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Fiona Randall and R S Downie, Oxford, Oxford University Press, 1999, 305 pages, £21.95 (pb).
The main purpose of a book review is to convey to the reader the essence of the book's content, thereby facilitating an assessment of its relevance for specific interests. Book titles alone are usually inadequate and/or misleading and sub-titles are used to be more informative. In this case, the subtitle, A companion for all specialties, is not only relevant but incredibly important. Without it, the book might easily be ignored by those who neither work nor have a special interest in palliative care, and more particularly in the care of dying patients. The target readership for this book is very much wider than that. The authors, one a consultant in palliative medicine and the other a professor of moral philosophy, have produced a profound treatise on many aspects of health care by raising ethical issues which permeate all specialties.
In their preface, they present a rough outline of their book, which is divided roughly into three parts. Chapters 1-5 are the more general and express a basic philosophy of palliative care. Chapters 6-12 deal with a range of clinical topics and chapters 13 and 14 raise wider and more challenging philosophical issues. This is not so much a textbook on ethics as a springboard for discussions, seminars and other small group activities which aim to stimulate thinking. Mixed groups, representing various specialties, including lay carers, would benefit enormously from using this resource. As the authors themselves say, it is often the collaborative dimension, the need for teamwork, which poses the most interesting and important ethical challenges.
This is the second edition of the book, just three years after the first and it has already had two reprints. This edition is the result of feedback from readers and the responsiveness of the authors to changes in the delivery of health care and in consumer expectations, most of which seem to have some ethical implications.
Three significant changes have been made. In the first place, the subtitle has been amended from A good companion to A companion for all specialties, which is more descriptive of the book's potential. Secondly, three new chapters have been added. They are: The relative-professional relationship, chapter 3; Reply to critics, chapter 13, which discusses emotional care and patient autonomy and touches on euthanasia, and Quality and value of life, chapter 14. The third change in this new edition is the introduction at the start of each of its 14 chapters of a brief literary quotation, which focuses one's mind on the underlying philosophical issue.
The successful partnership of a clinician and philosopher in writing this book demonstrates the benefits of such collaboration and the bringing together of different modes of thought. The same benefits also find expression in the many examples from the real world of caring which illumine the pages of the text.
In his foreword, Dr Derek Doyle expresses his satisfaction, which I share, that the authors focus on daily ethical issues and problems, such as information giving and confidentiality etc and not on the dramatic ones. Their work is truly reality-oriented and shows due regard to the ever pressing problem of limited resources.
This book represents a superb addition to the literature on health care ethics. It demonstrates the need for experience, wisdom, common sense, sensitivity and professional integrity, all of which are ingredients of a high quality service, though rarely amenable to quantitative measures.
The authors deserve our gratitude and serious attention. I have no hesitation in recommending their book to every person who has the responsibility and privilege of giving any form of health care to another.