More than 40 Mendelian disorders for which the biochemical basis was not
previously known have been mapped. The case study on cystic fibrosis is
intended to as a model for clinical application. But knowing that a
condition exists is only the first step to determining how to treat it.

The current discussion and debate on policy concerned with mental illness
represents one peak on the tip of the iceberg explored by the 17
contributors to Gene Mapping. A year ago these geneticists, lawyers,
historians and philosophers participated in a workshop at the Center for
Human Genome Research of the National Institutes of Health in Bethesda,
Maryland. Annas and Elias co-chaired this event and they have also written
four chapters which, when read together with the other contributions, create
their own map of the current contours of social policy in the area of human
genetics.

Throughout the world, scientists are mapping and sequencing the estimated
three billion base pairs of the human genome. One application of this
knowledge could include medical manipulation of genetic bases for mental
illness. While the means to cure some conditions may take years to develop,
identification of genetic markers can lead to early treatment.

Specific social policy issues arising from the map of the human genome are
examined. Implications can be drawn from the not too distant past of the
potential for discrimination arising from any foray into eugenics. At the
same time an elite demand for designer babies can already be met to some
extent by aborting unwanted fetuses. Does access to the prevention of human
tragedy justify the possibility of misuse? Consider a DNA database for the
purpose of law enforcement identification. There is concern that such a
programme is on the brink of a ‘slippery slope’ – where the inclusion of
disease markers results in false inference of a connection between physical
conditions and antisocial behaviour.

There are several manifestations of the slippery slope in law as well as
ethics. The fundamental question is: If x is permitted what is to prevent y
being done? All along the route critics will protest that the next action
cannot be undertaken without ‘playing God’. Yet who is to decide when gene
therapy crosses ‘a symbolic barrier beyond which medicine and mankind become
involved not in treating disease . . . when we extend our notions of gene
therapy towards enhancement genetic engineering?’. This volume warns us of
the pitfalls.

The contents of this book are often very technical and there is a necessary
glossary of nearly two dozen acronyms. Yet the narrative of scientific
discovery is placed in the context of ‘real problems affecting real people,
without abandoning our concern for broader social policies and fundamental
philosophical questions’. A gene for schizophrenia has not yet been mapped.
When it is, this book will need to guide our policy towards afflicted
persons.

Pat Hagggard has recently worked with a district health authority to develop
a code of ethics.

The perfect gestation and an old age that is alert and comfortable are goals
for which medical science strives, encouraged and driven by all of us. If
these ideals cannot be attained, at least we may have the means to choose
some outcomes: the defective fetus can be aborted, the respirator can be
turned off. I believe that the title of this book is a paraphrase intended
as a political comment on the preoccupation of today’s society with issues
concerning death. Medical technology has developed clinical techniques
beyond anything imagined a few decades ago. Yet successful application of
the new skills has brought expectations that are inevitably frustrated.

In his absorbing and readable exploration, Ronald Dworkin does not attempt
to reconcile any of the factions in the ongoing argument about abortion and
euthanasia. He covers clearly and sympathetically the history of the liberal
positions as well as the conservative one, but repeatedly points out that
the quality of an individual life is not and should not be a political
issue. Ethics is about the person, politics about the group.

Dworkin argues that it is our own dignity, a respect for the inherent value
of our own lives, that lies at the heart of the issue, saying: ‘We
intensely care what other people do about abortion and euthanasia, and with
good reason, because those decisions express a view about the intrinsic
value of all life and therefore bear on our own dignity as well.’

If that dignity is somehow frustrated, however, by illness or disability,
our view invariably alters. If our mobility or our abil-ity to sustain
concentration is diminished we experience frustration that is unrelated
to any pain the body suf-fers. Other persons may be frustrated in their
efforts to assist us.

So, at the centre of his discussion of the value of life, Dworkin uses the
word ‘frustration’, although he admits that the word has other
associations, to describe this more complex measure of the waste of life
because, he says: ‘I can think of no better word to suggest the combination
of past and future assessment of a tragic death.’ The richness of this
notion is compelling, and Dworkin leads us ever deeper in reflecting on
frustration as an element of the ethical concern with ending life.

