The living dead: fiction, horror, and bioethics.

Popular fiction responds to, and may exacerbate, public anxieties in ways that more highbrow literary texts may not. Robin Cook's 1977 novel Coma exemplifies the ways in which medical thrillers participate in the public discourse about health care. Written shortly after the medical establishment promoted "irreversible coma," or brain death, as a new definition of dying, and at a time when the debate over the removal of Karen Ann Quinlan from life support was the subject of popular attention, Coma crystallized public fears over the uses of medical technology. While Cook hoped that Coma would encourage public participation in health-care decision-making, the book may have fueled public concerns about medicine in ways that he did not anticipate. The public engagement that accompanied the rise of bioethics and that led to increased transparency and patient autonomy in medical decision-making had its birth, in part, in the distrust and paranoia reflected in the medical thriller. Because fiction can shape public perceptions of health-care dilemmas and may affect decision-making on bioethical issues, bioethicists need to pay attention to popular fictional accounts of medicine.