Document bBzvyLmK6a52ROXdXEbXGDrE1

Vol. 325 No. 5 BOOK REVIEWS 367 The author himself acknowledges that the extent to which cur rent social values are affected by new technology "will depend in large part on how the issues are presented to the public," and yet he chooses to focus on difficulties and dilemmas out of proportion to the beneficial aspects of these techniques. Nevertheless, the book is a thoughtful and careful analysis of certain reproductive choices. It is especially informative in bringing to light inconsistencies in repro ductive policies from state to state, comparisons of legislative at tempts to resolve newly arising disputes in the context of common law, and issues involved in quality control of reproductive technol ogy, consumer protection, and forms of reproductive technology. It also emphasizes the need for public policy, if for no other reason than as an obligation to future generations. Two interesting and useful appendixes contain a summary of international regulations and laws on reproductive technology and a compendium of related court cases. Too little emphasis is placed on the fact that legal aspects are already overseen by professional associations such as the American College of Obstetricians and Gynecologists, the American Fertility Society, and the Society of Assisted Reproductive Technology. They have promptly formulated guidelines and standards and es tablished a National Registry of IVF Programs to ensure quality control and provide a framework for these new forms of technology to be channeled into socially and ethically acceptable uses. For the interested reader, Regulating Reproduction is a comprehen sive discourse on all aspects of new forms of reproductive technol ogy, including an emphasis on the difficult distinction between mat ters in which private judgment is adequate and matters requiring the force of law. Chicago, IL 60612 Ewa Radwanska, M.D. Rush Presbyterian- St. Luke's Medical Center Ethics and Policy in Scientific Publication Edited by John C. Bailar III and six others. 290 pp. Bethesda, Md., Council of Biology Editors, 1990. $24.95. Can a book written by editors still be a good read? Can a book about ethics without a single ethicist among its authors be useful? The answer is yes to both questions. Here, members of the Council of Biology Editors have responded anonymously to a survey about typical ethical dilemmas that they face. This book has assembled and elaborated on the answers. The respondents were editors, authors, reviewers, or more often, combi nations thereof. The provocative results stimulated a 1988 confer ence during which formal presentations were followed by invited and open discussion. The book is indeed a good read: it is logically organized, well written, and uses effective editorial tricks (boldface type, bullets, tables, and indentations) to enliven the pages. It starts with a de scription of 19 scenarios, including falsification of data, conflicts of interest, bias, and disputes over authorship. Then, for each, it iden tifies issues, lists examples of responses, discusses important ele ments, reaches conclusions, makes recommendations, and ends with a few references and readings. Grosscutting issues and multiple dimensions of ethical issues are highlighted. The last section con tains the proceedings of the conference. The distinguished invited participants are diverse, among them a president and the deans of several research universities, editors, writers, and attorneys. This diversity enriches the book. The book's topics include medical misconduct, statistics, repet itive publication, and peer review. These subjects, coupled with discussions of the scenarios, are the stuff of nightmares, or at least insomnia, for even the strongest editorial souls. They may keep authors awake, too. Consider the fact that book reviewers must use caution lest they be accused of restraint of trade. Some papers have references; most are followed by comments from invited partici pants with a response by the presenter. The give-and-take through out the book emphasizes the complexities of scientific publication during this time of turbulence in the interactions among academe, the public, the media, and funding agencies. Finally, with appro priate editorial compulsiveness, this book furnishes the titles and the responsibilities of the committee members, conference participants, and authors. Could one quibble with this book? Only a bit. It started and ended as a labor of love: only a quarter of those in the Council of Biology Editors returned the questionnaire. There is no hope for statistical significance. One should perhaps not expect hard data on a soft, albeit crucial, subject. Other problems? Some of the papers ramble. Contributions from an ethicist or two might have added depth. Finally, the book does not delve into the darkness. It does not explore the reasons why well-informed authors, and even editors, misbehave. Deliberate misconduct, unreconciled dis putes, and undisclosed conflicts of interest haunt scientific publish ing and threaten the health of the scientific enterprise. What motives, what flaws lead to unethical behavior, and what can we do to prevent and detect it? This subject cries out for study -- and publication. Overall, the book is practical and sensible. The Council of Biol ogy Editors hopes that it will appeal to audiences interested in ethics and science. It should be read by journalism students, science writ ers, the governing bodies of scientific publications, congressional staff members, authors, editors (new and old), and all others inter ested in the way in which scientific information reaches the profes sion and the public. This is a first-rate and thought-provoking book, and it helps round out the literature on a neglected topic. San Francisco, CA 94105 Linda Hawes Clever, M.D. Western Journal of Medicine Euthanasia: Toward an ethical social policy By David C. Thomasma and Glenn C. Graber. 302 pp. New York, Continuum, 1990. $24.95. Drawing the Line: Life, death, and ethical choices in an American hospital By Samuel Gorovitz. 195 pp. New York, Oxford University Press, 1991. $19.95. Two recent books by philosophers address the problem of assert ing selective moral control over the expanding scope of medical technology to prevent death. In the first book, Thomasma and Graber discuss physicians' obli gations to ease human suffering, especially the suffering created by partial medical success -- that is, the postponement of death but the inability to cope with illness. Medicine is a healing art. Some times healing means helping patients bring closure to a life that can no longer be lived purposefully. The principles of medical ethics permit active, direct euthanasia (mercy killing), these authors ar gue, as well as passive and indirect forms. The latter include with holding or removing life-support measures, administering effective pain controls that often hasten death, and assisting patients in sui cide. Yet the authors do not advocate legalizing active or direct measures, at least for now, because of the danger of slipping into Nazi-style abuse and because of possible adverse effects on the image of the physician as friend and healer. For both physicians and the larger society, there is a psychological barrier between killing and allowing to die that we would dissolve at our peril. According to the authors, social policies and professional standards should pro mote therapeutic planning for death, aggressive pain management, and other hospice principles of terminal care to meet the needs of the suffering. This is not a quick technical fix. Instead, it calls for skilled care and human engagement. Unfortunately, these sensible conclusions are reached by a laby rinthine path of flawed argument and exposition. Early allusions to the distinctions between voluntary and involuntary, direct and indi rect, and active and passive are not entirely consistent with their later development. More than once, a disorienting misstatement stops the reader short, as when murder and do-not-resuscitate or- The New England Journal of Medicine as published by New England Journal of Medicine. Downloaded from www.nejm.org at HOUSTON ACADEMY OF MEDICINE on August 5, 2010. For personal use only. No other uses without permission. Copyright 1991 Massachusetts Medical Society. All rights reserved.