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Edited by Ulrich Tröhler and Stella Reiter-Theil, Aldershot, Ashgate, 1998, 357 pages, £39.95
This book is a collection of essays which originate from two, mainly European, workshops in 1996 on ethics codes before, and especially after, the appearance of the Nuremberg code in 1947. The book has previously been published in German, and a number of contributions have been translated from the original German and French manuscripts.
The majority of the 26 papers cover the development of ethics codes from the Hippocratic oath to the present time, but some papers look at possible codes for new areas such as predictive medicine and resource allocation in health care, and some discuss the more general questions of the importance and transcultural validity of ethics codes. The papers are generally well written and clearly argued. There are no serious translation errors, but there are a number of minor annoying translation problems, as when the names of ancient Greek doctors in a French contribution are not translated but given in their French form (“Celse” for “Celsus” etc).
Very few of the historical papers contain findings that have not been published previously, but by being collected in one volume they make the history very easily accessible. The most philosophically interesting papers are those that discuss the legitimacy of ethics codes and the transcultural validity of such codes. These papers raise some fundamental questions about the legitimacy of codes produced by official representatives of (a segment of) the medical profession. Can codes regulating the conduct of one party in an essentially two-sided doctor-patient or researcher-research participant relationship be formulated without taking account of the views of those on both sides of the relationship? And, can codes produced by Western medical associations be transferred to other areas of the world without modification? A very interesting answer to the last question is given in a paper by Robert Baker. He argues that the reason the Nuremberg code has transcultural validity is not primarily that it is based on some set of universal moral norms, but that it is a resolution of a universal set of conflicts. Baker argues that wherever medical research takes place in its modern form there will be conflict between the interests and rights of researchers and research participants, and that these inevitable conflicts can base a claim to transcultural validity. Transferring Western codes is therefore not necessarily a problematic form of cultural imperialism, but a necessary corollary of transferring Western forms of medical research practice.
The book is a valuable and up to date resource for anyone interested in the relationship between ethics codes, legal regulation and medical practice and research. Its usefulness as a reference and teaching tool could, however, have been greatly improved by the provision of an index. Despite the lack of an index, however, it should be an essential part of the library of any institution involved in teaching medical ethics.