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Principles of Biomedical Ethics

It's a keystone medical ethics text, but will the latest edition draw in newcomers to the topic as well as those with an interest?

It's a keystone medical ethics text, but will the latest edition draw in newcomers to the topic as well as those with an interest?

Thirteen years ago, when I joined the panel of examiners for the MRCGP, young doctors knew very little about ethics.

Five years later, most of them had heard of beneficence, non maleficence, autonomy and justice and now most of them understand (at a basic level) what these concepts mean and a few can even quote the names Beauchamp and Childress, whose monumental text has now reached its sixth edition.

At over 400 pages, it is not a quick read and it's not an easy read either though once I realised that it had to be read paragraph by paragraph (and not word by word) I began to appreciate it a bit more.

Thanks to a couple of long plane journeys and nights in hotel rooms, I did actually read it from cover to cover.

For those with an interest in the subject, this is a very important book because Beauchamp and Childress' thinking really has influenced contemporary ethics and their analysis of ethical theories and structures is both detailed and comprehensive.

Those with a lesser interest in the subject could usefully just scan the introduction and conclusion to each chapter, though in doing so they would lose out on the argument and balance that make ethics so interesting.

What, for example, would constitute a valid and generalisable principle of distributive justice?

Beauchamp and Childress propose and examine six such principles: to each person an equal share, to each person according to need, to each person according to effort, to each person according to contribution, to each person according to merit and to each person according to free-market exchange.

So - when the PCT next suggests that a service should be designed to incorporate principles of equity, which one should I choose?

And what is not to like?

Well, I regretted its complete focus on American issues and case histories and, because the authors are champions of their four principles, they take a defensive position in dismissing (albeit after argument) the views of other contemporary ethicists.

They also sometimes make definitive statements about what is right and what is wrong, which made me really uncomfortable.

So, on balance, is this a book that you should buy for your library?

No if you are looking for an introduction to the subject, but Yes if you like a big read and want to learn more than the accessible texts offer.

And Yes also if you want an authoritative reference source to take you further into a fascinating subject.

Dr James Heathcote

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