S Bloch, P Chodoff, S Agreen, Oxford, Oxford University Press, 1999, 531 pages, £65 (hb) £34.50 (pb).

When receiving this book to review, I was irresistibly reminded of those advertisements for washing powders, which are described as “new and improved”. Drs Bloch and Chodoff have made an important contribution to the literature on medical ethics since the first edition of their book was published in 1981. As conceptual and practical thinking has developed in mental health services, so the ethical dilemmas too have multiplied; and so one might expect a new and improved edition of Psychiatric Ethics to address these.

A welcome addition is the chapter by Fulford, who has written extensively in the area of the conceptual aspects of mental disorder and their implications for ethics. This might have been an appropriate starting chapter, and many of the chapters could have done with similar conceptual analyses, aimed at trying to get at the heart of the real ethical tensions. For example, in the chapter on confidentiality, there seemed to me to be little attention to …