Edited by K O’Rourke. Georgetown University Press, 2000, £15.75, pp 323. ISBN 0878408029

• O’Rourke K
• editor Primer for Health Care Ethics: Essays for a Pluralistic Society

This is a thoroughly revised and expanded edition of a book originally published in 1994. It consists of a series of clear and thoughtful short essays, grounded in real cases in health care ethics. The range of coverage is extensive—from informed consent, through futile therapy, genetic testing, organ donation, the use of fetal tissue in research, physician assisted suicide, and many other issues, to early delivery of anencephalic infants. The discussions of individual cases, although necessarily brief, are always clear and well informed, and in general lay out the ethical issues and the various options fairly rather than being strongly directive, partisan, or one-sided.

The book has little to say about the philosophical and theological underpinning of bioethics; one must turn elsewhere for that. The book and all the authors adopt a mainstream Roman Catholic stance. They rely, they say, “on a very definite concept of the human person and some precise values and goals of the healing relationship that we believe have brought out the best in people in the health care professions over the centuries” (page xii). Their arguments, they believe, are founded on reason and natural law as well as on faith. At key points recent Roman Catholic teaching on such matters as the evil of abortion in virtually all circumstances, even rape, is affirmed, as is the conviction that an embryo from the moment of conception has the status of a human being rather than a potential human being. There are numerous impressive examples of the vigour and cogency of discussions within that tradition of the ethical acceptability of specific forms of treatment.

The book directly addresses the injustices generated by the fact that in the United States some four million people do not have proper medical cover, and by the invasion of health care by the market: “the only way to solve the health care problems in our society is to insist continually that we must have universal health care coverage. Until that goal is accomplished, we are fighting bush fires and ignoring the major conflagration” (page 256). This is also a reminder, however, that to a certain extent this book addresses specifically American issues, or matters which are treated in a rather different way in the United States from elsewhere because of legislation and court decisions. But for the most part the problems with which it wrestles are common to the major industrial societies.

Two final comments. First, the book claims to be “essays for a pluralistic society”. It may fairly be regarded as a very useful and irenic Roman Catholic contribution to a very complex and confusing debate about how we can agree on the principles and practices of health care in societies which are deeply fragmented morally. This book does not wrestle with the underlying problem of ethical pluralism, but its tone is constructive and positive rather than hectoring, arrogant, or aggressive. Secondly, the book presents itself as a “primer”, but denies that it is intended to be a textbook. Probably its real value is as a resource and a stimulus for conscientious and reflective practitioners, and for students of ethics who are anxious to ground their studies in real situations.