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The United Kingdom and Australia: new titles.

The United Kingdom and Australia: New Titles

The last few years have seen an upsurge of interest in medical ethics outside North America, where the subject is already well established. In 1987, a number of significant publications, reflected this change.

In Britain, a Working Party from the Institute of Medical Ethics produced the "Pond Report" on undergraduate teaching of medical ethics in medical schools. [1] This authoritative document has been widely read and discussed and, although the standards of ethics courses very widely among medical schools, they are now at least accepted as a formal part of the curriculum. These and other initiatives, notably the development of three postgraduate masters degree programs, are described in a symposium on teaching medical ethics teatured in the autumn issue of the Journal of Medical Ethics. [2]

In November the British government published a long-awaited white paper on "Human Fertilisation and Embryology: A Framework for Legislation," following the Warnock Report published in 1984. [3] This document, which willform the basis for a new bill following debate in Parliament, contains two main sets of proposals. The first concerns an independent Statutory Licensing Authority to be set up to control certain types of treatment for infertility where serious ethical issues arise, and human embryo research if it is decided that such research should be made lawful. The second concerns surrogacy; it is proposed that no surrogacy contract should be legally enforceable, although criminal sanctions will not apply to private surrogacy contracts. This document heralds the first wide-ranging piece of legislation in this area in Britain.

The British Medical Association's recent report on euthanasia will be widely considered in Britain and abroad although it contains little that is new and fails to deal satisfactorily with many of the issues that trouble doctors and patients. [4] It considers active euthanasia wrong both morally and legally, but does not present the arguments coherently and dispassionately. Indeed, ethical reasoning seems to be introduced to support particular positions already held. Much of the problem may have arisen because the membership of the working party was composed entirely of medical professionals (apart from observers); this serves to warn even the most prestigious groups working in medical ethics against having too narrow a composition. We can hope that the failure of this report to provide a lead in this contentious area will prove a stimulus to others in tackling the questions that remain unresolved.

In Australia, a major new international journal, Bioethics, was launched in 1987, edited by Helga Kuhse and Peter Singer. It was a year in which the moral issues related to AIDS reached a new height of prominence, so it is not surprising that Bioethics contained two articles on the subject in its first volume. One of them, a review of the ethical and practical issues, came from Finland and revealed the depth of terror the subject engenders. [5] In an otherwise sober and analytic account, as would be expected from philosophers, the authors conclude with what would be regarded as a hysterical statement in almost any other context: "Nuclear holocaust, the main source of fear among people today, will tomorrow look like the only peaceful way out of our misery if governments do not care to stop the triumphant march of AIDS now."

Another significant development is the increasing number of articles on ethical issues appearing in a wide range of nonspecialist journals. An excellent example is a paper in Update (a journal for general practitioners) that explores the ethical complexities of the doctor-patient relationship arising from the case of a young man who requests a vasectomy from his doctor without having consulted his wife. [6] Ethical principles are introduced so as to engage the attention of practitioners who may have no previous formal training in ethics, yet with a considerable degree of sophistication.

In contrast to such materials of direct practical relevance, Reznek's The Nature of Disease is primarily theoretical. [7] It returns to a familiar theme, but one so central to the whole medical enterprise and so pervasive in its ethical implications, that it requires continual reexamination. Reznek provides an excellent review of the field and while some of his conclusions may not be accepted, the following should meet with wide approval:

In spite of the fact that there is no easy solution to the classificatory problems with which we started, this does not mean that there is a carte blanche to call anything we do not like "pathological"....It is because we value the states that we do that we become committed physicians working towards ridding man of certain conditions.

The importance of medical ethics in determining how such judgments should be made is central to the thesis of the book.

Finally, my favorite book of 1987, though not concerned with medical ethics as narrowly defined, is philosophical in the sense of being a critical and reflective enquiry. Glin Bennett, who wrote The Wound and the Doctor, is in the rare if not unique position of having been both a surgeon and a psychiatrist. [8] In a masterful synthesis, he describes doctors' troubles and vagaries at a personal and professional level, and links them to the way that illness has been viewed both historically and within different cultures to reexamine some contemporary preconceptions. He suggests that "the idea that a modern doctor could benefit from being wounded in some way stands rather ironically beside the contemporary image of medical practice." Yet this is exactly what is required if doctors as individuals, and the medical profession as a whole, are to "revision" or look afresh at illness, at their social role, and at themselves. Medical ethics must begin from an understanding of doctors and medicine and this book provides a fascinating and valuable analysis, inspired by and distilled from Bennett's exceptional personal experience.


[1] K.M. Boyd, editor, Sir Desmond Pond, chairman, Report of a Working Party on the Teaching of Medical Ethics (London: IME Publications, 1987).

[2] "Teaching Medical Ethics Symposium," Journal of Medical Ethics 13 (September 1987), 127-59.

[3] "Human Fertilisation and Embryology: A Framework for Legislation," cmnd. 259 (HMSO 1987).

[4] Working Party to Review the British Medical Association's Guidance on Euthanasia, The Euthanasia Report (London: British Medical Association, 1988).

[5] Heta Hayry and Matti Hayry, "AIDS Now," Bioethics 1 (October 1987), 339-56.

[6] A.H. Keller, "Handling a Patient's Unwise Request," Update 36 (February 1, 1988), 1614-17.

[7] Lawrie Reznek, The Nature of Disease (London: Routledge and Kegan Paul Ltd., 1987).

[8] Glin Bennett, The Wound and the Doctor (London: Secker and Warburg, 1987).

David Greaves is director of research at the Centre of Medical Law and Ethics at King's College, University of London, England.
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Title Annotation:Special Supplement: International Perspectives on Biomedical Ethics
Author:Greaves, David
Publication:The Hastings Center Report
Article Type:Bibliography
Date:Aug 1, 1988
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