr. Peter Julius, director of the hospice, and Dr. Jim Kelly, chief resident, speak forth on the moral and practical values involved in final health care.

Dr. Julius holds that dying patients are demanding, ignorant of medical procedure and that looking after them has become too expensive. Dr. Kelly reminds himself that a doctor's mission is healing and, while he opposes health care that delivers death, cites the high cost of treatment and sees the terminal care problem as a "managerial" rather than a medical one.

Both doctors accede to the Trueman-Andrews management policy that for terminal patients a speedy demise is both the humane and cost-effective way to go.

This policy is fostered by the hospital's aggressive, businessman president, Trip Conley. He has married the founder's daughter and subsequently made her miserable with his infidelities.

One of these is with Rebecca Forsythe, an English widow who has had great success with a book about assisting her husband's suicide. Conley has brought her to the hospital from London, ostensibly to improve the hospital's poor public relations.

The local newspaper has noted the accelerating death rate among elderly patients at Trueman-Andrews, augmented by occasional suicides.

A particularly troublesome case is that of an AIDS patient, who fails his own expectations of extended life, in sudden demise. His surviving lover writes angry letters to the newspaper's editor accusing the hospital staff of murder and threatening dreadful reprisals. Whereupon the lover also dies under suspicious circumstances.

The central love story of "In the Name of Mercy" stems from the beautiful widow, Rebecca Forsythe. Trip Conley, first smitten with her in London, has found Forsythe unresponsive since her arrival in Michigan and he is further displeased to discover that she has fallen thunderously in love with Dr. Peter Julius, and he with her.

A Grand Guignol ending left this reader no clearer of mind over arguments for and against euthanasia, but certainly persuaded of a need for governmental oversight of the nation's health services. Some readers may vow to steer clear of all hospices whatever their need for nursing care.

As a novel, "In the Name of Mercy" has its frailties. While Delbanco is praiseworthy for taking on so grand a theme, he seems to lose heart for it along the way.

If he did reach satisfactory conclusion about the mercy-killing controversy before telling his story he did not find a character to address or portray it. We miss the figure who might show a concern for the patients of this frightening institution.

Indeed all the important characters have been bereaved, wounded in some way, so that they can respond to events only with self-concern and self-pity. The hospital management personnel who have coasted into health care on the profit motive are a particularly sleazy bunch and such punishments as Delbanco devises for them are not nearly harsh enough.

(The hospital's image is not enhanced by admitting its two sponsors as patients, J. Harley Andrews for a heart complaint and Richard Trueman for prostate cancer. Given the quality of health care at the hospital bearing their names, it is not surprising that neither man recovers.)

The narrative voice that describes the events at Trueman-Andrews has a suitably sinister tone. Its grasp of the language of medical treatment provides authenticity at occasional cost of encrypting meaning for the uninitiated. It is also a voice weighted with the irony of a man who is all too familiar with the gap between what men say and what they do.

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