Philosophical Medical Ethics
Raanan Gillon
John Wiley and Sons, £22.95
ISBN 0 471 91222 0
Rating: 3/4
The media have not been kind to the
medical profession lately. The General Medical Council and BMA
students have been quick to issue guidelines
on ethical matters ranging from cheating at
exams to euthanasia. Deluged from all sides
by corporate condemnation and prescriptive guidance it is difficult to know what to
read, and what it means, or where lofty
guidelines meet real life. What should have
been done does not always bear much
resemblance to what was done. The core fact
emerging from this whirlwind of papers and
handbooks is that we must always be
prepared to justify ourselves.
Raanan Gillon's Philosophical Medical
Ethics was initially written as a series of articles in the BMJ, taking core principles from
ethics and relating them to medical cases
that had arisen in the media. An example is
Baby Pearson, the handicapped neonate
who was prescribed dihydrocodeine and
nursing care, and "allowed to die." "Why?" is
the question that every practitioner must be
prepared to answer.
This slim volume is regarded as something of a blockbuster in its field. It does not
pretend to give answers, but in nonpartisan
fashion Gillon takes us through some of the
questions that we should be asking
ourselves - for example, "In whose best
interests am I acting?" It breaks the issues
down to four core principles: beneficence
(do good), nonmaleficence (do no harm),
autonomy (the right of self determination),
and justice (including rationing).
What is most enjoyable about Philosophical Medical Ethics is that it does not require
great intelligence to read, nor is it patronis
ing. The philosophical core is not neglected
either (hence the title). Taking, for example,
the critical concept of "person hood," Gillon
asks us, when confronted with an alien from
another planet, what would make the difference between our inviting it to dinner or
having it for dinner? However the emphasis
is not real life. The book might be cynically
titled Premillennial Ethics because the cases
arose in the latter decades of the last century,
but this counts in its favour. There's a slim
possibility that when we qualify we will have
to make decisions concerning new space age
treatments and research, but the majority of
issues involved will be those of the last
century, and even cloning involves concepts
such as "the sanctity of life," "best interests,"
etc. The only drawback is that, despite many
reprints, this book remains unrevised, and
priced at the upper range of what a student
might pay at £23.
With a title like Philosophical Medical Ethics it is easy to imagine a turgid multivolume
epic of rational discourse, which no medical
student can ever hope to read, and much
less understand. This is not the case. Raanan
Gillon wrote this book for a group of people
with a shorter attention span than medical
students-namely, doctors. This is a book
that should be referred to but also deserves
to be read.
Andrew N Papanikitas, fourth year medical student, Guy's,King's, and St Thomas's Hospital
Email: email
studentBMJ 2001;09:171-216 June ISSN 0966-6494
