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Ethics in Clinical Practice
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J. C. Aronheim, J. Moreno, and C. Zuckerman. 394 pages. Boston: Little, Brown; 1994. $45.00.
The authors—a physician, a philosopher, and a lawyer—have combined their talents to successfully create a "flexible resource for clinical ethics." The first six chapters (80 pages) of their text define clinical ethics as a distinct discipline, listing the basic principles that underlie a "standard theory." Their opinions stem from individual cases, a predominantly casuistic approach (with which the authors apparently do not wish to be unequivocally identified). Sensitively written paragraphs on sex discrimination and feminism are noteworthy.
The larger part of the book is occupied by 32 case reports, well chosen to exemplify the ethical dilemma. These cases are superbly discussed; the issues are precisely identified, the basic questions listed, and the problem considered from ethical and legal viewpoints. Each case discussion is followed by a few pertinent references, lists of suggested readings in ethics, and relevant legal citations.
The abbreviated case reports do not include all the historical medical data one might wish, but this is immaterial to the thrust of the ethical message. The authors also point out that "as it is so often said, actual cases are more difficult than those in textbooks." A minor flaw is that the case vignettes begin with the patient's first name, a familiarity to which I have an aversion because it erodes the patient's autonomy. At the end of each case discussion, the options for action are given and preferences are indicated. However, the actual course of action and the outcome is not routinely provided.
The authors point out that they have excluded "research ethics" from the book's content. A case in which a clinical ethical problem overlaps a research ethical one, such as those in randomized clinical trials, may have been a worthwhile addition. The authors' views on problems related to the medical care of an incarcerated criminal and resource allocation might also have been included.
Although library shelves are filled with textbooks on bioethics, this book should successfully compete for the scholar's attention and is an excellent source book for introductory courses in bioethics.
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