Ethics and Law in Health Care and Research

Ethics and Law in Health Care and Research

Ethics and Law in Health Care and Research, edited by Peter Byrne. John Wiley & Sons, Chichester, 1990 (ISBN 0 471 2198 7). 192 pages. €25. This book ...

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Ethics and Law in Health Care and Research, edited by Peter Byrne. John Wiley & Sons, Chichester, 1990 (ISBN 0 471 2198 7). 192 pages. €25. This book is the latest in a series stemming from lectures given a t the centre of Medical Law and Ethics at King's College, London. The contributors include both members of the Centre and visiting lecturers, and the topics covered range over a wide spectrum. The first t w o chapters consider clinioal trials. The first, by a professor of surgery, consists largely of a defence of the enterprise of clinical research, and includes an interesting case study of a breast conservation trial. The second, by Sophie Botros, a philosopher, looks at the concept of equipoise (ie the notion that, prior to a trial, the researcher should be genuinely ignorant of the relative efficacy of the treatments under scrutiny). Such a state of uncertainty is a two-edged sword, in that it can equally well be advanced in arguments against clinical trials as it can in their defence. Using consent as a central issue, Botros helpfully combines an analysis of the methodological aspects of clinical trials with an assessment of their ethical implications. A chapter follows which is highly topical, and of likely interest to therapists involved i n neurological rehabilitation. Peter McCullagh considers the ethical ramifications of the transplantation of fetal tissue. This technique has recently been employed in the UK at the Midland Centre for Neurosurgery and Neurology for the treatment of Parkinson's disease, and much of McCullagh's paper consists of criticism of the manner in which early results of the treatment were released by the Centre. This chapter is full of interesting observations, but the author rather overstates his naturalistic claim that 'any assessment of the ethics of the situation is completely dependent upon the specific details of the situation'. Among the remaining chapters in the book, three are of particular interest. Ian Kennedy and Julie Stone present a vigorously argued critique of, as they see it, the haphazard and piecemeal way in which public policy is created in relation to moral issues in medical care. They join Mary Warnock in calling for a permanent national body which would address itself systematically to these issues, rather than the reactive a d hoc responses on the part of the Government and the Courts which characterise current policy-making. They illustrate their argument with revealing analyses of recent cases. In the following chapter, Sarah Spencer, a former general secretary of the National Council for Civil Liberties, considers the implications of AIDS for civil liberties. She effectively refutes many of the confused arguments surrounding such issues as confidentiality and testing. Her basic message is that protecting the rights of those infected with HIV is as much in interests of the non-infected population at large as it is of this specific group. Measures which threaten or discriminate against individuals with HIV are likely to impede the process of containing the spread of the virus - for example, by making those infected reluctant to come forward for treatment. This chapter takes an essentially commonsense view, and delivers its message all the more effectively for that.

In contrast, Peter Byrne's lengthy chapter on homicide and the principle of double effect systematically explores t h e philosophical intracacies surrounding this problematic question. As an alternative to moral absolutism on the one hand, and thoroughgoing consequentialism on the other, he posits a distinction between acts that are intended and those which are done intentionally, as a means of establishing a moral gradation of homicide in medicine. Byrne makes a valuable contribution to the contemporary debate on this issue. This volume is a useful addition to the literature on health care ethics, and is marred only by a very low standard of proof-reading (among lesser oversights, a crucial error occurs on page 136, line 4). It is attractively presented in a hardback format. I would not imagine many physiotherapists will buy personal copies, as it is comparatively expensive for individual purchase. However, I would recommend it strongly for the libraries of educational institutions. JULIUS SIM MSc BA MCSP Physiology for Sportspeople - A serious user's guide to the bady, by Peter G Bursztyn. Manchester University Press, Oxford Road, Manchester M13 9PL, 1990 (ISBN 0 7190 30870). Illus. 278 pages. €9.95. The title of this book might deceive the reader into thinking that it is simply another volume to join the growing ranks of sports and fitness manuals. It correctly aims itself at sports coaches, schoolteachers, students and those interested in physical activity. However, the title and target disguise what is a refreshing and somewhat different look at exercise physiology. The author is an experienced educator in the field of exercise physiology, and his experience in clarifying the subject for students is apparent in the text. This is further bolstered by Peter Jack's cartoons and diagrams, regularly reinforcing the main points which are being made. A key feature is that the book attempts to put these main points into context, so that they are of direct relevance for the reader concerned with exercise and physical performance. The book is divided into appropriate

sections: muscle, metabolism, respiratory physiology, oxygen and carbon dioxide transport, cardiovascular system, temperature regulation, and fluid balance. A later section discusses the physiology and issues of 'adjuncts' to performance, both legal and illegal. The final chapter looks at the extent to which exercise is beneficial. A minor criticism is that, though the text refers at times to studies which support some of the points being made, references are not provided. Considering the breadth of intended readership, this 'omission' is presumably deliberate. The interested reader would undoubtedly have access to more detailed texts, and a suggested additional reading list is provided. This book is recommended for students requiring a clear summary of exercise physiology, as a support t o other texts. It would be a suitable book to recommend to intelligent lay readers, and as a reference for physiotherapists involved in sports medicine. Finally, for those of us who did not fully grasp the finer details of the physiology of the exercising body the 'first time around', it provides a good, well-rounded, and easyto-read summary. MARTIN J WATSON MSc MCSP Aging in the Designed Environment, by Margaret A Christenson MPH OTR, edited by Ellen D Taira. The Haworth Press, 10 Alice Street, Binghamton, New York 13904-1580, USA, 1990 (ISBN 1 56024 031 8). Illus. 133 pages. $19.95.

This small book covers the whole area of environmental design for older people. It incorporates all aspects, such as aesthetics, privacy, security, comfort, furniture design, etc. The principal author is an occupational therapist who had thirty years experience before setting up her own consultancy business in environmental design. The book combines her practical experience with extensive and well-referenced studies. The opening section of the book describes how the senses change as we age and leads on to how the environment can accommodate these changes. Some of the information will be very familiar to therapists, such as the danger of rugs, poor lighting on stairs, the use of contrast in the kitchen, etc. Other sections 1 however, contained fascinating information. One study quoted described how residents exhibited less 'territoriality' towards a particular chair when they had their own private room. The section on 'glare' describes how important this can be on an older person's function. There is even information on how a stereo should be adjusted for a person with high-frequency hearing loss. Unfortunately the presentation of the text is rather dull - there are only three black and white photographs and one table. I felt the book would have benefited enormously from more diagrams, charts, etc, which would have made it more readable. I However, I certainly found it thoughtprovoking and it would be of particular interest to therapists working in residential The cardiovascular system's flow control is homes or in continuing care units. far more sophisticated than that usually I would therefore not recommend it for found in homes. In the giraffe, the heart has personal purchase, but would consider it an to overcome the weight o f a l o f t column of interesting addiition to the library. blood above it. Line illustration from 'Physiology for Sportspeople'



Physiotherapy, September 1991, vol77, no 9