Although they constitute a powerful political issue, the formal questions of
the sanctity of or the right to life for all human persons are perhaps
unanswerable. Examining the quality of an individual life in terms of
expectations and opportunities that are inevitably frustrated focuses on the
dignity of that individual life. Dworkin does not provide a universal
theory of ethical decision making. Rather he assures us that ‘we discover
what we think about these grave matters not in advance of having to decide
on particular matters, but in the course of and by making them’. With this
reminder, of course, Dworkin provides a guide to this thinking.

Pat haggard is an ethicist who has just completed a book discussing the
police service’s recent statement of ethical principles.

To expect that the addition of moral philosophy to the medical curriculum
will somehow make the practice of medicine more rigorous is unrealistic.
Or, rather, it is unlikely to achieve the desired effect unless a similar
programme of study is made available to, if not required of, other professionals
including statisticians and politicians.

Although technological development in medical science has been as great
as in any other field in our civilisation, the ethical focus of medicine
has really changed very little. In The New Medicine and the Old Ethics,
Albert Jonsen focuses on the competent pursuit of benefit and avoidance
of harm, compassion and self-sacrifice in the care of the sick, and the
rights of patient access and professional autonomy as three aspects of medicine’s
historical development.

Jonsen’s recurring theme in this book, however, is that in the practice
of the ‘old’ medicine, the individual doctor with individual patient could
afford to have a humanistic touch. But to practise the ‘new’ medicine the
physician must also look to statistical populations.

In the ‘old’ medicine, he explains, ‘almost all the ethical problems
. . . could be resolved within the framework of a relationship between the
professional and the patient’. As an example of the ‘new’ medicine, he quotes
the APACHE (acute physiology and chronic health evaluation) system for admitting
patients to intensive care units, which is based on statistical probability
of survival.

Jonsen points out the contemporary relevance of competence and compassion
in the dilemma of determining patients’ access to intensive care. The technological
‘success’ of sustaining a life must be tempered by the consideration of
the quality of that life. More important, the delivery of health care has
become a responsibility between more persons than simply a physician and
a patient.

The issue appears to become one of allocation of resources. In practice,
however, decision-making is still forced back on the individual physician
while the responsibility for such decisions is not clearly placed. Who shall
live and who shall die may be determined less by medical triage than by
bureaucratic lottery. As a result, the physician must function with an almost
overwhelming degree of ambiguity. Jonsen tells us that this sort of ambiguity
has always been characteristic of medicine.

The conversational style of each of this short book’s eight chapters
makes the breadth of scholarship easy to savour. The material is an expansion
of the Gay Lectures he delivered in 1988 at Harvard Medical School.

From his depth of concern for how persons may live with ambiguity engendered
by new technology, Jonsen reminds us that this conflict is the oldest feature
of the ethics of medicine.

Bridging the chasm that divides the individual patient from society
at large, Jonsen gently suggests that we might develop a stronger and surer
concept of ‘neighbour’. As doyen of the biomedical ethicists, Jonsen does
not propose any new ethical theory, but rather he encourages us to reflect
on the old ethics to enlighten our approach to new problems.

Pat Haggard lectured in ethics in the US. She now teaches medical staff.

To expect that the addition of moral philosophy to the medical curriculum
will somehow make the practice of medicine more rigorous is unrealistic.
It is unlikely to achieve the desired effect unless a similar programme
of study is made available to other professionals such as statisticians
and politicians. However, the study of the humanities, especially philosophy
in an historical context, is not just an ideal, but an idea to be considered.

Although technological development in medical science has been as great
as in any other field, the ethical focus of medicine has really changed
very little. In The New Medicine and the Old Ethics, Albert Jonsen focuses
on the competent pur-suit of benefit and avoidance of harm, compassion and
self-sacrifice in the care of the sick, and patient’s rights of access to
information and professional autonomy as aspects of medicine’s historical
development.

