An introduction to medical ethics

Medical ethics manual. John R Williams. Ferney-Voltaire, France: World Medical Association, 2005 (134 pp, no charge, free download available at www.wma.net). ISBN 92 990028 1 9.

The World Medical Association (WMA) has been active in promoting ethical standards in medicine for over 50 years, with notable publications including the Declarations of Geneva and Helsinki. With the Medical ethics manual, the WMA turns its attention to the practical ethical issues facing medical students and physicians. Despite its brevity, the Manual presents a fair introduction to medical ethics together with an argument for its inclusion in medical education. Three core values of compassion, competence and autonomy are identified in the first chapter, reflecting a general shift away from the “four principles” approach in medical ethics. Interestingly, the value of “autonomy” described here refers to both physician and patient autonomy. The three central chapters describe physicians’ relationships with patients, society and colleagues, respectively. The chapter on patients contains standard medical ethics fare: confidentiality, informed consent, incompetent patients, and issues at the beginning and end of life. Euthanasia and assisted suicide are condemned as unethical, while abortion is left to “individual conviction and conscience”. The chapters on society and colleagues discuss a range of issues including resource allocation, public and global health and the evolving role of doctors in the health care team. The international orientation of the WMA is reflected in sections on human rights, professional duties (such as avoiding participation in torture), and the need for countries to educate their own doctors rather than securing them from less advantaged places. Research ethics are covered in a brief but comprehensive discussion. Each chapter begins with a set of objectives. These are overly ambitious at times (for example, “deal with the ethical issues involved in allocating scarce medical resources”), but will be helpful for teaching, as will the case studies. The appendices contain a somewhat idiosyncratic glossary as well as various resources. The listed Internet resources are disappointing and do not reflect the nature and scope of current web offerings. I enjoyed reading the Manual; this attractively presented, pocket-sized text is a useful introduction to ethics for students. The emphases upon relationships, public health and the global context are particularly welcome. Wendy A Rogers Associate Professor of Medical Ethics and Health Law Flinders University, Adelaide, SA