Homosexual relationships: a contribution to discussion

subject from many angles. One very interesting contribution is that of Charles Coor of the Southern Illinois University on a Model Syllabus for Death and Dying Courses. For anyone engaged in such educational enterprise this essay gathers together experience and practical guidance about films and books on the subject. Other contributors deal with such subjects as telling the patient, and the problem of the patient who refuses treatment, and with the cultural aspects of talk about death. The second section carries a number of contributions about euthanasia, some factual, some argued from different perspectives, all concerned with the sanctity of human life. Many of the most thoughtful comments come (not surprisingly in Tel Aviv) from Jewish doctors and Rabbis, and this cross-cultural aspect of the book there is an article on 'The dying human in christian philosophy' is one of its great assets. The Holocaust and its lessons, and life and death in Kibbutzim are subjects much worth considering in our preoccupation with dying in our affluent society. The section on post-death brings together useful information about mourning and funeral rituals as well as an evaluation of St Christopher's bereavement service by Colin Murray Parkes. This is a most worthwhile compendium, and all three books are recommended for doctors, hospital chaplains and all those concerned with dying and death. Facts are gathered, and the moral dilemmas highlighted, and final answers are not given. How could they be, when we deal with mystery ? DEREK DOYLE, DEREK MURRAY

interesting contribution is that of Charles Coor of the Southern Illinois University on a Model Syllabus for Death and Dying Courses. For anyone engaged in such educational enterprise this essay gathers together experience and practical guidance about films and books on the subject. Other contributors deal with such subjects as telling the patient, and the problem of the patient who refuses treatment, and with the cultural aspects of talk about death. The second section carries a number of contributions about euthanasia, some factual, some argued from different perspectives, all concerned with the sanctity of human life. Many of the most thoughtful comments come (not surprisingly in Tel Aviv) from Jewish doctors and Rabbis, and this cross-cultural aspect of the bookthere is an article on 'The dying human in christian philosophy' -is one of its great assets. The Holocaust and its lessons, and life and death in Kibbutzim are subjects much worth considering in our preoccupation with dying in our affluent society. The section on post-death brings together useful information about mourning and funeral rituals as well as an evaluation of St Christopher's bereavement service by Colin Murray Parkes. This is a most worthwhile compendium, and all three books are recommended for doctors, hospital chaplains and all those concerned with dying and death. Facts are gathered, and the moral dilemmas highlighted, and final answers are not given. How could they be, when we deal with mystery ? DEREK  Homosexual Relationships is the report of a working party set up by the Church of England Board of Social Responsibility, submitted to the Board in the summer of I978 but only published a year later after prolonged discussion and accompanied by a substantial postscript in which the Board dissociates itself from many of the arguments and some of the conclusions ofthe Working Party. One turns to the Report, therefore, with the expectation that it will say things which are radical and divergent from more traditional Christian views on the matter.
Two introductory chapters examine briefly the social setting of homosexuality in the modern West, and some medical and psychological accounts of the genesis and nature of a homosexual orientation. The biblical evidence is discussed in chapter three. There are, it is true, few passages in the Bible dealing specifically with homosexuality; but the Report frankly acknowledges that such references as there are suggest a pretty consistent disapproval of homosexual behaviour. This, however, does not close the matter; biblical injunctions of this sort cannot, the Working Party believe, be simply and directly applied today without a pastorally dangerous legalism and a total disregard for changed circumstances and enlarged understanding of the homosexual condition. Homosexuality should be understood in the light of the biblical witness as a whole, rather than derived directly from the few isolated passages which deal with the matter, wrenched from their context. The conclusion of the chapter is not altogether clear, but appears to be to the effect that the Church may not abandon the biblical condemnation of homosexual behaviour but should interpret it as involving a rejection of any misuse of sexuality, the affirmation of the norm of heterosexual monogamy, and the belief that 'complementarity and companionship are as much a part of the divine pattern for sexual relationships as is procreation'.
Chapter four is devoted to theological and ethical considerations. Traditional natural law approaches which base sexual ethics on the priority of procreation as an end in sexual relationships are rejected, like the appeal to isolated texts of scripture, as inadequate. An extreme libertarian approach is also rejected.
What is labelled 'The personalist view' meets with more favour. By this is meant the opinion that the important thing is sexual behaviour is the quality of the personal relationship expressed and confirmed. The chapter concludes with the statement that there are circum-stances (somewhat vaguely outlined) in which a homosexual relationship 'with physical expression of sexual love similar to that which is found in marriage' is proper and ethical.
Both these chapters, which are obviously crucial, are rather disappointing. As the response of the full Board points out, there is a lack of cogency in argument and, particularly in the biblical chapter, one feels that the evidence is not quite fairly faced. This provides a rather shaky basis for the recommendations in the latter part of the Report. In the legal area, the Working Party recommends a reduction in the age of consent from 2I tO I8, as against sixteen for heterosexual intercourse. Concern is expressed about discrepancies in police enforcement of the law, and the continuing distrust between the police and the gay community. Considerable attention is devoted to questions of pastoral care. On the presupposition that celibacy is a vocation and cannot be imposed upon the homosexual (or anyone, for that matter), the pastoral role involves helping the individual to reach decisions about his relationships, including whether or not to enter into a homosexual union, which are informed by Christian insights and values. There is also a pastoral responsibility laid upon the Church to be more tolerant and supportive of its homosexual members. In relation to homosexual priests who have 'come out' and have a partner, the Report suggests that they should submit their resignation to the diocesan bishop, to whom is left the decision in the light of all the circumstances whether or not to accept the resignation. D J Atkinson's book, is a conservative evangelical response to the Report discussed above, written when the general tendency of the latter was already known, and with a four page appendix added after the publication of the Working Party's Report. As one would expect, it supports the traditional church teaching that genital sexual activity between homosexuals is in all circumstances wrong, although it distinguishes between a homosexual disposition, which is not properly to be regarded as sinful, and homosexual genital activity, which is. This reffirmation of the traditional ethic is balanced with warnings against the dangers of 'homophobia' within the Church, and calls, which will hardly satisfy gay Christians, for the Church to be made a more truly accepting fellowship. The biblical, theological and ethical material is examned in very much more detail than in Homosexual Relationships, and even those who find the argument not fully convincing and the conclusions unacceptable will still find this book a very useful guide to the literature and the present state of the discussion of this much controverted issue in the Christian Church.
Neither of these works represents a position which is likely to command general agreement at present in the Church of England or any other of the main-line denominations in Britain. They are early salvoes in a debate which is bound to take some time and has not yet got much beyond some clarification of the issues and a little modification of entrenched positions.

