Healthcare, ethics and insurance Edited by Tom Sorell Routledge 234 pages £15.99

Insurance is a potent source of ethical debate. For instance, should HIV or genetic testing ever be a prerequisite for insurance? What about fairness, frankness and privacy?

These are already well-rehearsed in ethics literature, but what this timely and provocative volume does uniquely is bring together the traditional writers of ethics publications (philosopher and lawyers) with the insurance industry and the newer academic disciplines of decision sciences and government.

Its major value lies in this comprehensive approach to issues of broad public policy. The first section of the book is devoted to the ethics of underwriting. The opening chapter by consultant underwriter Spencer Leigh sets the scene for a fight-back by insurers, who have generally had a bad press.

It is unfortunate that as a first taste this is rather dated - being based on a January 1996 article.

Developments in the last two years are either absent or only briefly touched upon. But, when he defends freedom in underwriting, this is refreshingly honest: 'Let's face it, life insurance underwriting is about discrimination, although we call it 'selection'.'

And the editor's response is gracefully measured and thoughtful. He concludes that private insurers cannot be allowed a free reign to accept or refuse risk, or set prohibitively high premiums, because such freedom could conflict with things more important than an efficient insurance market. The remainder of part 1 picks up the developing debate about genetics and insurance and ties this in with past dilemmas concerning HIV and disability. This comparative style and balance of argument and counter-argument works well to inform and educate, although it is a shame that it is largely lost in part 2.

The book next ambitiously addresses major policy issues, including funding for healthcare, pensions and benefits. How can the costs of healthcare be contained given the moral imperative to support those in need, and how can the rising expectations of consumers be met? We are taken forward to inter-generational justice, solidarity and rights of access to healthcare, and given examples of success and failure in other countries.

Perspectives are argued forcefully. But it is here in the rather patchy latter chapters that the reader is left wanting to see some challenge to - justification for - the glib assertions that competition improves efficiency, that managed care improves things, that welfare spongers cost the country dearly.

These chapters are of patchy quality. But despite its failings, it is an insightful and enjoyable read, unique for bringing together such interestingly varied authors.

And though the book doesn't provide any practical solutions, it makes implicitly clear from the start that it never set out to.

Instead, it is a valuable and thought-provoking contribution to the ongoing public policy debate.