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S Loue. Kluwer Academic/Plenum Publishers, 2000, US$55.00 (hb), pp 255+xix. ISBN 0-306-46448-9
Research ethics is high on the agenda of medical ethics and regulatory topics worldwide at the moment. In this field it is thus important to have good textbooks, to educate health care professionals, researchers, ethicists, students, and policy makers about the nature of research ethics, its history and social contexts. Professor Loue's book is thus published in an increasingly competitive marketplace.
The book has many merits. It consists of five chapters and two appendices. The first chapter summarises several of the iconic scandals in medical ethics, notably the Tuskegee syphilis study and the Nazi doctors' atrocities. The historical scholarship of this chapter is solid, if not original, and it is useful to have it gathered here in a convenient place. There is a serious debate to be had about the pedagogy and philosophy of starting research ethics from a consideration of its worst breaches: does this blind students to the myriad of more minor but more pressing problems that arise in “routine” research? Does it encourage the thought that ethics is about hard cases only? Does it take seriously the fact that research ethics is, historically speaking, an evolving discipline? Nevertheless, this is the traditional place to start, and Loue does it very well.
The second chapter summarises some of the main theoretical positions in bioethics. This is the weakest chapter in the book, several times stating a thumbnail sketch of a position (for example, lesbian ethics) with a list of pros and cons before moving on. A survey is always vulnerable to this fault, of course. More seriously, in my view, these views are set out, but few of them are seriously illustrated in the remainder of the book. A more ambitious book would have given a more thorough sketch of what, for instance, Gilligan's ethics of care would say about HIV vaccine trials in the Third World. The promise of non-utilitarian, non-principlist approaches in research ethics has often been asserted, but rarely has a serious attempt been made to apply them in a systematic way.
Chapters three and four analyse the ethical issues that arise in study design and implementation. These chapters are very competently done, but focus in the main on consent and confidentiality, with interesting material (and this is unusual) on conflicts of interest and the rights and duties of the controller of research data relating to publication and use. Chapter five is a valuable account of the regulatory and legal frameworks governing research in the United States. This chapter is of little direct applicability for non-US readers, but is most informative for both students of comparative bioethics and for researchers who wish their studies to have US sites or to be acceptable to US sponsors and regulators. In an increasingly globalised research context, this is a valuable asset. On the other hand, there is relatively little in the book about international research.
The book closes with a pair of appendices, one setting out in some detail the various kinds of research study design and the other setting out the principles of US law. Both of these are very useful and helpful, and should be of great assistance to readers who are unfamiliar with either—a situation common enough, since research ethics interests both the researcher (who may know no law or ethics) and the ethicist (whose grasp of research design may be weak).
The book is not comprehensive: gaps include health services and nursing research, and human rights in medical research. A useful feature is the inclusion of exercises for the reader, although these are very taxing at times, and no model solutions are provided.
In summary this is a valuable textbook, which aptly summarises much of current scholarship in research ethics. It would be suitable for undergraduate or postgraduate courses in medical ethics and in research methods. I find the price of the book rather high, considering the existence of more affordable alternatives. That said, the teacher of research ethics will find this a very useful addition to his or her library.
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