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Gurcharan S Rai
163 pp Price £19.95 ISBN 1-85775-851-X (p/b)
Abingdon: Radcliffe Medical Press.
In most specialties healthcare professionals are treating increasing numbers of elderly patients. Often the management decisions go far beyond diagnosis and treatment, demanding a knowledge of ethics as well as the law. The publication of an updated edition of Medical Ethics and the Elderly is particularly timely in view of developments such as the Human Rights Act 1998, the draft bill on mental incapacity and new guidelines on cardiopulmonary resuscitation. It begins with the obligatory chapters on principles of ethics, confidentiality, consent and mental incapacity, and these form the basis for the discussion of ethical issues in clinical work. Most of the chapters, indeed, deal with specific difficulties commonly encountered in the management of older patients. Chapters on stroke and dementia are very comprehensive and offer guidance on many of the clinical dilemmas that arise in treatment of these common conditions. Other particularly noteworthy chapters are those on life-sustaining therapy, cardiopulmonary resuscitation, advance directives and achieving a good death.
The style and layout is user-friendly. Most chapters can be read in isolation, allowing the reader to dip into an area of interest; key points at the end of every chapter highlight what is to be learned. All difficult ethical decisions must be taken within the legal boundaries, and many chapters include useful summaries of the law of the land. Where opinions differ—for example, on the matter of achieving a good death—the various points of view are sensitively and fairly described. This impartial approach will help clinicians to understand points of view different from their own. Some chapters include algorithms that allow for those difficult circumstances where personal opinions (including those of relatives), ethical issues and legalities must all be taken into account. Particularly useful are those relating to initiation of feeding, cardiopulmonary resuscitation and life-sustaining treatment. If there is room for improvement, it is in the discussion of some of the illustrative cases—too simplistic in my opinion.
Medical Ethics and the Elderly will appeal primarily to professionals working in general and geriatric medicine, though much of it is of general interest. Examination candidates may well find it useful, now that ethics is being included in undergraduate and postgraduate curricula. I personally found the book informative and enjoyable, and will be keeping it handy for reference.