The Cambridge Medical Ethics Workbook is an introductory
text for students new to the field. As a teacher in this field
for nearly twenty years, I have examined many books with an eye
toward their possible use in a university course. The Cambridge
Medical Ethics Workbook is admirably different than most.
Two kinds of textbooks dominate the field of medical ethics. The
first type includes anthologies that gather together a number
of articles on an array of topics written by professionals in
the field (usually philosophers, lawyers, or physicians) usually
prefaced with an introductory chapter by the editor(s) who outline
for readers the various approaches to philosophical ethics that
have dominated the field in the modern era (deontological approaches,
utilitarianism, virtue ethics, the ethics of care). The second
type includes those that are authored by one expert (or two or
three) that presents his or her (or their) own take on the issues.

Each type has its advantages and disadvantages. The first type
demonstrates the complexity and controversy of the issues by exposing
students to an array of opinions. But this virtue is often offset
by engendering in students’ minds simple confusion or the belief
that there can be no consensus on moral issues, inadvertently
encouraging them to embrace a naïve moral relativism. The
second type can often avoid the weakness of the first by summarizing
issues, making connections, offering coherent analyses, and suggesting
concrete policy proposals. But this is often gained at the expense
of developing just these sorts of critical skills in the students
themselves who quickly come to depend on the author(s) to do the
hard intellectual work for them.

The Cambridge Medical Ethics Workbook represents the rare
alternative that combines the virtues of the first two without
reproducing their weaknesses. As the authors/editors are quick
to point out, this book “is very much a workbook, designed
to help readers think about, reflect upon and to work their own
way through ethical problems, by deliberating on the issues raised
by them either alone or together with others” in order to
“develop skills of independent study and research in ethics”
(xi). The book is divided into three parts of two to four chapters
each, has a useful but sparsely populated glossary, and adds two
interesting appendices, a study guide for teachers and the UK
core curriculum. Part I explores some key ethical themes arising
as a result of recent and ongoing technological developments in
medicine. Chapter 1 concerns issues relating to the withholding
and withdrawing of life-prolonging treatment and other ethical
issues at the end of life. Chapter 2 concerns issues raised by
genetic testing and by the use of genetic information in clinical
practice. Chapter 3 concerns the ethical implications of developments
in reproductive technology. Chapter 4 concerns the ethics of medical
research.

Part II examines four themes which permeate medical ethics: vulnerability,
truth-telling, competence and confidentiality. Chapter 5 concerns
issues that arise in long-term and daily care. Chapter 6 concerns
the ethics of mental health and of the treatment of psychiatric
patients. Chapter 7 concerns the ethics of work with children
and young people. Part III explores some broader ethical issues
relating to healthcare. Chapter 8 concerns the ethical issues
relating to the allocation of healthcare resources, questions
of priority setting and just distribution. Chapter 9 considers
the extent to which we ought to see autonomy and patient choice
as the key measure of whether healthcare provision and treatment
are ethical.

This book does two things not usually found in textbooks in the
field. First, it has a sustained examination of ethical issues
in mental health. Second, each chapter contains in some combination
a general chapter introduction, specific introductions to the
topics covered in each section, real or life-like cases, activities
(questions and writing assignments), and articles (or excerpts)
written by experts in the field.

Let me illustrate this by describing the contents of only one
section of chapter 7 on mental health. The chapter opens with
a brief introduction to the ethical issues likely to emerge in
the area of mental health and it contextualizes a life-like case
about a 90-year-old man suffering form dementia and how he is
treated by staff and physicians. The case ends with the insertion
of an “activity” consisting of several questions prompting
the reader to reflect on what might be problematic in the case
both in terms of clinical and ethical problems. The authors then
discuss some of the key conflicts encountered in the case which
is followed by a brief commentary by a practicing psychiatrist.
This is followed by more thought provoking “activities.”
Then there is a substantial excerpt from an article, “The
Psychiatric Patient’s Right to Self-Determination,” by Maritta
Valimaki and Hans Helenius, interspersed with more “activities”
and followed by a brief commentary by the authors/editors.

The authors’ discussion of the tension between the healthcare
professional’s duty to respect the wishes of his or her patients
and the difficulty in determining just what those wishes are in
cases of psychiatric patients is sensitive, thorough, and clearly
connects these preliminary concerns with important aspects of
ethical theory without over-burdening the reader with philosophical
niceties. Their discussions of consent and involuntary hospitalization,
competence and autonomy, and some of the ethical issues specific
to the mental healthcare of young people and children are similarly
intelligent and clear. What is perhaps most interesting about
this chapter is that several of the article excerpts are written
by practitioners outside of the U.S. (U.K., Netherlands, and Italy,
for example). This is particularly helpful in allowing those of
us situated in one country (or state) to gain some perspective
on and alternatives to current health policy.

A textbook can be judged according to the answers to three questions:
what is the author’s purpose? does that purpose have merit? have
the authors/editors achieved that purpose? According to Parker
and Dickenson, “This workbook is intended to be a flexible
educational resource which will enable those who teach medical
ethics in any of these or any other educational setting to explore
the core themes and issues in the ethics of medicine…and
be engaging for, both medical and nursing students and those healthcare
professionals who wish to develop their skills in this area”
(xii). The authors/editors set out their purpose clearly and the
Cambridge Medical Ethics Workbook achieves this aim admirably.
Does the medical ethics universe need such a text? Undoubtedly.
As I said earlier in this review, this book is a clever and useful
addition to the medical ethics textbook catalog.



© 2001 Ben Mulvey

Ben Mulvey, Ph.D.,
is an Associate Professor of Philosophy and Director of Liberal
Arts at Nova Southeastern University. He received his doctorate
in philosophy from Michigan State University with a specialization
in political theory and applied ethics. He teaches ethics at NSU
and is a member of the board of advisors of the Florida Bioethics
Network.

This review first appeared online Sept 1, 2001

Categories: Philosophical, MentalHealth

Tags: Forensic Psychology