During a conversation with a physician colleague about a particularly vexing clinical conundrum, I suggested consulting a renowned ethicist we both know. My colleague responded with an angry look and said, "Why ask his opinion? He can never reach a decision."

Indeed, physicians expect consultants to tell us which path to follow. By contrast, ethicists explore the spectrum of paths available and the principles influencing decisions. Many physicians are troubled when they discover that more options need consideration, that an optimal choice is not available, or that a choice is not theirs to make. Reactions include a range of responses. Some state emphatically, "I know what is right and will now proceed to do it." Others welcome the opportunity to illuminate ambiguities. If you count yourself among the latter, this text is for you.

The book avoids the ponderous, convoluted presentations of ethical principles often found in other texts. It moves at a steady pace through areas particularly relevant for practitioners dealing with adult situations, especially internists, family physicians, geriatricians, nurses, social workers, and fellows. Ethical principles are labeled in chapter subheadings and explored in a straightforward way using a minimum of jargon. Comments that expand on important concepts but that would interrupt the flow of the text are discreetly placed in chapter endnotes. Case discussions at the end of each chapter engage the reader and encourage self-assessment. Clinicians will find the issues clinically accurate and timely.

The text is detailed and critical, reflecting the author's wide experience. The topics presented include withholding and withdrawing life-sustaining treatment, dealing with terminal conditions and dementia, age rationing, paternalism, research in elderly populations, and the obligations of adult children to frail elderly parents. Practical advice is woven into the discussion. For example, the author cautions physicians against adopting the role of the "ethical police." When confronted with family members who resist decisions by older relatives, the author suggests that patience is a limited virtue. Sooner or later, family members must come to terms with the loss of their loved one.

Although the book covers many areas of concern, it provides no analysis of cultural differences. For example, some persons feel that mentioning illness triggers a decline because they believe that words become reality. Full disclosure is harmful for them. In some cultures, family members must decide important issues on behalf of their elders. For them, advance directives are inappropriate.

This is an extremely useful text. It is readable and will serve as a guide and an excellent teaching resource.