Jonsen’s recurring theme in this book is that in the practice of the
‘old’ medicine the doctor could afford to treat each patient as an individual.
But to practise the ‘new’ medicine the doctor must take a wider, less personal
view, and look at populations rather than a single sufferer.

In the ‘old’ medicine, he explains, ‘almost all the ethical problems
. . . could be resolved within the framework of a relationship between the
professional and the patient’. As an example of the ‘new’ medicine, he quotes
the APACHE (acute physiology and chronic health evaluation) system for admitting
patients to intensive care units, which is based on statistical probability
of survival in the US.

Jonsen points out the dilemma of determining which patients are allowed
access to intensive care. The technological success of sustaining a life
must be tempered by the consideration of the quality of that life.

More important, the delivery of health care is no longer just the responsibility
of the doctor. In antenatal care, for instance, the needs of the many for
minimal health care may limit the supply of the wants of a few for in vitro
fertilisation. Who determines how much is enough: policy-makers or doctors?

The issue appears to become one of allocation of resources. In practice,
however, decision-making is still forced back on the individual doctor while
the responsibility for such decisions is not clearly placed. Who shall live
and who shall die may be determined less by medical triage than by bureaucratic
lottery. As a result, the doctor must function with an almost overwhelming
degree of ambiguity.

Jonsen tells us that this sort of ambiguity has always been a characteristic
of medicine. As an historian, his analysis ranges from medicine’s Hippocratic
origins to contemporary times, even choosing a paraphrase of Sir William
Osler’s The Old Humanities and the New Science as his title.

The conversational yet scholarly style of each of this short book’s
eight chapters makes the breadth of scholarship easy to savour. The material
is an expansion of the Gay Lectures Jonsen delivered in 1988 at Harvard
Medical School. One feels drawn into the collegiality of a lecture endowed
more than 70 years ago to promote medical student education ‘in medical
ethics and business’.

From his depth of concern for how we should cope with the ethical dilemmas
thrown up by new technology, Jonsen reminds us that this conflict is the
oldest feature of the ethics of medicine.

Bridging the chasm that divides the needs of the individual patient
from society at large, Jonsen gently suggests that we might develop a stronger
and surer concept of ‘neighbour’. As doyen of the biomedical ethicists,
Jonsen does not propose any new ethical theory, but rather he encourages
us to reflect on the old ethics to enlighten our approach to new problems.

Pat Haggard lectured in ethics in the US.

The information in this collection of twelve articles by lawyers, journalists
and scholars may cause a reader to ask two questions. Just because a thing
can be done, should it be attempted? And alternatively, if something should
be done, can it be done?

Both questions presuppose that everyone should have access to reproductive
technology. Not surprisingly, seven articles refer to contraception. Women
should be able to control their reproduction, but mostly do not have either
choice or opportunity to exercise this control because of social, religious,
political and other constraints that have nothing to do with the technology.

We have known for more than 20 years that technological means did not
slow down the birth rate, even in the so-called advanced nations. While
medical research into more sophisticated means of population control goes
on, however, another area of research has made it possible for a very few
who seek help in reproducing to succeed. It is this new reproductive technology
that has made women more than ever a component in a machine. So the title
of the book, The Baby Machine, refers to the depersonalisation, if not dehumanising
of women as the biological vessels of reproduction.

Many years ago the anthropologist Margaret Mead attributed the way doctors
increasingly controlled childbirth to the ‘ . . . jealousy of males because
women can make a new life. The male would like to take over himself.’

The two short chapters in this book of anecdotal material concerning
the downside of in vitro fertilisation make one wonder why the demand for
this procedure is increasing. The chances of success are extremely low,
the financial cost is extremely high, while the effect of technological
manipulation on ova and sperm for the resulting human being is relatively
unknown.

Another anecdotal chapter deals with one woman’s experience of agreeing
to become a surrogate mother and then refusing to relinquish the child.
It is the legal rather than the medical profession that will control this
new reproductive technology, which is dealt with in several chapters.

