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Michael Palmer, Cambridge, Lutterworth Press, 1999, 190 pages, £14.15 (sc).
Moral Problems in Medicine is based on Michael Palmer's earlier, well-received, book, Moral Problems. The new book retains much of the structure of the earlier volume and the majority of its philosophical component. But whereas the earlier text was a course in applied philosophy covering such topics as warfare, crime and punishment and civil disobedience in addition to topics in medical ethics such as abortion and euthanasia, Moral Problems in Medicine focuses entirely on medicine.
The text is primarily intended to be of interest to health care professionals, medical students and to those who teach them but is also aimed at the newcomer to medical ethics and would be suitable too for the general reader with an interest in the ethical issues raised by modern medicine.
Following an introductory chapter on “What is ethics?” the rest of the book is divided into four sections, each of which begins with an account of “an ethical theory”: egoism, utilitarianism, Kantian ethics and the determinism/free will debate. Each account is supported by exercises, selections of original text, and criticism of the theory in question and ends with some essay questions and a bibliography. The second part of each section follows a similar pattern but focuses on a particular moral problem in medicine through the presentation of original texts. The topics covered include: abortion; euthanasia; human and animal experimentation; truth-telling; autonomy and paternalism, and genetic determinism. These sections again finish with a series of essay questions and a bibliography.
Whilst the book is of great value as an educational resource it does have one or two weaknesses. Though the book is marketed under the title of Moral Problems in Medicine, the retention of the philosophical component of the earlier book gives it the feel of a course on moral theory taught through the use of medical examples rather than of a practical course in medical ethics. The book is driven by the philosophy rather than by the medicine. Some students will find this a stimulating approach but there will be those who will find it difficult to see the relevance of the course to their practice. For these students it would need to be supplemented by discussion of relevant cases and of their own clinical experience. Whilst the book is practical (there are lots of very good and effective exercises and activities) it is not practical in the sense that many involved in the teaching of medical ethics would recognise.
In his introduction to the book Michael Palmer explains that the book is not intended to be comprehensive either of ethical theory or of contemporary problems in medical ethics. He is right to do so and his straightforward and very accessible structure, moving as it does from egoism, to utilitarianism, to Kant and so on works extremely well and makes the material both interesting and useful. That being said, there are inevitably one or two areas—to do with inclusion and exclusion—where many would disagree. Palmer says he would have liked to include Marxist and Christian ethics. I didn't feel that the book was weakened greatly by their exclusion, given its overall aims. Nevertheless, I felt the exclusion of other mainstream approaches to medical ethics, such as narrative, virtue, communitarian and feminist approaches and, perhaps most surprisingly given the medical target audience, principlism, did rather narrow the educational range of the text.
Despite these reservations, I found Moral Problems in Medicine a very useful and interesting sourcebook and a resource which I will definitely use in my teaching with medical students at some point, in combination with other resources. As the influence of the medical ethics core curriculum, published in the Journal of Medical Ethics in 1998,1 continues to grow there will be an increasing need for good quality, educational materials in this field. Whilst there is a great deal of the core curriculum which this book does not cover I would recommend it as a part of the armoury of those who teach medical ethics.
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