Book Review

Your Guide to Bio-Ethics

Bio-ethics is defined as the study of ethical dimensions of medicine and the biological science

Title: Bioethics An Introduction to the History, Methods, and Practice Publisher: Jones & Bartlett Publishers, Inc Format: Textbook Paperback, 545pp Edition: Second edition, 2010 Price: Rs 395

As the book's title suggests, its purpose is to introduce the history of bioethics and its methodologies and techniques for carrying ethical analyses into the various settings in which healthcare is practiced. Should a pregnant mother be allowed to abort her baby at 22 weeks when she discovers that her baby has congenital heart disease incompatible with life? Should a mentally challenged woman with IQ of 12 years old girl be allowed to bear a baby conceived against her wishes? Should an aged with poor chances of survival be allowed to take his/ her own life or to die with assistance of his or her physician? Do we own our own bodies and our lives? If we do own our own bodies, does that give us the right to do whatever we want with them? Isn't it cruel to let people suffer pointlessly? Who should decide that Siamese twins should be separated or not to rescue one sibling or risk life or of both later on? Parents or law? Should cloning be banned or allowed without any restrictions? Should India be allowed to become the outsourcing capital of surrogate motherhood?

Each society faces many such and many more bio-ethical and medico-legal dilemmas every day. These issues existed ever since the existence of medicine and become more complicated with advancement of knowledge and practice of medicine. These complex dilemmas have to be resolved by the best considered opinion of healthcare providers, life sciences and legal experts, policymakers, insurers, patient's relatives and all stakeholders within the realms of the current scientific knowledge, social values and prevailing practices. Above all, should individual's wish be allowed to prevail over or be considered in these testing situations? 'Bioethics- An introduction to the History, Methods and Practice', discusses and delves into many such issues and concerns facing mankind.

Bio-ethics is defined as the study of ethical dimensions of medicine and the biological science. Ethos (Greek) and Mores (Latin) are terms having to do with custom, habit and behavior. Ethics and moral are not synonymous. Morality is about personal values that guide our actions and decisions. An increasing awareness of the need for understanding the ethical issues encountered by the health professionals all over the world has brought the teaching/ learning of medical and bio-ethics as an integral and essential part of medical education. Ethics is a complicated issue as it cuts across social, economical, cultural, moral and spiritual beliefs and practices.

Usually, the self-imposed framework of professional behaviour and code sacred is in medical practice due to the character and complexity of healing and is laid out as general principles of medical practice and duties owed to patient, profession and community. Ethics is the code of behavior accepted voluntarily by the members of a profession as opposed to statutes and regulations imposed by official legislation. Legally, ethical obligations are moral exhortation and fail to convey definitive duties of medical practice, leaving certain situations in gray area or conflict of interest.

The authors accomplish task of providing a solid grounding for biomedical ethics. It not only describes the field of ethics, its theories and their application to biomedical issues through the principles of autonomy, non-malfeasance (not intending to harm), beneficence(intending to do good), and justice, but it also actively engages the debate about the principle-based approach. It is expected that the book will be useful in the teaching/ learning of medical ethics.

This collection of essays is divided into three main parts, each with an introduction by one of the editors. The history part (introduced by Jonsen) looks at moral foundations: moral norms, moral character and moral status, Kantian (human beings were distinctive) vs Utilitarian (morality is a matter of consequences) model and contains 13 essays on such themes as organ transplantation, experimentation, terminating treatment, and bioethics as a discipline; the methods part (introduced by Jecker) studies what the authors define as the four key moral principles, general norms of our common morality: respect for autonomy, doing no harm, beneficence, non-malfeasance and justice and has 15 essays; the practice part (introduced by Pearlman) examines moral theories and moral justification has 16 selections, including bits from state and federal statutes and professional association statements as well as scholarly discussions of ethics committees and ethics consultation. Most of the essays in the first part are indeed classics. Attention to the cultural context of bioethics in the method and the practice parts offer an important addition to bioethics. The essays, as well as the introductions, are mostly lucid, free of unexplained jargon, and comprehensible even to those without much background in philosophy or bioethics.

Putting the four principles of bioethics into practice results in moral behavior, the authors argue that respect for autonomy is not necessarily individualistic, rationalist or legalistic. With beneficence, we must take responsibility for our community, competently, compassionately and cooperatively. The authors advocate that justice entails that Governments fund health care, as our collective social protection against threats to health. Justice (fairness and equity) and utility (efficiency) are essential to healthcare systems. They sum up, "Policies of just access to healthcare, strategies of efficiency in healthcare institutions, and global needs for the reduction of health-impairing conditions dwarf in social importance every other issue considered in this book."

Integrating numerous readings, cases, and abundant pedagogical tools, the book addresses the most provocative and controversial topics in bioethics, including paternalism (philosophy of curtailing the autonomy and responsibilities of dependent patients in supposed best interest) and patient autonomy, truth-telling and confidentiality, informed consent, clinical trials, abortion, assisted reproduction, surrogacy, cloning, genetic testing, gene therapy, embryonic stem-cell dilemmas, euthanasia and physician-assisted suicide, and the just allocation of healthcare resources. Throughout, the authors sensitively discuss real life dilemmas using a number of actual cases to illuminate and to test their theory, method, and framework of principles.

An area where newer ethical guidelines have emerged in a big way in India and abroad, are drug trials and human experimentation. It is expected that quantum jumps will be visible in the field of human experimentation, especially in clinical trials of drugs developed in the county and abroad. With the unraveling of human genome, various issues in genetics will have to be addressed. These will include gene therapy for correction of genetic disorders. A related area which has been exercising the minds of those involved in ethics has been the prenatal diagnostic techniques. Concern is expressed on sex selection and selective abortion of female foetus. Ethical issues have been raised by transplantation of organs, especially of kidney from live, unrelated donors, due to commercialisation of the process and exploitation of the poor.

This book is well suited for advanced undergraduate and graduate students who plan to pursue careers in ethics and healthcare. It is also a useful resource and a comprehensive reference for life sciences professionals and those entering the field of biomedical ethics from other disciplines, clinical or non-clinical. Established practitioners in the field will welcome it as a valuable contribution to the debate of the principle-based approach. The new millennium needs a new ethical perspective. In new era, the code of ethics should be practical, transparent, contemporary and capable of being observed.

Reviewed by Gp Capt (Dr) Sanjeev Sood, healthcare manager and hospital administrator in IAF, Jodhpur.