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Life Choices: A Hastings Center Introduction to Bioethics, 2nd edn.
  1. L Frith

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    Edited by J H Howell, W F Sale. Georgetown University Press, 2000, £25.25 (pb), pp 601. ISBN 0-87840-757-X

    Life Choices is the second edition of a collection of “some of the very best articles published in the Hastings Center Report over the last 28 years”. The collection has two main aims: to provide a challenging text for classrooms and to serve as a testimony to the achievements of the Hastings Center. The first edition was published in 1994 to mark the 25th anniversary of the Hastings Center's foundation. The Hastings Center, based in New York state, is the oldest independent, non-partisan interdisciplinary research institute of its kind in the world and has become a highly influential organisation. The center's mission is the study of the moral problems that arise out of the rapid advances in medicine and biology, and collaboration with policy makers, both in the private and public sphere, to aid the analysis of the ethical dimension of their work.

    The collection is organised around themes which reflect the center's research concerns. The introductory section is a consideration of the question “can ethics provide the answers”? It includes articles from James Rachels, Sidney Callahan, and Carl Elliott and these will be useful for students who are starting out on the study of ethics and want to examine the role that ethics can play in practical decision making. There are sections on rights and responsibilities; reproductive freedom; reproductive technologies; transplantation, and genetics. By far the largest section considers the ethical dilemmas raised by the termination of treatment. This section includes articles on setting standards for the limiting of care; terminating treatment for the terminally ill; treating neonates with birth defects; active voluntary euthanasia, and physician assisted suicide. It brings together articles by Daniel Callahan, Dan Brock, Cynthia Cohen, and Arthur Caplan, among others, giving the reader a good overview of the literature in this area.

    The second edition includes a new section on the goals and allocation of medicine. This is an important addition, coming at a time when policy makers throughout the world are faced with difficult choices over health care reform and how to set priorities for health care spending. The Hastings Center has conducted an international study on the goals of medicine and the executive summary of the resulting report is included in this section. The report starts from the premise that it is the ends of medicine not only the means used to reach these ends that are at stake: “too often it seems taken for granted that the goals of medicine are well understood and self-evident, needing only sensible implementation. Our conviction, however, is that a fresh examination of those goals is now necessary”. The report identifies and defends four main goals that medicine should aim to achieve: the prevention of disease and injury and the maintenance of health; the relief of pain and suffering; the care and cure of those with a malady, and the avoidance of a premature death, and the pursuit of a peaceful death. They argue that such a clarification of the goals of medicine is imperative as without such reflection, “the various reform efforts going on throughout the world may fail altogether or not achieve their full potential”. This report and the articles included in this section are a useful consideration of the often neglected area of public health ethics and include the important article by Daniels and Sabin. Last chance therapies and managed care. The second edition also includes a new section on the cloning of human beings. This includes a useful summary of the National Bioethics Advisory Commission's report on human cloning and responses to this by James Childress, a member of commission, and Susan Wolf on why the NBAC is wrong. In terms of the discussions of health policy this collection is predominately concerned with the USA, but this does not detract from its wider usefulness as the principles and the moral underpinnings of such policies are extensively debated.

    It is always useful to be able to direct students to collections of original articles that they might not otherwise have access to and this collection gathers together pieces by some of the best-known authors writing on ethics today. At the end of each article the editors have included some questions for consideration and these will be helpful for both teachers and study groups, as they can form the basis of discussion and enable students to critically evaluate the articles. The collection will be useful for students seeking a broad introduction to the subject and researchers who might not have subscribed to the Hastings Center Report over the years. It will be a valuable addition to university libraries, especially those who do not subscribe to the journal itself!

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