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Doody's Review ServiceReviewer: Julia A. Uihlein, MA (Medical College of Wisconsin Health Policy Institute)
Description: This is the fifth edition of a practical guide and approach to clinical ethics. Four topics are used as an effective foundation and method of organizing ethical issues: medical indications; patient preference; quality-of-life and; contextual features. The previous edition was published in 1997.
Purpose: The purpose is two-fold according to the three authors: first to offer a template that is useful in approaching the invariable complexities of situations clinicians encounter and second to offer as examples typical ethical problems that occur in medicine as well as resources to be used per ethical situation if further reading is needed. This format is extremely helpful in approaching ethical issues in medicine and can be used as a good organizational process for the analysis of ethical cases as well as writing ethics consultation reports. In this way, the authors most assuredly meet their promised objectives.
Audience: The book is intended not only for clinicians and students, but other individuals involved in healthcare, including hospital administrators, hospital attorneys, members of institutional ethics committees, quality assurance reviewers and administrators of health plans. A reference is made by the authors that all of these individuals who work in healthcare need to be sensitive and responsive to maintaining ethical standards in clinical practice-a kind of "we're all in this together" stance. The one recognizable area of difficulty in this fine book is in its statement that a broad group of individuals who are in the health care field would benefit from this reading. This is true, but overlooks the specific use of medical terminology that might not be understood by this broad of an audience. Having a medical dictionary on hand will be helpful for those individuals who are not clinicians. Having said this, the authors are very credible authorities on the subjects in the book.
Features: The book completely and effectively covers most of all basic ethical issues that clinicians and others might encounter in medicine. Arguments and counterarguments, for example, about favoring or not paternalistic interventions in enigmatic refusal of healthcare (p. 74) are thoroughly discussed in all of their convolutions. There is a very comprehensive review of the interpretation of advanced directives and truth telling. The cases used throughout the book in the divisions of the four chapters mentioned above are excellent. Further credible resources are easily available in the middle of the discussions of ethical issues rather than having to refer to the back of the book in a resource section. The locator section at the end of the text is easily used to find particular subjects of interest by the reader. The only true shortcoming of the book is an inconsistency of explaining medical terminology. For example, terms such as moribund patient, terminal patient and futility are well defined. Then there are medical terms referenced such as infiltrating ductal carcinoma, uremia secondary to obstructive nephropathy and encephalopathic, which are used as if all readers have this knowledge base.
Assessment: This book is an extremely useful book in the field of applied clinical ethics. A fifth printing certainly validates its usefulness, but may beg the question as well, "Is the fifth edition necessary?" The answer is a resounding "Yes." The authors seriously look at the issues in need of updating from its last printing, such as organizational ethics and the section on conflicts of interest. Even public health issues are covered since the terrorist attack of September 11, 2001.