The provocative essays and cases presented in Choices and Conflicts: Explorations in Health Care Ethics offer a range of topics relevant for both discussion and personal reflection. The subjects are varied, yet address timely and relevant issues in the ethics of health care. Both personal and institutional issues are examined, and the collection of essays reflects different perspectives; patient, family, nurse, physician, society. Situations representing both classic ethical dilemmas as well as perplexities imposed by new technologies and paradigms of financing health care are explored. While many essays deal with concerns that would be expected in such a collection (“Fetal Survival – What Price?”, “Outcomes Research, Cost Containment, and the Fear of Health Care Rationing”, “Ethics and Corporate Culture”), others are surprising and add texture and depth to the compass of health care issues (“Leprosy: a Disease of the Heart” and “Courts, Gender, and the ‘Right to Die’ “).

The essays in Choices and Conflicts are succinct, but substantive. Each raises multiple issues that demonstrate the complexity and uncertainly inherent in addressing ethical dilemmas posed by the gamut of nuanced values intrinsic to a pluralistic society. The extensive bibliographies included with each essay offer a wealth of additional resources for the reader to pursue. The authors present issues with compassion, focus, and personal perspective, yet refrain from pedantry and sanctimoniousness. The result is an invitation to reflection rather than an imperative to accede to theoretical parameters that often define response in the application of ethics to health care realities.

We may not be able to resolve ethical dilemmas or make them go away, but, particularly if our decisions affect others, we must be able to talk about them. “Choices and Conflicts” sets a tone of dignity, caring, and honesty in initiating these discussions. It is an excellent book for Hospital Ethics Committees and students in multiple disciplines: medicine, science, humanities. It can be an invaluable tool to begin a dialog about these delicate issues, to anticipate situations and allow reflection and examination, to identify responses before a crisis. It is also an extremely satisfying book to read quietly; reading the essays feels almost like talking quietly with a wise and reflective friend. Each essay is articulately and thoughtfully developed, reminding us that personal and social morality is not universally consistent, and that the act of seeking answers is both unsettling and comforting.

Peggy Connolly, Ed.D., Illinois Mathematics and Science Academy, Aurora, IL

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