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Doody's Review ServiceReviewer: Chris Hackler, PhD (University of Arkansas for Medical Sciences)
Description: The first three chapters of this book present an ethical framework based on the rules of common morality, which prohibit harmful behavior such as killing, deceiving, and causing pain. The fourth chapter is a critique of the most widely accepted theoretical account in terms of competing principles, such as beneficence, autonomy, and justice. Each of the remaining eight chapters deals with a central concept or issue in medical ethics in light of the theory presented.
Purpose: The authors' purpose is to illustrate the grounding of bioethics in our common morality by making its rules, ideals, and methods of reasoning explicit and then relating them to the fundamental concepts and issues of medical ethics.
Audience: The book will be most interesting and accessible to bioethicists and students of bioethics. It can be read with profit by professionals with no background in moral philosophy, but the rigorous and sustained philosophical argumentation may be slow going for some.
Features: The book is a monograph and as such has no illustrations, tables, or other unique features. The book is full of careful, rigorous conceptual analysis and argument. The prose sometimes is rather dense, and it proceeds at a philosopher's pace. This is not a criticism of the book, but a warning that readers not used to the detailed and meticulous style of analytic philosophy may require some patience.
Assessment: Books on medical ethics typically begin with a chapter on ethical theory that summarizes the leading theories of our Western philosophical tradition, such as utilitarianism, formalism, and libertarianism, then move to a discussion of ethical issues in medicine, leaving it to the reader to "apply" the various theories to the issues in an ad hoc manner. The authors are correct that this approach promotes superficiality and inconsistency. They offer a deeper and more fully integrated treatment of the subject by developing their own theory of morality and then using it to illuminate and resolve particular moral issues. The discussions of competency, consent, and paternalism are especially rewarding. The last chapter, which deals with terminating life-sustaining treatment, physician-assisted suicide, and active euthanasia, is not as well organized and focused as the others. On the last two topics, especially, the argument is imprecise and inconclusive, perhaps reflecting the lack of complete agreement among the authors on the subject. The book is a significant contribution to the field of medical ethics and deserves a studious reading. It is recommended for purchase by college and university libraries as well as libraries on health sciences campuses. Individuals studying or working in medical ethics will want to have their own copy as well.