Moral problems in medicine

A practical coursebook

By Michael Palmer The Lutterworth Press 192 pages£14.50

Michael Palmer's book is presented as a text for the beginner, and is therefore accessible to those with little knowledge of philosophical or moral theory. In an attempt to achieve this, it packs a great deal into fewer than 200 pages, with broad philosophical theory used to illustrate specific medical ethical dilemmas, backed by brief criticisms, essay questions and 18 lengthy extracts from selected authors. A rich mix, therefore, and a layout that lends itself to structured study, rather than a selective read.

The author acknowledges that the book suffers from limitations. Two are significant. The first is the lack of any consideration of Christian ethics. This places the discussion of major ethical problems in a rather narrow historical context.

The second arises from the flow of the book. It starts with the right to life in the context of abortion and euthanasia. This is followed by utilitarianism, focusing on human experimentation and organ donation. A surprising omission is any significant discussion on foetal research, the author preferring to discuss animal experimentation. While this issue is important, the decision seems perverse in a medical book.

The more traditional cornerstones of ethical thought emerge on page 118. Concepts of conflicting issues and justice are considered. The principle of autonomy is covered - less in relation to consent, more in the narrower context of truth telling.

Finally, the author develops ideas on eugenics and the compulsory treatment of mental illness. A survey of the ethics of genetic screening suffers from a lack of attention to concepts of 'normality'. The new genetics poses challenges to society on such issues as our compassion for, and attitude to, a range of 'disabilities' that technology may in future allow us to eliminate.

How we choose to use this opportunity, through screening and selective termination, is a major ethical issue. I would also have welcomed some mention of priorities and rationing.

While it may have significant omissions, the book does succeed on other fronts. It presents basic philosophical principles well, includes challenging texts and poses good questions based on realistic practical dilemmas. As a text for the student it is of value. For the practising health professional it provides useful background and theory, but the reader should be aware of its limitations.

Michael Wilks

Chair, medical ethics committee, British Medical Association.