Edited by R B Baker, A L Caplan, L L Emanuel, et al. The Johns Hopkins University Press, 1999, US$59.95, pp 396. ISBN 0801861705

Codified moral medicine is an antidote to many problems, a bulwark against wallowing in the morass of moral idolatry, and a rampart that should be strengthened continually, rather than dismantled. The notion of medical professional self regulation, by means of codification and collaboration, was actually conceived in Britain, by Dr Thomas Percival, but born in America. The American Medical Ethics Revolution, through the medium of a tetrad of editors and a stellar collection of luminaries, displays the pedigree of codified American medical ethical thought back to its earliest progenitor: the primordial 1847 American Medical Association (AMA) code of ethics. The clash of deftly handled academic sabres vivifies the medical ethical dimension of the practice of medicine in America, and reveals the sharp contentiousness underlying American medical ethics, as well as the acute timeliness of the volume.

The rich blend of varied viewpoints culled by the editors was delivered, originally, as papers at a conference in Philadelphia, PA, in March 1997, intended to commemorate the founding of the AMA, and to celebrate the sesquicentennial of its pristine code of ethics. The ensuing volume ramifies into branches of good writing and philosophic musings appertaining to American medical ethics, reaching from the far past to the uncertain future. The volume is comprised of 20 chapters and includes notable appendices, showing the evolution of AMA principles and codes of ethics, from 1847 to 1997. The thoughtful ruminations on the evolution of American medical ethics reflect the crisp thinking of noted scholars drawn from diverse fields, including: ethics, law, public policy, philosophy, medical history, and sociology.

The AMA code of ethics has a history of dissonance, albeit of continued vitality. The lineaments of the code have shown the ability to evolve, in response to professional and larger societal pressures. Although today, in America, medical ethical issues are possibly more beguiling than ever, some may opine that the code is really an anachronism which offers a mere patina of relevancy, and really nothing in the way of enforceability. Rigorous debate about its continuing vitality and relevance is certainly a very healthy exercise. And, it is in the realm of stirring, informed debate and discussion that the volume particularly excels.

Three chapters, for example, proffer a thought-provoking, trichotomy of views concerning the singular question: who should control the scope and nature of medical ethics? Several chapters examine the relevance and adequacy of the traditional paradigm of codified, collaborative medical ethics in the context of particular, contemporary challenges to American medical ethics, relating, for instance, to “alternative medicine”, managed care, population health, and the challenge of providing universal access to health care, given limited resources.

The lengthy time continuum of the volume encompasses forward-looking comments on future challenges to traditional medical ethics, involving, for example, molecular medicine. Given the uncertain role of ethics in the unfolding genetics revolution, it cannot be gainsaid that it is timely and potentially salutary, to ponder, in an informed intellectual sense, whether codified ethics can favourably help guide the future of biomedicine.

The recondite nature of this volume is well tailored to suit the curiosity of academically inclined readers, interested in medical ethics in America. Its abstruseness, however, is ill tailored to fit the lay reader; and may even fall outside the ken of comfort of some clinicians. In this respect, the volume is ineffectual as an educational conduit for the possible linkage of professional ethics with broader societal ethics.

Withal, the volume indubitably is a beacon of superb scholarship, illumining the path to moral rectitude, and barriers along the way, for academicians.