Medical Ethics Today: Its Practice and Philosophy: The BMA's Handbook of Ethics and Law, 2nd edition

Abstract

The avowed aim of this book is to help doctors function in the modern world where ‘patients, other health care workers, media, regulators and the courts’ all expect more explication and justification of the medical decision. These interactions have to be viewed within the context of multiple ethical issues faced by practitioners. Society's interaction with medical science and practice is often represented by professional codes or legislation, meaning that we must be aware of all aspects of this social contract. Thus this handbook aims not only to ‘bridge the gap between theory and practice’ but also to be a source of relevant law and jurisprudence in diverse specialized spheres such as assisted reproduction, genetics and end-of-life issues. The book, with an accompanying CDRom easy to search by subject, succeeds well in its aim, thanks to a structured approach ranging from the basics of practice relevant to all (the patient-doctor relationship, consent and refusal in all ages, confidentiality and health records), to other concerns such as research, public health and custodial settings. These may be specialized areas, but the practitioner who is also a citizen cannot ignore them. Indeed this reflects an ethical stance itself, in the spirit of Aristotle and the practice of ethics as a citizen ‘in the city’ (or in the society where one belongs). In each chapter, general principles are outlined and practical issues then detailed: these are the questions faced by many in everyday practice, such as who has the responsibility for prescribing, how to deal with explicit rationing within the NHS, and how to respond to guidance issued by NICE. The text is also well presented and readable, avoiding the philosophical jargon much loved by the specialist in ethics but obscure to those who passed through the medical curriculum before the subject became compulsory. Vignettes illustrate complex issues: for instance, a chapter on euthanasia refers both to national debates (‘assisted suicide—a human right?’ explains the Dianne Pretty case) and relevant other European models (legislation in the Netherlands). Important points are highlighted in the text; summaries of all the pros and cons are provided—a clear approach to the dialectic tools of philosophical discussion. This is also well exemplified by the chapter on genetics, which furthermore stresses that all individuals have responsibilities, including ‘a general moral duty to take account of the impact of their decisions on others’. This chapter contains also a plea for case-by-case decision making within a framework rather than inflexible rules, and ‘concern for others’ both in general and in the field of genetics where there is an interdependence of interests amongst individuals, family and society at large. Last but not least, the ‘limits of rights’ are outlined in clear terms. This, combined with the introduction to UK human rights legislation in early chapters, is only one of the important points made in this book, of use to all who wish to go further than the letter of the law. Human rights have been discussed in commentaries of mixed quality in various fields (as with the words ‘reproductive rights’ which means many different things to different people); here the concept is well clarified as an important tool in the modern approach to ethical arguments. Twice the size and eleven years after the first edition, the book was well worth waiting for. Clinicians, students and teachers will find it a valuable synthesis of what they should know about the ever more complex field of medical ethics.