Writers also consider the advances in biological engineering and the
extent to which the choice of a child that is free of inherited defects
can be extended to engineering desirable characteristics. Are the commercial
possibilities here as great as in the use of this technology for livestock?
The two chapters on genetic and reproductive engineering are truly frightening.
It should not happen that genetic engineering and in vitro fertilisation
be used with women from the Third World as surrogate mothers, but the technology
is already here.

The Baby Machine is strongly feminist in the orientation, both politically
and personally, of each of the writers. But just as the material goes beyond
its origins in Australia, so the intentions and concerns of the 10 writers
are for all people, men and women, and perhaps most particularly, unborn
children.

*10 Malden Road, London NW5 3HR.

Pat Haggard lectured in ethics in the US. She is engaged in the discussion
of ethics and the working world.

While some philosophers may focus on one or more other areas of philosophy,
such as metaphysics or epistemology, this fundamental ethical question is
hard to avoid. Even when a philosopher does not label a discussion ‘ethics,’
later students and followers may perceive elements of moral philosophy.
The compilations called the Nicomachean and the Eudemian ethics and the
Politics of Aristotle mark a culmination of the discussion of the classical
Greek philosophers. T. H. Irwin’s Aristotle’s First Principles, is an emminently
readable reference book to the history of the field.

The next 1500 years of philosophical debate on ethics is rich with writers
such as Cicero and Augustine, Thomas Aquinas and Niccolo Machiavelli joining
the discussion. From the 16th century, however, the development of modern
science led to enormous changes in the way in which people lived and how
they thought about how they should live. Philosophers flourished in this
Classical Modern period.

Not all were directly concerned with moral questions, but relevant readings
from 32 philosophers are included in Moral Philosophy from Montaigne to
Kant. More important, with each selection, the editor J. B. Schneewind has
provided a useful introduction, notes, and suggestions for further reading.

Ethics as we attempt to apply them to contemporary life can best be
seen in Ethical Practice in Clinical Medicine. Here, case studies by John
Douard are woven into William Ellos’s extremely well-written text in which
he explains a variety of philosophical principles in the context of medicine.
The value of this book is that these principles are so clearly discussed
that you can see easily how they apply to other areas of society.

Genetically Engineered Organisms has a narrower perspective but the
data J. R. S. Fincham and J. R. Ravetz offer can easily be used as a source
of case studies. Both these books have more than adequate references and
glossary.

David Lamb limits the focus of Organ Transplants and Ethics with a straightforward
exposition of the topic. Any of the essays by Rosemary Rodd in Biology,
Ethics, and Animals would make a valuable starting point for discussion,
but I found the glossary of fewer than 30 items odd.

Environmental ethics is topical and an increasingly popular subject.
Philosophy Gone Wild covers the 20-year interest of Holmes Rolston in a
less philosophical or scientific tone.

One feature of textbooks from the US is that they are generally written
by lecturers who have used, sorted and reused the material, so that it is
fully ‘student tested’ even before the publisher requires the writers to
develop questions for discussion, refine their case studies and write introductions
to each chapter.

Environmental audits are now becoming common among businesses and ethical
audits are the next step. Much of the debate on how we examine or measure
the ethical consequences of different courses of action can be studied usefully
in case studies from business rather than science based courses. In Contemporary
Issues in Business Ethics, J. R. Desjardins and J. J. McCall present their
material as written ‘lectures’ on each topic, followed by articles by other
authors and interspersed with a few case studies. Thomas Donaldson and A.
L. Gini offer more than two dozen Case Studies in Business Ethics in six
chapters, covering topics such as communications, obligations to shareholders,
employer/employee relations and multinationals. The introduction to this
book consists of two excellent essays, one on the application of philosophical
reasoning to business and the other on the use of the case method, a valuable
inclusion for any lecturer setting up a course in business ethics.

The compilers of People in Corporations, George Enderle, B. Almond and
B. Argandona, are from Switzerland, Britain and Spain. The variety of articles
from the European Business Ethics Network conferences reflects this international
collaboration. This is a reference book rather than a textbook, but it deals
with topics including empowering people and the role and responsibility
of top managers.

