There are many challenges to be met when writing an introductory treatise on an academic topic. The subject matter must be presented in a simple but not oversimplified manner. Enough theory must be included to ground the discussion of specific issues but not so much as to overwhelm or bore the readers. The text should be long enough to do justice to the subject matter but short enough to be readily accessible, especially for readers such as healthcare professionals, whose primary concerns lie elsewhere.

There are additional challenges in a relatively novel interdisciplinary field such as bioethics. The scope and methodology of bioethics are matters of great controversy, as are its relations with related subjects such as professionalism and human rights. The field is so broad that a single author cannot claim expertise on all topics. Rivalries between law and ethics and among medicine, other health professions, and disciplines such as philosophy complicate efforts to produce a broadly acceptable text. Finally, national and cultural differences pose major challenges to anyone trying to write for a truly international readership.

The difficulty of meeting all these challenges in producing the WMA Medical Ethics Manual provides ample opportunity for criticism, especially from bioethics experts. The three expert reviewers of the manual in this issue of the journal are remarkably restrained in pointing out its shortcomings.^1–3 I am grateful for both their positive evaluations and their constructive criticism. In what follows, I will respond to each of them in turn, focusing in particular on their suggestions as to how the Manual could have been improved.

Before addressing these suggestions, I wish to clarify a matter raised by Søren Holm, namely, to what degree the manual …