This comprehensive and authoritative survey of philosophy was first published in 1998, when Peter Singer was a central figure at the Centre for Human Bioethics at Monash University (Australia), and just before his controversial appointment at the Princeton University Center for Human Values. Helga Kuhse, who has co-authored with Singer many titles on medical ethics, became Director of the Monash Centre in 1992. Kuhse’s and Singer’s own contribution to this book, though, is limited to a very short historical introduction to the field. The rest of the book comprises 45 specially written essays by a wide selection of scholars, whom present the key issues and concepts in contemporary bioethics.

Although the growth of bioethical discussion and practice has been huge in the last decades, the contents of the book provide a good introduction to the whole of the discipline, from discussions about the relationship between bioethics and law, culture, gender, or religion, to a survey of the different approaches available in ethical theory. Standard philosophical problems such as the mind-body dualism, or the psychological features of being alive, are not devoid of interest for the bioethicist. After all, professional practice faces her with the need to answer tough questions in metaphysics, such as whether a human person is to be identical with its organism (let us think of the famous case of Chang and Eng, the original Siamese twins), or those about what makes possible to think of one’s own continued existence (a question crucial to discussions of brain death, cortical death, or persistent vegetative states).

The central chapters are the devoted to issues involving embryos and fetuses, human reproduction and the “new genetics,” euthanasia and other “life and death issues,” resource allocation in health care (with whole sections devoted to organ donations and AIDS), and issues raised by experimentation, both with animals and humans subjects. This kind of research involves interesting issues such as the “psychologist’s dilemma” described in page 414: if animals are used as a model to study noxious psychological states that are analogous to the same states in humans, why are we morally entitled to produce those states in animals (such as pain, fear, anxiety, addiction, aggression, etc) when we would not be so entitled to produce it in humans? And if the animal state is not analogous to the human state, why create it in the animal?

The last sections of the book are devoted to ethical issues in the practice of health care. This is particularly relevant to mental health, for psychiatrists deal with a number of relatively specialized ethical questions about the care of mentally ill persons, many of which intersect with legal issues: questions about the conditions under which a patient accused of wrongdoing is competent to stand trial, or when a psychiatrist is justified in breaching confidentiality, and when she has a duty to warn the victims of a potentially violent patient. Health workers must also consider the question of when it is justifiable to confine or treat an incompetent patient against his or her expressed wishes -- for instance, with antipsychotic drugs, or less commonly, with electroconvulsive therapy.

The fact that many mentally ill and disabled patients live in long-term care institutions raises many questions of its own, such as the effects of institutionalization on the quality of informed consent. While there is still fierce debate on many of these issues, over the past decades a fairly broad consensus has emerged in the bioethics literature about two questions that are relevant to many incompetent patients: how competence (or decision-making capacity) should be assessed, and how decisions should be made for patients who are incompetent. In one of the final chapters, Carl Elliott outlines the standard approaches to these questions and points out several unsolved problems.

At last, the discussion is directed to special issues facing nurses, teachers, and ethics consultants, providing a critical review of how ethics committees work and how bioethics is being taught. Together with an useful index and directory, and its accompanying volume of classical texts Bioethics: An Anthology, also published by Blackwell in 1999, this book provides an ideal basis for course and committee use in this field, and will be of interest to doctors, therapists, lawyers, journalists, and philosophers alike. Not to forget, of course, patients -- a group we all are likely to join at one time or another.

© 2002 Antonio Casado da Rocha

Antonio Casado da Rocha, Ph.D., teaches Philosophy at the University of the Basque Country, Spain.