Carl Elliott, New York and London, Routledge, 1999, 188 pages, £12.99.

Bioethics became established as a distinct discipline in the United States in the 1960s. The paradox is that it arose in part from a general background of criticisms of biomedicine at that time, but has largely followed the traditional pattern of biomedicine in being reductionist and orientated to pragmatic problem-solving. So for some thirty years the theoretical debate within bioethics was mainly about which ethical theory, principle, or combination of principles to subscribe to; whilst in practice many came to see bioethics as a new medical subspecialty, with hospital ethicists as professional experts.

However, this mainstream development of bioethics has not gone unchallenged, and there have always been those advocating other approaches. The Centre for Philosophy and Health Care here in Swansea has been a good example of this, having consistently concerned itself with many of …