Engaging ethics | |
Cambridge medical ethics workbook. Michael Parker and Donna Dickenson. Cambridge: Cambridge University Press, 2001 (359 pp). ISBN 0 521 78863 3. |
The Cambridge medical ethics workbook may well be the first text to make ethics educationally accessible, clinically relevant and interesting while still maintaining academic rigour.
Over the past decade ethics has come to be regarded as an essential element of undergraduate medical curricula, but it continues to receive limited curricula time or educational resources, and many clinicians, academics and students see it as a peripheral aspect of the “real” task of learning medicine. While, in part, this reflects curricular overcrowding and a historical emphasis on science, it is also a reflection of the failure of ethics and ethicists to convey the message that ethics is a substantive, integral feature of modern medical practice. This failure has been reflected in ethics textbooks, which frequently lack clinical relevance, overemphasise moral philosophy at the expense of other academic perspectives and are generally written in a dense and inaccessible manner. This book, which is written by two well-respected British clinical ethicists, is intended as a practical, case-based introduction to medical ethics and aims to encourage the skills of critical reflection and independent learning. It is based around a selection of clinical cases, case commentaries reflecting the perspectives of healthcare professionals, ethicists and lawyers, and a series of relevant papers. Part I explores the ethics of technological advances, including decisions at the end of life and genetics. Part II examines the themes of vulnerability, truth telling, competence and confidentiality, and Part III explores the issues of resource allocation and autonomy. The style is clear and uncluttered and there is little doubt that the workbook would be a valuable text for undergraduates. It is unlikely to appeal to clinicians in Australasia or North America, however, because of its rigorous and didactic structure and its European focus. While the authors acknowledge that the text cannot provide a comprehensive account of contemporary bioethics there are nonetheless some puzzling omissions. There is a limited exploration of culture and no real attempt to address non-Western or non-medical approaches to bioethics. There is also a relatively impoverished account of “alternate approaches to bioethics”, with no consideration of the value of Continental philosophy or discourse ethics to clinical practice. Most surprisingly, the social and political construction of the “profession”, the ethical basis of professional practice and the ethical significance of audit, clinical governance, guidelines, pathways and evidence-based medicine are not really addressed. In light of the Alder Hey and Bristol scandals, these omissions appear unjustifiable. At $85.00 (paperback) and $250.00 (hardcover), the workbook may be priced out of the reach of many students, but it should be a required part of the libraries of medical schools and teachers of medical ethics. Ian Kerridge
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