Edited by H-M Sass, R M Veatch and R Kimura, Baltimore, Johns Hopkins University Press, 1998, 311 pages, US$48.

End-of-life decision making for mentally incompetent adults is the subject of this scholarly but eminently accessible book. It questions the extent to which attitudes to death and incompetence are determined, on the one hand, by common human factors and the nature of dying or, on the other hand, by cultural and legal influences. The book examines how three countries, America, Germany and Japan, approach the same dilemmas. National law, literature, traditions and general societal attitudes are analysed by authors from those countries. The United States is held up as the epitome of individual choice and self determination, far outstripping the rest of the world in debate and litigation on consent issues. But it is made clear that a six-fold increase in documentation about advance directives only achieved a minimal increase in American usage of them. Japan, at the other end of the spectrum, appears to value family loyalty and group solidarity over self determination. Very different attitudes prevail there towards suffering, death, truth-telling, fate and personal choice. Far from …