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From The CriticsReviewer: Virginia A. Sharpe, PhD(The Hastings Center)
Description: With this volume, the editors have made a valuable contribution to remedying the problem of scarce resources — in this case, resources that document the evolution of the field of biomedical ethics in the Anglo-American West. The editors are well placed to perform such a service as they have played an important role in shaping the field (as well as U.S. public policy) through their scholarship and their participation on important national commissions, federal advisory bodies, and task forces. There is no other single source available for these documents.
Purpose: The purpose is to collect, in one interpretive volume, difficult-to-find, landmark documents in the history of medical ethics.
Audience: The audience includes students and scholars of medical ethics and others who are interested in the contemporary history of the field in the Anglo-American West.
Features: The book is divided into five subject headings. The first four reflect the defining issues of the field: the ethics of research with human subjects; ethics of death and dying; issues in human genetics; and issues arising from human reproductive technologies and arrangements. A fifth section, "Ethical Issues in the Changing Health Care System," presents key documents which, although outside the specific topic areas in the first four sections, nonetheless reflect the institutionalization of practices and values that have fundamentally shaped this field in United States: the values of moral community and distributive justice as reflected in documents on organ procurement and distribution; the value of patient rights and reasonable disclosure in informed consent law; and the emerging consensus on the limits of confidentiality. Each section and individual entry begins with an introduction that usefully sets the historical context. The selections are drawn from landmark legal cases or statutes; national, international, and religious bodies; and specialty societies. What do the documents in this volume tell us about the history of biomedical ethics? They tell us that the field is largely Anglo-American in origin; that the 1970s and 1980s have been very busy years; that manipulating life (and death), manipulating the building blocks of life, and manipulating other human beings have emerged as the central concerns of the field; that this history has been played out on the public stage and has shaped and been shaped by public policy; and that the field has not been particularly concerned with public health questions, with the issue of universal access to healthcare, or with the question of the ethics of healthcare financing.
Assessment: The trick for such a volume is, of course, to decide to what extent the story told by the selections is an accurate representation of history or a reflection of the editors' particular experiences, scholarly interests, or oversights. In this case, given the editors' roles in development of the field, readers can be confident that the selected documents and themes do accurately reflect its history. In addition, it is safe to say that deficiencies reflected in the absence of documents on public health and universal access to healthcare are those of the field rather than of the editors. The largely American origins of the field, and the American emphasis on autonomy concerns, has meant that public attention to these issues has been largely absent, except in the case of the Oregon Health Plan (absent from the collection). No doubt because the United States is far from a consensus on the ethics of healthcare financing arrangements, documents such as the AMA statement on ethical issues in managed care have been omitted. As for other omissions, given the ongoing debates about abortion in this country, it does seem to be an oversight that the Roe v. Wade and Planned Parenthood v. Casey decisions are not included. A section on pregnancy and the state could also have included the South Carolina statute extending child protection laws to fetuses as well as state legislation on pregnancy restrictions in living will and durable power of attorney statutes. Finally, although I suspect that the Oregon Death with Dignity Act had not overcome legal challenges when the book went to print, it would nonetheless have been useful to have the United States' first voter-approved assisted suicide measure in the section on death and dying. The editors of this volume have provided a valuable resource by bringing together these signal historical documents. As evidence of the practical usefulness of the book, I plan to use at least two of the selections in a talk and am very happy at the convenience of finding them here.