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From The CriticsReviewer: Mary C. Barnhart, MA (St. John Hospital and Medical Center)
Description: This extensive revision of Bioethics: A Return to Fundamentals (Oxford University Press, 1997) consists of concepts, information, lines of reasoning, and theory that are basic to medical ethics. One significant feature in this revision, as well as in its predecessor, is the importance placed on publicity when a violation of moral rule is being considered. Although this unique difference sets the theory apart from typical consequentialist systems, the theory offered continues conform to rule-consequentialism
Purpose: The authors' intent is to provide a systematic account of common morality as a public system. The authors attempt to apply this common moral system to the moral problems that arise in medical practice. In addition, they offer an account of concepts of death and euthanasia that fit within the systematic morality and rationality that they have provided. As a whole, the book has several merits and a worthy objective. The authors are attentive to detail and thorough in their consideration and arguments presenting, most notably, the central concepts of bioethics. In addition, the structure and intent are clearly outlined and developed. In general, the authors' objectives are clearly defined and met. However, the move from the mass of ordinary moral judgments to the fundamentals of the authors' theory is quick and lacks pertinent information and detail about the features of all of moral experience for the reader to make any conclusions. For example, the discussion of what constitutes moral experience is meager and makes assumptions unsubstantiated in theory.
Audience: According to the authors, "We hope this account of morality will be used to teach those entering the health care professions." The authors hope to reinforce health professionals' trust in their own moral intuition and remind them that the moral framework that is used in medicine is the same moral framework they have always used. The authors are credible authorities by virtue of education, years of research and authorship, years of ethics training, and service in the fields of education and bioethics.
Features: The first four chapters discuss the basics of bioethics theory such as morality, moral disagreement, moral rules, and special duties while comparing and contrasting several theories. The intent is to present an overview of the traditional schools of moral thought such as deontology, consequentialism, constructivism, and virtual ethics. In addition, the authors consider how each of these types of theories addresses a standard set of specific problematic cases. However, in not attempting to reconcile the differences among them, the authors leave students with the perception that moral theory is either confused, irrelevant, or relative. The second part of the book, chapters five through twelve, includes discussion and argument surrounding the key concepts specific to bioethics. The discussion of these fundamental concepts takes up two-thirds of the book and includes malady competence, consent, confidentiality, paternalism, death, and euthanasia. The discussion is exceptionally detailed and complete. One characteristic of the final section of the book is the use of cases to illustrate both the application of the authors' moral theory and their accounts of particular concepts. A number of questions relating to the moral theory presented appear to be inadequately developed. For example, from the beginning the authors emphasize ordinary moral intuition and our common moral experiences. However, the discussion of details of moral experience sometimes lacks relative details surrounding the features of all moral experience that precludes readers' ability to come to common conclusions. As a reader, this lack of detail detracted from the theory and inhibited my own ability to reason through the concepts.
Assessment: The second part of the book on the current topics in bioethics is more defined and detailed than in the original publication. The authors provide a significant contribution to the field of bioethics and, overall, provide an insightful and useful discussion of what a systematic analysis of the key bioethical concepts ought to bring to the general understanding of the moral issues involved in the practice of medicine, in particular cases as well as at a societal level.