Legal
and Ethical Aspects of Healthcare is authored by United Kingdom
bioethicists, Sheila McLean and John Kenyon Mason.  Overall, the casebook is well-written, thoughtful, and serves as
a useful reference tool on general bioethics principles and concepts.  The breadth of topics and issues in bioethics
range from resource allocation, confidentiality, assisted reproduction,
life/death, and even sex, gender, and the law.    

Readers will immediately identify that the authors
have chosen to pursue a dedicated perspective to the United Kingdom.  Throughout the casebook, the authors
primarily rely on U.K. cases, content, examples, citations, and U.K.
governmental authorities and decisionmakers. 
This reviewer also noticed that the authors’ perspective and analysis
necessarily incorporates an assumption and common reference to universal health
care and regulatory aspects, making the casebook less relevant for U.S. medical
students and/or other individuals with vested interests in the U.S. health care
delivery system.  Additionally, the lack
of supplement U.S. cases or legal decisions, and solitary reliance on U.K.
cases severely limits the scope and outreach of this casebook. 

In general, the case discussions
and narratives are helpful but, as with any casebook, are far too brief and
limited in analysis.  Compared to other
bioethics casebooks or textbooks, one lacking feature of this casebook is
absence of a comprehensive appendix with more detailed case excerpts, analysis,
and possible discussion topics.   The
authors’ approach to a more abstract overview of life, death, and the
associated bioethical aspects (Chapter 12, "Is Life Worth Living")
was both novel and well-presented. 
However, for topics commonly associated with case-specific guidance and
thus topics that require clearly-identified theories and foundations, the
authors focused on generalities and minimal reference to accepted
principles. 

For example, with regard to chapter
3, "The Confidential Relationship," this reviewer generally observed
that the content has limited relevance as the authors’ scope of information is
restricted to the U.K. authorities, cases, and laws.  The lack of reference to, or mention of, U.S. health information
privacy laws governing individuals’ protected health information and
security/integrity of electronic health information, is concerning.  The casebook’s reference point and analysis,
especially a notion of deference to public health basis for disclosing and
breaching patient confidentiality, may be misaligned with contemporary
bioethics.   Additionally, given the
practical realities within the contemporary health care environment, recent
trends indicate that health care systems and stakeholders are moving towards
acceptance, implementation, and utilization of electronic records and
protection of patient health information. 
Thus, the authors’ omission  of
this aspect of confidentiality may create a gap in information for readers of
the casebook, as bioethical inquiry necessarily will need to acknowledge and
address issues such as limits to patient confidentiality, scope of
responsibility for maintaining electronic records, and data and security of
electronic health records. 

Similarly, the authors pursued an
intriguing yet divisive approach to discussion of patient consent and
autonomy.  The authors’ choice of terms
and chapter titles reference the competing aspects, related subjects, and
implications of patient consent and autonomy, however, the casebook never
directly addresses informed consent as a theory, model, or in a cohesive case
analysis.  Moreover, the authors in
Chapter 4, pages 49-50, "The Therapeutic Partnership," the authors
shy away from a glaring opportunity to present a full discussion between the
U.S. trend of "prudent patient" for determining informed consent and
the U.K. trend of "prudent professional standards." 

As a general criticism, the
casebook would certainly have been strengthened if additional supplementary
materials, secondary sources, law review articles, and other journal articles
were referenced, cited, or included in an appendix.  The restrictive scope and intended audience is clearly evident
and limits the practical usefulness and overall appeal to the general bioethics
community.   

©
2005 Kari Karsjens

Kari Karsjens is an
Illinois-licensed attorney, specializing in health care law.  She currently works as an investigator for
the U.S. federal government in the San Francisco regional office, focusing on
civil rights, health policy, and HIPAA compliance.  She may be reached at:  kari.karsjens@hhs.gov.

Categories: Ethics, MentalHealth