W. C. Frederick and L. C. Preston collected essays from the US in Business
Ethics: Research Issues and Empirical Studies, discussing such questions
as: Do written codes of ethics deter corporate crime? Is there a gender
difference in the handling of job-related moral conflicts? Can social justice
and efficient hiring practices be simultaneously achieved through employee
testing?

Ethical Decision Making in Everyday Work Situations does not use classical
philosophical approaches. Instead Mary Guy gives an array of 10 ‘core values’
to be considered as spokes in a wheel of ethical decision-making. While
an individual or a group can try to bring as many as possible of these values
to bear on a problem, the absence of general principles is not helpful.

Craig Smith discusses not only consumer ethical purchase behaviour as
social control in Morality and the Market, but also ways of ensuring that
business delivers what is in society’s best interest. One key issue is sex-role
stereotyping in advertising. This book provides expanded case studies as
well as tactics for resolving problems.

Marlene Winfield’s excellent Minding Your Own Business is a valuable
resource for students-and prospective whistle-blowers who need to be warned
that their efforts are rarely appreciated.

Corporate Culture is the overall context in which to move from ‘vicious
cycles to virtuous circles’. Charles Hampden-Turner uses the word ‘culture’
to mean what I understand as ‘ethos’-that environment in which we live-and
‘ethics’-that question of how we live.

Finally, an important resource, though not strictly for student use
is Teaching Business Ethics in the UK, Europe and the USA. The opposing
cases for making ethics either a separate course or a topic to be integrated
throughout the curriculum are explored both in the discussion of business
ethics and the tabulated survey. Jack Mahoney also draws parallels between
business ethics and biomedical ethics and points out that there is, ultimately,
only one ethics.

Pat Haggard lectured in ethics in the US. She is engaged in the discussion
of ethics and working world.

Aristotle’s First Principles by T. H. Irwin, Oxford University Press,
pp 702, £17.50 pbk

Moral Philosophy from Montaigne to Kant: An Anthology by J. B. Schneewind,
Cambridge, 2 vols, pp 664, Volume 1, £30 hbk, 10.95 pbk, Volume 2,
£27.50 hbk, £9.95 pbk

Ethical Practice in Clinical Medicine by William J. Ellos, Routledge,
pp 190, £30 hbk, 224 pp, £8.99 pbk

Genetically Engineered Organisms by J. R. S. Fincham and J. R. Ravetz,
Open University Press, pp 158, £27.50 hbk, £8.99 pbk

Organ Transplants and Ethics by David Lamb, Routledge, pp 162 £25
pbk

Biology, Ethics, and Animals by Rosemary Rodd, Clarendon Press, Oxford,
pp 272, £27.50

Philosophy Gone Wild by Holmes Rolston, III, Prometheus Books, pp 289,
£11.50 hbk, £11.50 pbk

Contemporary Issues in Business Ethics (2nd edition) by J. R. Desjardins
and J. J. McCall, Wadsworth, pp 485, £25 hbk, £22 pbk

Case Studies in Business Ethics (2nd edition) by Thomas Donaldson and
A. R. Gini, Prentice Hall, pp 284, £26.75 pbk

People in Corporations by George Enderle, B. Almond and B. Argandona,
Kluwer, pp 264, £54 hbk

Business Ethics: Research Issues and Empirical Studies by W. C. Frederick
and L. C. Preston, Jai Press, pp 280, $22.50/ £13.50. Tel: 071 833
1778

Ethical Decision Making in Everyday Work Situations by Mary E. Guy,
Quorum Books. British distributor Eurospan, 3 Henrietta Street, Covent Garden,
London WC₂E 8LU, pp 185, £30.95

Morality and the Market by N. Craig Smith, Routledge, pp 351, £12.99

Corporate Culture: From Vicious to Virtuous Circles by Charles Hampden-Turner,
Hutchinson, pp 240, £16.99

Minding Your Own Business by Marlene Winfield, Social Audit, pp 94,
£6.50

Teaching Business Ethics in the UK, Europe and the USA by Jack Mahoney,
Athlone, pp 204, £25