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Emerg Med J. 2007 June; 24(6): 450–451.
PMCID: PMC2658301

Making Sense of Medical Ethics

Reviewed by Bernard A Foëx

Edited by Alan G Johnson, Paul R V Johnson. London: Published by Hodder Arnold, 2007, $29.95, pp 222.

Don't know your “Deontology” from your “Consequentialism”? Well, don't panic. Making sense of medical ethics by the late Alan Johnson and his son Paul will clear that up for you. And much else besides.

This pocket‐sized book, described as “a hands‐on guide”, is written by two clinicians: surgeons, as it happens. It seems to be aimed, fairly, at the beginner.

The book is divided into three parts. The first six, introductory, chapters are especially rewarding as they provide a clear summary of general principles and a pithy dispelling of some ethical myths and misunderstandings. It is also here that you will find an excellent explanation of deontology, consequentialism (teleology), virtue ethics and subjective individual ethics. You will also be guided through the various religious and non‐religious value systems, which form the moral basis of medical ethics. The chapter on “Ethics in conflict” alludes to such contemporary issues as whistle blowing, government targets, Jehovah's Witnesses and the case of Charlotte Wyatt. Although the authors, very reasonably, make no attempt to examine the history or development of medical ethics, to write that, “This document (The Hippocratic Oath) stood in splendid isolation for hundreds of years until the atrocities of Nazi Germany in the 1940s … led to the modern spate of declarations and codes.” is stretching things. Thomas Percival's Medical ethics published in 1803, and which had an impact in both Britain and North America, may not merit a mention, but at least makes the statement untenable. Apart from that, these chapters alone make the book worth reading.

The middle part covers the core areas: autonomy and consent, beneficence, confidentiality, justice and fairness, truth and integrity, which can be found in most books on ethics. The chapter on autonomy and consent is perhaps the weakest of these. Although capacity is an essential prerequisite for informed consent, no attempt is made to define capacity or how it might be assessed. Having said that, it contains several gems, including a clear exposition of why we should not refer to patients as “clients”.

The word patient comes from a Latin word meaning “to suffer” whereas client comes from a word meaning “a person who is dependent on others' patronage”.

The authors remind us that even in an age of increasing patient autonomy, many patients put their trust in us as professionals to guide them to the right decision. After all, we fly to our holiday destinations without being told about all the risks involved: we trust the pilot and the crew to get us there safely. And that is a perfectly reasonable way to behave.

The final chapters tackle the practical difficulties in applying these principles. Here, the authors present the fact that, in a given situation, ethical principles may be in conflict. By forming “ethical pathways”, the authors suggest, an ethical solution appropriate to the patient may be found. The book concludes with an “Ethics survival guide for medical students”, and a chapter on “What makes an ethical doctor?”.

The layout of the book makes it very accessible. The text is broken down by the use of multiple subheadings, summary boxes, clinical scenarios and occasional quotations. Each chapter ends with a summary box of bullet points. The wonders of modern publishing mean that the authors have managed to include some of the important events from 2006, if only sketchily. Unfortunately, this excellent little book is let down by a large number of irritating typographical errors. A second edition deserves thorough proof‐reading.

If you have never considered reading a book about medical ethics, this would be a good one to start with. Even if you have read others, there is plenty in this one for it to make a useful addition to your collection.


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