Eds Stuart J Youngner, Robert M Arnold, Renie Schapiro

Johns Hopkins University Press,
£45, pp 368
ISBN 0 8018 5985 9

This is an excellent book. The editors have managed to put together contributions from some of the most influential thinkers in biomedical ethics in the United States, and some experts from other countries, making for an engaging and fascinating collection of short articles. For readers unversed in the depth of the debate, some articles may initially seem somewhat difficult, but, by reading the book through, even the less well informed will soon grasp the nature of the debate that has engaged some of these scholars for a considerable time.

The book looks at various aspects of this most vexing subject, including the historical and clinical framework, the interface between the philosophical and the clinical, regulation of and public attitudes to the definition of death, international perspectives, and public policy. It concludes with a consideration of the future.

Much of the book concentrates on the definition of death itself. Should the definition used be that adopted in some US states - namely, the death of the whole brain - or are other tests adequate to countenance acceptance that death has occurred (or, at least, that the process is irrevocably established)? The answer to these questions will, of course, inform both treatment decisions and the use to which the "deceased" body may be put (such as in organ transplantation programmes). There are no simple answers, and this book exposes the extent to which the debate is truly complex by demonstrating the critical differences of opinion between experts.

Admittedly, reading the book requires concentration and a certain amount of knowledge about the ethical and clinical debate, but perseverance is rewarded. If the book is occasionally hard to read, it is not because the writing is anything other than clear, but rather because the ideas themselves are so subtle and complicated. That experts disagree may be discomfiting, but it is also somehow reassuring. This book cautions both implicitly and explicitly against complacency and alerts readers to the immense ethical and clinical concerns about the meaning of death, its definition, and its determination.