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Principles of Biomedical Ethics

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Book Review PRINCIPLES OF BIOMEDICAL ETHICS Tom L. Beauchamnp and James F. Childress

"You can't tell a book by it's cover." Don't you believe it! Principles of Biomedical Ethics by Beauchamp and Childress is every bit as formidable as it's cover might suggest. That is not to say that the book is poorly written or inadequate in any way. It is just that this reviewer is a student, whose professor, at the end of the course confessed to the class the the text was indeed a demanding work requiring proportional effort on the part of the student. Granting that, it was the best of several texts he had examined.

After setting the stage, in chapter one with a discussion of approaches to ethics, the authors, in chapter two, deliniate in detail, eight classical ethical theories, which form the foundation of the study. Through liberal use of examples, the authors reveal that all theories have both weaknesses as well as strengths and that to rely on one theory to the exclusion of others is indeed a hightly questionable approach to ethical decision making.

In the subsequent six chapters, the authors continue with a wealth of case studies, elaborate on the importance of autonomy, privacy and dangers of paternalism; they discuss the elements of nonmaleficence and beneficence as essential elements in the Hippocratic oath. Distictions are made between killing and letting die. Arguments are made for and against the use of medically administered nutrition and hydration. Balancing prima facie norms to provide treatment and for truth telling are examined and the extenuating circumstances when these seemingly basic tenets may not be appropriate are discussed.

The authors have not dodged the knotty problems of availability of organs for transplantation, rationing of scarce treatments and health care resources, costs of health care or the concepts or theories of justice as they relate to health care. The appendix consists of ten case histories. There is a abundance of footnotes at the end of each chapter sufficient to satisfy the most rigorous student.

This is not a book for the casual reader. But for someone desiring an in depth treatment of current issues in health care from the standpoint of the physician, chaplain or health care administrator, I recommend this book without reservation.

Ernest G. Barr

This is the most recent edition of a first rate textbook on the difficult topic of medical ethics. The authors' approach is neither to attempt to derive a set of guidelines from abstract moral theory nor to be completely empirical in the sense of simply assessing what clinicians and researchers do when dealing with moral issues. The approach of this book is to extract a series of important principles from the best aspects of practice and then to generalize these principles. The 4 basic principles set out by the authors are respect for autonomy, non-maleficience, beneficience, and justice. The book is divided into a series of well written and integrated chapters covering the basic rationale for the authors' approach, each of the principles, professional-patient relations, and concluding with a set of chapters covering basic moral theories and how the authors' approach fits in with moral theory and competing approaches.

This book has many virtues. The basic approach is strong and practical. Each principle and the exposition of each principle is embedded in real clinical moral problems. The authors make the interesting and important point that none of these principles have priority over another and that balances need to be sought between these principles. This book is simultaneously an excellent exposition of a strong approach to medical ethics and useful reference source to clarify thinking. The bibliography is excellent. Some of the chapters, notably the sections on autonomy and those on justice, are outstanding. The quality of writing is clear and the sections are distinguished by clarity of thought. The authors set themselves objective of writing a book that would combine a high level of rigor and would be useful, reaching a mixed audience of physicians, researchers, and others concerned with medical ethics. They have succeeded.

Tom Beauchamp, of Georgetown University, and James Childress, of the University of Virginia, have produced a splendid sixth edition of their classic book on biomedical ethics. Throughout, the authors sensitively discuss real life dilemmas.

Part 1 looks at moral foundations: moral norms, moral character and moral status. Part 2 studies what the authors define as the four key moral principles, general norms of our common morality: respect for autonomy, doing no harm, beneficence and justice. Part 3 examines moral theories and moral justification.

They argue that there is not just one supreme moral value, a single absolute yardstick to solve every ethical problem. They write, "The problems of bioethics are often problems of getting just the right specification or balance of principles. Principles should never be conceived as trumps that allow them alone to determine a right outcome. ... rights, like all principles and rules of obligation, are prima facie (i.e., presumptively) valid claims that sometimes must yield to other claims."

To aid our moral deliberation and decision-making, we need to consider our actions or inactions in regard to dilemmas in the light of each of the principles. "Principles need to be made specific for cases, and case analysis needs illumination from general principles." Putting the four principles of bioethics into practice results in moral behaviour.

The authors argue that respect for autonomy is not necessarily individualistic, rationalist or legalistic. With beneficence, we must take responsibility for our community, competently, compassionately and cooperatively.

The authors argue that justice entails that governments fund health care, as our collective social protection against threats to health. Justice (fairness and equity) and utility (efficiency) are essential to health care systems.

They sum up, "Policies of just access to health care, strategies of efficiency in health care institutions, and global needs for the reduction of health-impairing conditions dwarf in social importance every other issue considered in this book. ... we have proposed that society recognize global rights to health and enforceable rights to a decent minimum of health care within a framework of allocation that incorporates both utilitarian and egalitarian standards."

Having used this volume and its previous editions for over 20 years, the latest edition provides an easier read for those not steeped in traditional, philosophical writing. While emphasizing the importance of the blended principled approach to bioethics (autonomy, non-maleficence, beneficience, justice) the authors in this latest edition invite the reader to a deeper appreciation of the widening diveristy in ethical approaches, including such approaches as the ethics of care. An important read as well as a practical tool for leaders who seek to sharpen their thinking abilities and broaden their knowledge base in the area of health care.

Dr. James Wells, NHA, D.Min
Senior Living Institute
13 Roszel Rd. C120
Princeton, NJ 08540

Why would you buy any other book on biomedical ethics? As a nursing student I struggled to understand all the principles behind biomedical ethics and this was my saving grace! When writing articles for university on ethics I found that slmost every other ethics book or journal article referred to Beauchamp and Childress, often as their main source! If you are interested in learning about biomedical ethics than this is the book for you. This book has helped me understand all the medical principles, beneficience, nonmaleficence and justice. Recently I have been challenged to use these principles and I am proud to say that this book stood me in good stead. Don't get me wrong, it is not easy reading, but it does make you think about autonony, justice, paternalism and much more. Maybe it is this challenge that helps to set all the principles in concrete. You won't forget what you've learnt if this book challenges your thinking process as much as it did mine.

Very useful for anyone interested in Bioethics. Well written and comprehensive.

This text was exactly what I was looking for and it arrived right on time. Thanks!

The book arrived in excellent shape and very quickly as stated in the order summary.The ethics of Beauchamp and Childress(1994) are key to my dissertation research. Thanks

The book is pretty good. Like all medical ethics books though, without a solid professor, most of the theories and "ethics lingo" just sails over your head. Happy Reading.

This book is a classic book for those who`s study the principles of bioethics, because Beauchamp and Childress shows what they think in terms of good medicine and good practice