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M Parker, Donna Dickenson. Cambridge University Press, 2001, £29.95, pp 359. ISBN 0521788633
This is very much a workbook rather than a conventional textbook in that it presents readers with cases and, through structured activities, aims to facilitate the understanding of key topics in medical ethics. As the authors state: “The workbook is intended to be both a coherent approach to medical ethics and also a toolkit of resources for teachers and lecturers”. The book is organised around themes, such as reproduction, genetic testing, medical research, and mental health. In their choice of topics the authors say they aim to focus more heavily on ordinary cases rather than “headline” issues so that the cases will be of relevance to health care professionals’ everyday practice. The chapters begin with the presentation of a case which is followed by commentaries and short articles elaborating on the issues raised. Activity boxes appear throughout the text to encourage the reader to critically engage with the cases and commentaries. The cases are based on real life events provided by health care professionals from a variety of countries.
The authors take a case based approach to the study of medical ethics, beginning with a particular case and then proceeding towards more general statements and solutions to problems. Their arguments for the merits of this approach are threefold. First, it cuts across disciplinary and cultural boundaries, as everyone can relate to a case study even if they come from very different backgrounds. Different professional concerns in ethics can be dividing but a case based approach allows, “the different slants of different disciplines to be explicitly built in”. Second, such an approach does not require any previous knowledge of medical ethics or any initial familiarity with moral theories or principles. This provides a less intimidating introduction to the subject and allows readers to consider their own views on the case before bringing in expert commentaries and analysis. Third, this approach encourages readers to think of their own cases and therefore “generalise what they have learned from one case to another, comparing similarities and differences”. In a sense this book is a living example of this approach in that the particularities of the case are discussed first without the aid of guiding principles or theories. These are then brought in and are generally middle order principles or maxims, such as children’s best interests should be served, rather than detailed applications of moral theories.
The authors use this case based approach to further their aim of making medical ethics relevant to health care professionals’ everyday practice and in turn to answer the question “why study medical ethics”. This is one of the strengths of this book, that it explicitly addresses the question of the relevance of medical ethics to health care professionals as well as the vexed question, often asked by medical students, of what makes a particular issue an ethical one. These issues are considered in an appendix entitled “Study guide for teachers”. A better title, which could encourage more readers to look at it, might be: “Why (and how to) study medical ethics”, as these are important and often neglected questions. In response to the question “why study medical ethics”, the authors argue that even in the most everyday of cases, ethical dilemmas and issues are raised and seeing ethics as also about institutional structures and power relations makes ethics, in their view, hard for practitioners to avoid. These points are nicely illustrated by taking the reader through a case and showing first of all how issues that might initially seem to be about clinical patient management have an important ethical dimension, and secondly how the solutions that the care team are grappling with can be construed as a clash between different ethical positions. One of the strengths of the book is its consideration of how medical ethics might be studied. The final chapter, “Thinking about ethics”, includes a discussion of alternative models and theories of ethics which gives the reader a useful overview of current debates about moral theory and shows that medical ethics is not simply wedded to one tradition.
Overall, I think the workbook is successful in fulfilling its stated aims. It provides a comprehensive and interesting introduction to medical ethics and gives the reader ample references for further reading. It will be useful for teachers as it provides a good source of up to date and stimulating cases that can be used in classroom discussion. One feature that stands out is the use of cases from a wide range of countries, (European countries, the United States, and Australia). This gives the book an international diversity that is rarely found in medical ethics textbooks.