Alastair V. Campbell MORAL DILEMMAS IN MEDICINE 3rd Edition New York: Churchill Livingstone Inc., 1984, 179 pages, $9.75
SELECTIVE NONTREATMENT OF HANDICAPPED NEWBORNS New York, Oxford: Oxford University Press, 1984, 292 pages $27.95
Many years ago an obstetrician handed me an anencephalic infant he had just delivered, saying, "You know what to do with this." I was a resident and I knew what he meant, but I had been taught to save lives, not end them. I could not kill that baby. Such situations bring into sharp focus the moral dilemmas we, as physicians, must face as we try to decide what is good for a patient, for a patient's family, and for society. The moral codes we each live by are the distilled product of the behavior and philosophies of our families, our peers, our teachers and our preceptors, superimposed on the mores of our society. Although they serve us well in our daily lives they fail to guide us when, as physicians, we are confronted by some of the moral issues we encounter as we practice medicine today.
The two books listed above may not change a reader's attitude regarding the management of handicapped newborns or of the terminally ill of any age. But they will make the reader think and will help him analyze his own perceptions of what is morally right regarding the ethical issues created by the technological advances in modern medicine. They may also help him when the time comes that he is the one who must decide how one of these issues should be met.
Both of these books are far more important than their titles would imply. Although scienti6c advances have created new problems, and government attempts to interfere in the management of the handicapped newborn are new, the moral dilemmas facing the physician are as old as the aesculapian staff. Even though today's overloaded medical school curriculum has little space for the philosophical aspects of medicine, there should still be a niche for instruction in medical ethics. Weir's text will be of most interest to pediatricians, but Campbell's book, originally written as a course book for physicians and nurses, should be read by every medical student. It could well serve as the basis for much needed instruction in medical ethics either in medical school or during internship. Just as Osier's Aequanimitas was once the bedtime reading of many young physicians so should these two books be found on the doctor's bedside table.
The two books complement each other and should be read together; that by Campbell first, followed by Weir. Both authors are theologians and philosophers; despite the alliance of ethics and religion, neither allows theological dogma to intrude on his presentation of medical ethics.
Based on past experience with philosophical treatises I expected Professor Campbell's monograph on ethical theories applied to moral dilemmas in medicine to be a trifle dull. It is not. Rather, his use of case histories to illuminate situations where doctors or nurses are faced with moral decisions make the book easy to read and interesting. It covers a wide range of subjects and offers not only an insight into such problems as what is best for the common good but also explores the ethical approaches to abortion, the handicapped newborn, terminal illness, death, and organ transplantation. The role of the individual conscience in making ethical decisions is dealt with in a scholarly and sensible manner. The possible conflict between individual conscience and what is morally good and legally permissible is examined.
The text by Weir confines itself to the ethical problems related to the care of the seriously handicapped newborn. It describes in detail the ethical and legal problems related to the medical care of such infants. Like Campbell's book, the liberal use of case histories to illustrate various situations makes it interesting and easily read. Its final three chapters on "Ethical Criteria," "Clinical Application," and "Procedure: Criteria, Options, and Recommendations" are essential reading for pediatricians and should be required reading for all house officers in pediatrics, obstetrics, and family practice.