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the Complete Review
the complete review - fiction



A Case of Need

by
Michael Crichton
(writing as Jeffery Hudson)


general information | review summaries | our review | links | about the author

To purchase A Case of Need


Title: A Case of Need
Author: Michael Crichton
Genre: Novel
Written: 1968
Length: 319 pages
Availability: A Case of Need - US
A Case of Need - UK
A Case of Need - Canada
Extrême Urgence - France
Die Intrige - Deutschland
In caso di necessità - Italia
Un caso de urgencia - España
from: Bookshop.org (US)
  • Edgar Allan Poe Award for Best Novel, 1969
  • A Case of Need was made into a film, The Carey Treatment in 1972, directed by Blake Edwards, and starring James Coburn and Jennifer O'Neill

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Our Assessment:

B+ : a solid thriller

See our review for fuller assessment.



Review Summaries
Source Rating Date Reviewer
Minneapolis Tribune . 11/8/1968 Judith J. Fawcett
Pittsburgh Press . 4/8/1968 Barbara Holsopple
St. Louis Post-Dispatch . 4/8/1968 B.K.Schwartz


  Review Consensus:

  It's very well done

  From the Reviews:
  • "As surely as if he were cutting a cadaver at a post-mortem, Jeffery Hudson slices into the medical profession and dissects modern society in his first novel. (...) The story is dramatic, plausible, well-written and not only medically accurate but medically fascinating." - Judith J. Fawcett, Minneapolis Tribune

  • "(A) compelling novel that cuts through trite intellectualism and tells it like it is (......) There is much that is shocking in A Case of Need, but he author has not sacrificed his talents to shock. His people are real, his plot is real. the language, too, helps make A Case of Need an exceptional novel." - Barbara Holsopple, Pittsburgh Press

  • "(W)ildly exciting and broadly revealing about some aspects of the medical profession that are not likely to make you happier the next time you pay a doctor's bill." - Beatrice K. Schwartz, St. Louis Post-Dispatch

Please note that these ratings solely represent the complete review's biased interpretation and subjective opinion of the actual reviews and do not claim to accurately reflect or represent the views of the reviewers. Similarly the illustrative quotes chosen here are merely those the complete review subjectively believes represent the tenor and judgment of the review as a whole. We acknowledge (and remind and warn you) that they may, in fact, be entirely unrepresentative of the actual reviews by any other measure.

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The complete review's Review:

       Michael Crichton attended Harvard Medical School, receiving his MD in 1969; he wrote A Case of Need while still a student, and published it under the pseudonym Jeffery Hudson. With its narrator, John Berry, a pathologist at a Boston hospital it is also very much an insider-look at the practice of medicine, which doesn't come off looking great (one can sense why Crichton did not pursue a medical career after completing his degree; A Case of Need is, among other things, his reckoning with many aspects of the profession).
       A Case of Need is also a thriller, and while Berry admits: "I had no business playing amateur detective. In the cold morning light, the idea seemed ludicrous", playing amateur detective is pretty much all he does here, as he neglects his actual professional duties. There is quite a bit of medical action, including much that Berry does, from checking charts and X-rays to doing blood and other tests, and the like -- but it's not the stuff he's usually paid to do, but rather as part of his investigations.
       Berry gets involved because his friend, neighbor, and colleague, obstetrician Arthur 'Art' Lee gets arrested for supposedly performing an abortion on eighteen-year-old Karen Randall, a student at Smith -- and the daughter of prominent heart surgeon J.D.Randall --, leading to her death. Karen did bleed out after a botched abortion -- not her first -- and Art did perform abortions, and he was arrested because Karen's step-mother said that the dying girl had told her Art did it, but there are all sorts of things that don't add up. (Among the implausible elements is also that Art would be arrested, and kept jailed, based solely on what amounts to hearsay evidence; surely, any prosecutor would have held back until there was at least some corroborating physical evidence; beyond the fact that Art had seen the girl the previous day there doesn't seem to be anything other than the girl's stepmother's claim tying him to the crime.)
       The matter is, of course, complicated by the fact that, even if he didn't perform this one, Art does perform abortions -- this at a time, pre Roe v. Wade, when it was illegal throughout the United States (as it now is again in many states). And so A Case of Need is, of course, very much a novel about abortion.
       Crichton admirably realistically accepts abortion as a wide-spread given -- including having Berry note about Art: "He serves a very important function. After all, somebody around here has to do the abortions". But, of course, there's that one big, big problem: it is illegal.
       The fancy lawyer Art has doesn't want to touch this case, and it's fobbed off on a younger one (a good choice, as it turns out, but still); as the old school lawyer tells Berry:

We both recognize that abortion is a fact of life. It happens all the time. The last figures I saw listed American abortions at a million yearly; it's very common. Speaking practically, it is necessary. Our laws relating to abortion are hazy, ill-defined, and absurdly strict. But I must remind you that the doctors are much more strict than the law itself. The abortion committees in hospitals are overcautious. They refuse to perform abortions under circumstances where the law would never intervene. In my opinion, before you can change the abortion laws, you must change the prevailing climate of medical opinion.
       Among the interesting arguments batted around by Berry and Art is that part of the problem is that abortions are, generally speaking, relatively safe, with a low mortality rate. Very much so if performed in hospital ("about as dangerous as a tonsillectomy"), but even illegal ones are relatively safe (though, as Berry notes: "twenty-five times as deadly as they have to be" (i.e. if they were done by qualified professionals rather than the various back-alley alternatives many women are driven to)), with only some 5000 deaths out of somewhere around a million abortions annually. Art suggests that: "one reason abortion remained illegal was because it was so safe" -- not near enough to the 'Death Threshold', the number of deaths necessary "before anyone gets excited about it". With professionals like Art helping to keep the mortality rate down, by performing safe abortions, too few see any reason to change the status quo. As Art notes, his perfect track record of not losing any patients is: "good for my patients, of course, but bad for society as a whole. Society will only act out of fear and gross guilt. We are attuned to large figures".
       Berry's investigation takes him all over -- and soon he's also dealing with Art's lawyer, who has some ideas of his own but whose approach Berry can't fully get on board with either. (Berry went to law school for a year and a half before dropping out and trying medicine instead; he seems even less enthusiastic about the ways of the legal profession than of those of the medical profession .....) Their timing is absurdly good when they go to question some of the interested parties, allowing them to figure out an essential piece of the puzzle (and document it on film), but otherwise Crichton's thriller is sufficiently convincing.
       They key to getting Art off is to find who actually performed the botched abortion, and Berry eventually figures it out -- along with a great deal about the Randall family ..... Berry isn't so much out for justice; he just wants innocent Art freed and, basically, the whole thing to go away, as if the law just weren't equipped to properly deal with anything involving abortion. Of course, it helps to squeeze a good old-fashioned murder in as well .....
       A Case of Need is a very solid thriller, and Crichton tackles the complex issue at its heart well, avoiding being either sensationalistic or preachy. The professional, matter of fact tone -- buttressed by footnotes explaining medical terminology and the like -- helps, as Crichton doesn't talk down to his audience (as doctors are often wont to ...), but Crichton also does well with Berry otherwise, as the narrator's own issues (many of which he is aware of) add some nice shading to his (inter)actions and account. And the insights into medical training and practice are also of interest. (There are also a series of Appendixes, devoted to various related subjects -- from 'Cops and Doctors' to 'Arguments on Abortion' -- which are somewhat more of a mixed batch.)

- M.A.Orthofer, 14 July 2026

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Links:

A Case of Need: Reviews: The Carey Treatment - the movie: Michael Crichton: Other books by Michael Crichton under review: Other books of interest under review:

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About the Author:

       American author Michael Crichton (1942-2008) wrote many bestselling novels, several of which have been made into successful films.

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© 2026 the complete review

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