DUNCAN B FORRESTER
Soldier Without a Rifle David Stafford Clark Collins £5.95 This book seemed initially an unusual choice for review by the Journal of medical ethics. Further reading however, proved this to be in error. The psychiatrist in a fringe professional role is well portrayed. It reminded me very much of an acquaintance who consulted me one day about some personal difficulties and said that he had come to see me, as a friend who happens to be a psychiatrist.
The book takes us into the lives of four people intimately. There is little background on any of them prior to adulthood and the vignettes of interpersonal episodes. The complexities of these are amply shown with great skill in dialogue and descriptive detail. The scene is also well set, like the scenery for a play, the author gives is a glimpse of the life of a bomber squadron and its philosophy and also the post-war world.
The central character, Mike Rudge, is an illustration ofa man who is insecure in himself and yet highly attracted to others. He rationalises his situation almost convincingly. The psychiatrist sums up this rather brilliantly 'he's like a sincere philanthropist who has overdrawn his account at the bank. He's compounded the error by opening a new account on credit of course, at another bank'. This follows the central character finding that he cannot carry on with two love affairs, one with his wife and the other with the tragic female of the book. The psychiatrist's flash of insight and his humanity in trying to help yet not having any brilliant or convincing solutions is very real to life. What is just as real and recognisable are Saru (Jean) and Janet, the two women involved with Rudge, the psychiatrist and his wife. All have their personalities illuminated and come across so well that we are left in no doubt as to why they either survive or succumb.
My feeling at the end was one of sadness. The book did not even venture to look at the meaning in all the interpersonal upheaval the characters went through. It failed to look at the meaning in the deaths which we are left with. I also thought of the psychiatrist and the forlorn love-sick South African who conclude the book is lacking in overview quite desperately. I and others might consider this to be a spiritual one. Having

£6.50
Places which provide institutional care for child patients also supply a setting for the themes of medical sociology in microcosm. Here are different professional groups, each imbued with their own ideologies and intent upon their special purposes, busily negotiating a semblance of order within a complex organisation. We are used to the problems arising from differing perspectives of patients and staff, the imbalance of power, the lack of information, the prevailing uncertainty. Such settings, it has truly been said, are 'cradled in anxiety'. The metaphor is peculiarly apt when applied to children. The very word patient derives from suffering, but there is an extra poignancy attached to the vulnerability of the very young when they are led into the doctors' domain. Although we, as rational adults and sometime parents, may have convinced ourselves that the treatment is 'for their own good' things must look and feel very different to the child victims. It is in this area of medical activity that we, on their behalf, have to rely most completely on the physician's ethical code. Without absolute trust in the operator's integrity paediatric surgery would constitute appalling ritual assault and we should see all kinds of minor medical or nursing procedures as unjustifiable afflictions.
We very much need, therefore, to believe that all is well with children in hospital, and, indeed, the notable clinical successes of paediatrics encourage our confidence. Moreover, tbe outlook at this end of the age span is so predominantly hopeful that it is easy to ignore the details of transient individual unhappiness. The contributors to this book have not flinched from addressing a disturbing subject, in careful detail, with varying research strategies. They report on ways of predicting children's responses to brief hospitalisation; they manage to uncover the meaning of what is being done to them for young patients in an orthopaedic ward; they reveal how staff in a long stay unit may escape from their own personal feelings by denying emotion and replicating Goffman's total institution; they see how repeated episodes of illness fit into the pattern of a child's short life and how parents, play leaders and others may take the painful edge off these experiences and maintain some continuing link with the lively world beyond the walls. Margaret Stacey, who was the original inspiration of this admirable work, which was then reported in Hospitals, Children and their Families, has put its main objective frankly and plainly, 'Our central concern is that unnecessary suffering should not be caused to children in the course of treating an ailment'. All the contributors to this volume have kept this aim in mind without its preventing them them from carrying the study of the hospitalised child far beyond the simple concept of separation from mother. The topics are wide, the age range extends to adolescence and the many criticisms of current practice which it contains are balanced by wise recommendations for improvement.