Abstract
I approached this book with a certain arrogant assumption: what did a Professor of Physiotherapy Studies have to tell doctors, let alone psychiatrists, about ethical decision making bearing in mind his target audience was mainly physiotherapists, speech pathologists and occupational therapists? With all due humility, quite a lot. In nine short, lucid and balanced chapters he covers the essential ethical principles which underlie ethical decisions observing that just as physiology and histology are the foundations of medicine, so moral philosophy performs a similar task in ethics. A pardonable omission is an insufficient appreciation that psychopathology, and psychodynamics, also play a major part. The author makes two fundamental points: medical ethics is a reflective process which involves the whole of society, not just the professions, and it deals with ends as well as means. Moreover, he makes another point, ignored by so many ethicists, that since there is often little time for ethical analysis, an informed mind sensitive to the issues is required whereby virtue informs the decision-making process. The corollary is that Codes of Ethics are not sets of rules but guidelines based on principles of morality which are then related to practical clinical issues.
There are a number of areas which are over-simplified for the purposes of psychiatric practice such as compliance, diagnostic related groups, outcome measures; but since the volume is aimed at the ‘therapy’ profession (as defined above), this is understandable. Indeed, it is remarkable how much of the content can be applied to psychiatric practice, such as the concepts of weak and strong paternalism and the traps of advocacy also weak and strong. And, as ever, the growing pressure of the ethics of resource allocation. Naturally, the examples refer to the book's target professions but most are applicable to psychiatry. The volume is well presented, the references sufficiently broad and the explanatory tables and diagrams good. This work should cause us to recognise that ethics is no profession's monopoly in our multidisciplinary world. Nor is it a guild protective device; society as a whole rightly demands an input.
There are many esoteric tomes on medical and healthcare ethics but few as clear and comprehensive as this modest easily absorbed volume. It is an excellent introduction to the subject for registrars, useful especially to liaison psychiatrists and to any psychiatrist requiring a rapid revision of ethical principles and their application.