Ryan Downie

The book offers an introduction to the moral concepts and value of health care. It is written by a moral philosopher, a doctor and a nurse and contains questions, cases and exercises which are suitable for medical, nursing and all students and commentators on health care. Moral dilemmas include consent, confidentiality, the giving or withholding of information, and the economics of health care. The issues of artificial reproduction, terminal care and the research and testing of drugs are addressed.

There is a widespread assumption that responsibility in health care is vested in the last resort in the individual doctor who is caring for a given patient. In the first section of this article I shall try to bring out the plausibility of this assumption, and examine the concept of collective responsibility which it allows. In the second and third sections I shall try to show the fatal weaknesses of the assumption in its unmodified form, and shall argue that if we are to understand the nature of health care at the present time we must take the norm to be collective and not individual responsibility. I shall discuss the two relevant senses of collective responsibility and try to show how they can be reconciled with what is acceptable in the widespread assumption of individual responsibility. CiteULike Connotea Del.icio.us What's this?

This paper examines the ethicalproblems that arise when research is carriedout after autopsy on dead infants. It comparesthe right of parents against that of the publicinterest in matters of research on dead minors. The basis for the respect that is widelyaccorded to the body of a dead person isexamined and is shown to ground the parentalinterest. A discussion of the nature of thefamily suggests that `informed consent' is notthe best term to apply to the process ofparental consultation. Some reasons areprovided against using this term in the contextin which bereaved parents are consulted aboutautopsy and research on their dead infants. Itis suggested that a term such as `authorize'might better apply to this situation.

The treatment decisions of competent adults, especially treatment refusals, are generally respected. In the case of minors something turns on their age, and older minors ought increasingly to make their own decisions. On the other hand, parents decide on behalf of infants and young children. Their right to do so can best be justified in terms of the importance of preserving intimate family relationships, rather than in terms of the child's best interests, although the child's best interests will most often follow from this arrangement. Nevertheless, there are and ought to be legal, ethical, and financial constraints on parental decision making.

Some practical problems in the teaching of ethics to medical students are described. The definition of the objectives of the course remains the central aspect, and is more important than the specific content. The use of student projects, buzz groups, case histories and discussion points is described. There is a need for student assessment or examination at the end of the course. The teachers require a broad background in philosophy, clinical medicine and teaching skills. The learning of the teachers may be as important as that of the students.

Critiquing many areas of medical practice and research whilst making constructive suggestions about medical education, this book extends the scope of medical ethics beyond sole concern with regulation. Illustrating some humanistic ways of understanding patients, this volume explores the connections between medical ethics, healthcare and subjects, such as philosophy, literature, creative writing and medical history and how they can affect the attitudes of doctors towards patients and the perceptions of medicine, health and disease which have become part of contemporary culture. The authors examine a range of ideas in medical practice and research, including: the idea that patient status or the doctor/patient relationship can be understood via quantitative scales the illusion fostered by medical ethics that doctors, unlike those in other professions, are uniquely beneficent and indeed altruistic. An excellent text for undergraduate and postgraduate students of law, medical ethics and medical healthcare law, Bioethics and the Humanities shows the real ethical achievements, problems and half-truths of contemporary medicine.

The aim of the article is to distinguish for a medical readership different senses of and connections between the words 'ethics', 'morals', and 'moral philosophy'. 'ethics' and 'morals' can be used as synonyms to refer to first order morality; they can be used to distinguish different areas within morality; 'professional ethics' can be a specialized form of first order morality; or it can refer to codified procedures; 'ethics' can be a synonym for moral philosophy, which is the study of first-order morality.

Supererogation can be distinguished from altruism, in that the former is located in the category of duty but exceeds the strict requirements of duty, whereas altruism belongs to a different moral category from duty. It follows that doctors do not act altruistically in their professional roles. Individual doctors may sometimes show supererogation, but supererogation is not a necessary feature of the medical profession. The aim of medicine is to act in the best interests of patients. This aim involves neither supererogation nor even the moral quality of beneficence. It is simply a job description. Morality enters medicine through the quality of the individual doctor's work, not by the definition of that work