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Doody's Review ServiceReviewer: Birgitta Noel Sujdak-Mackiewi, MA (Saint Louis University)
Description: This is a collection of 71 surgical ethics cases originally published in varying forms in surgical journals. The book begins with a brief introduction to ethics and virtues and continues with seven chapters that cover a range of ethical issues, including informed consent, research, conflicts of interest, business ethics, professionalism, and end of life issues. Each chapter opens with an introduction, followed by a case presentation, and ends with a consideration of four possible resolutions.
Purpose: The authors seek to stimulate ongoing discussion rather than artificial theoretical reflection on the usual cases. Additionally, the authors hope to assist readers in reorienting their ethical sensibilities to be preventive rather than reactive.
Audience: As the title indicates, this book is intended for an audience of surgeons, fellows, residents, and medical students. It will be a useful teaching/learning tool for those engaged in surgery or those who encounter surgeons in their daily practice and wonder what ethics and virtues are guiding their discernment process.
Features: Perhaps the strongest feature of the book is its use of the virtues and understanding of professionalism in conjunction with the authors' "informal style intended to stimulate discussion." This combination allows the authors to take a candid look at what might be an attractive means of resolving a case, but a means that falls short of the professional responsibilities and ethical tradition of surgeons. An additional strength is the inclusion of excellent references for each case, allowing further study on a particular topic. Though the informal approach and broad scope are strengths of the book, they also lead to one of its primary weaknesses. The rapidity with which some of the possible resolutions are dispatched or favored and the resulting justifications often leave one wanting more discussion, explanation, or exploration of the issues. An additional weakness of this collection is its failure to address in a substantive way the ethical conflicts which might arise between surgeons and other members of the healthcare team, such as nurses.
Assessment: This book is a needed addition to the growing body of work focused on a particular specialty in healthcare. It will be an invaluable tool for surgeons and those involved in the formation of future surgeons, not only as technicians, but as those charged with upholding the virtues which engender the trust of their patients. For those wishing for a deeper exploration of the virtues invoked in the cases presented here, Pellegrino and Thomasma's The Virtues in Medical Practice (Oxford University Press, 1993) would be a good companion text.