Ethical Dimensions in the Health Professions.

Purtilo R. Philadelphia, PA 19106, WB Saunders Co, 1999, paperback, 310 pp, $30.

The author states that the purpose of this text is to provide ethical tools for health care professionals to use to build understanding, to resolve problems, and to improve the lot of patients, communities, and themselves. This third edition maintains all of the practical information from the previous editions, books that health care professionals have come to rely on.

The book does not assume previous study of ethics by the reader. It has value as an introduction to the subject for students in the health care professions and as a reference for practitioners. In addition, the author recognizes the increasing frequency of ethical issues that practitioners confront in today's health care system. In response to this situation, the dialogue moves to a higher level where ethical issues are discussed, compared, and analyzed and where it is assumed that health care professionals are gaining exposure and familiarity with the subjects addressed.

The 17 chapters are grouped into 4 sections: (1) "Introduction to Ethical Dimensions in the Health Professions," (2) "Ethical Dimensions in Professional Roles," (3) "Ethical Dimensions of the Professional-Patient Relationship," and (4) "Ethical Dimensions of the Social and Institutional Contexts of Health Care." The subjects include personal integrity issues, peer evaluation, confidentiality, information disclosure, distributive and compensatory justice, end-of-life issues, and informed consent. Issues that reflect the changing roles of health care professionals--including organizational ethics, diversity, cost containment, special populations, and technology--have been added to this edition.

The author uses the term "individual moral agent" to define the health care professional of today and points out the additional role of moral participation in team decisions. She further points out how practice environments affect ethical decision making, and she provides new insight into the proactive role that a health care professional can adopt to contribute to the common good of the broader community.

The author emphasizes a 6-step process of ethical decision making as a conceptual format. Each chapter states the educational objectives and lists new terms. There are questions for discussion at the end of each chapter as well as references pertinent to the chapter's subject matter. Case studies are added throughout the text for application and reinforcement of the concepts they represent.

The major ethical issues that affect health care are included in a straightforward, practical manner. The reader is moved from the basic theories and course of action through higher-level considerations of these complex issues. This book has been, and continues to be, an excellent text for basic ethics. Its consideration of ethics in the context of the current expectations of the practitioner's role has enhanced its usefulness and relevance. It is recommended as a text for both formal and informal ethics courses and as a reference for the practicing health care professional who wishes to understand ethics in the context of health care.

Donna El-Din, PhD, PT Eastern Washington University Cheney, Wash

Dr El-Din is a Distinguished Professor in the Department of Physical Therapy. Her teaching responsibilities include administration, research, evaluation and cultural diversity.