One of the unique contributions to the book is Littles discussion of the ethics of surgery and the analysis of its five moral domains. These follow the progression of the surgeonpatient relationship through the process of surgery and the patients response to each stage. As Russell Gruen points out in his associated commentary, they help us to understand why surgery cannot be practised as a purely technical exercise. In medicine, which is increasingly technology-dependent, the promotion of humanism in physicians and surgeons must be a strong antidote to the impersonalisation and deprofessionalisation which technology can bring.
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