Dr. Robert Martensen paints a surprisingly sympathetic portrait of a noncompliant patient in his medical memoir, "A Life Worth Living: A Doctor's Reflections on Illness in a High-Tech Era." Her name is Diana, and she comes into his emergency room blaming her blurred vision on "nerves" brought on by an upcoming job interview. But after a more careful examination, Martensen concludes it's more likely the onset of multiple sclerosis. "Noooo!" she screams at him. "Some other ... ER doctor told me that once. You're wrong!"

Diana's refusal to listen to medical advice fills Martensen, a medical historian and bioethicist, with regret three decades after the encounter. But her predicament -- and that of many of the patients he profiles in this compelling memoir -- makes him understand her unwillingness to be "medicalized." Refusing to submit to her diagnosis, Martensen writes, "likely meant that her sense of time -- her time, her existence -- would differ qualitatively from what she would experience if she participated fully in the rituals of chronic medical care." Because the treatment for MS at the time did little "to alleviate and nothing to halt or cure, why should she go down the orthodox path?"

Questions like these will be painfully familiar to anyone who has faced a chronic or terminal diagnosis, or sat at the bedside of someone who has. Although medical science offers such patients more treatment paths and promises of hope than ever before, choosing among them, particularly in our strangely commodified role as "health care consumers," can seem more confusing than ever. "Dying is not what it was in the 1950s or even the 1970s, as technology has transmuted the process from something that doctors and patients and their families could readily perceive into a range of contingent possibilities that often leave everyone in a quandary," Martensen writes.

Clearly an advocate for greater transparency between physicians and their patients, he collects case studies that suggest that's not always what we're getting. Consider Marguerite, a forty-something woman with inflammatory breast cancer, who after having her hopes raised by the promise of drug trials, is nearly refused admission to the same hospital when aggressive treatment fails. ("She's gonna die anyway," complains one of the residents.) Or Eliza, an eighty-something screenwriter, who undergoes surgery for a leaky heart valve only to suffer from more debilitating memory loss -- a major risk factor that her surgeon didn't mention during their eight-minute meeting. "It is as though the hospital has become a theater in which a strange inversion of roles has taken place: doctors acting as though the patients are primarily there to perform for them, when for patients and their families, it is the other way around," he writes.

Martensen's memoir may resonate with an eager audience of baby boomers learning to live with their own illnesses, or making end-of-life decisions for their elderly parents. This thoughtful volume doesn't offer all the answers, but against the relentlessly upbeat marketing of high-tech medicine, it does provide a challenging second opinion.

Laura Billings is a health columnist for MplsSt.Paul magazine.