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Health Care Ethics: Critical Issues
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JF Monagle and DC Thomasma; eds. 447 pages. Gaithersburg, MD: Aspen; 1994. $59.00. ISBN 08-342-05-05-X. Order phone 800-234-1660.
In 1988, Monagle and Thomasma published Medical Ethics: A Guide for Health Professionals. Its 38 chapters by 44 contributors addressed many various medico-ethical problems and controversies, making it a useful course text and reference. The present work, assembled by the same editors, is "a complementary volume that focuses on bioethical issues that have newly arisen." The number of contributors has increased to 58; only 10 of these participated in the previous book. The background and orientation of the authors is varied and generally appropriate to their topics. Nineteen are physicians; attorneys, nurses, philosophers, priests, psychologists, and sociologists are also included. Most of the authors write in the first person and, when appropriate, develop an argument from actual cases rather than from abstractions. Some cases, such as the well-known Cruzan case, are used by several essayists.
Fortunately, the editors have not restricted this work to "newly arisen issues" if, indeed, many bioethical issues have actually existed for less than a decade. For example, "the plight of the deinstitutionalized chronic schizophrenic" obviously antedates 1988. Some topics not considered in the earlier volume are the clinical implications of human genome research, ethical problems related to medically futile situations, and ethical issues in pharmacy practice. However, it is fairer to say that most of the articles amplify topics that were addressed by other authors in the earlier publication.
Two thirds of the book is organized chronologically: first are topics that pertain especially to pregnancy and the newborn; then topics relevant to midlife; and then topics related to how life may end. In the last third of the book, legal and political issues are presented, as are more abstract ethical problems such as the potential conflict in the physician's role as both therapist and clinical investigator. Much space is appropriately devoted to issues of patient autonomy and the familial, institutional, and public policy considerations that may prudently limit it. Surprisingly, the rather common problem of disagreement among family members about the use of life-sustaining procedures for the incompetent or comatose relative has not been dealt with in either book. The most practical entry is a model durable power-of-attorney document. A section on ways to orient members of ethics committees is also pragmatic. At the other extreme, some articles expound on potential remote circumstances, such as a visionary consideration of the possible ethical implications of the manipulation of brain chemistry as it becomes better understood.
All of the articles provide adequate, recent references, although these vary widely in number. The book's two-column format and larger type makes the present work easier to read than its predecessor. The index is adequate, but a glossary would have made the book even more reader-friendly; this would have been appropriate because, according to the editors, "this book is a response to requests from health care professionals and educational institutions." Some uncommon terms, such as heteronymy, are defined within the text, but their brief definitions alphabetized with casuistry, ontology, and so on would have been desirable. Nevertheless, Health Care Ethics: Critical Issues is a useful addition to the bioethics literature for physicians and health professionals. A wealth of information is made conveniently available; this should stimulate many thoughtful discussions and perhaps some administrative actions.
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