Absentees in a utilitarian crowd

It would be unwise to let undergraduate medical students, or even trainee philosophers, loose on this volume without a warning. The book might better be labelled Bioethics: A Utilitarian Anthology . Although Helga Kuhse and Peter Singer include some classic articles from outside their preferred utilitarian framework, the text is frequently constructed with the apparent aim of affording consequentialist arguments an easy win: for example, by setting up a Roman Catholic view as a "straw man" for subsequent utilitarian articles to knock down.

Although the introduction begins with trenchant arguments against the subjectivism or cultural relativism to which students often fall prey, it soon betrays its bent. All non-consequentialist schools of ethical thought, from Aristotle to Ricoeur, are lumped together in the claim: "(to suggest) that some things are always wrong, no matter what their consequences, has, for most of western history, been the prevailing approach to morality." This seems to allow ethical consequentialism to appear radical and rule breaking; but, in fact, the anthology is rather conventional.

Beginning with abortion, the sections include reproductive technologies, the new genetics, life and death issues, resource allocation, organ donation, experimentation with human subjects and animals, ethical issues in health-care practice (such as confidentiality and informed consent), special issues facing nurses, and ethicists and ethics committees. Although standard, this list omits four of the 12 topics agreed by lecturers in ethics and law for a national UK core curriculum in medical ethics. The missing subjects are: ethical issues in the treatment of children and young people, psychiatric ethics, vulnerabilities created by the duties of doctors and medical students and human rights. At least one other new textbook includes all 12.

Heavy reliance on utilitarian authors leads to some other oddities that would also require supplementation - particularly in the areas of abortion and new reproductive technologies. There are several articles by Laura Purdy, at the expense of other equally important feminist bioethicists such as Susan Sherwin, Mary Mahowald and Rosemarie Tong. Again, among British bioethicists, it is almost exclusively utilitarians who are represented.

Medical ethics has moved on from the hypothetical cases that dominated the literature in the mid-1970s to a more case-based and narrative-centred approach. Kuhse and Singer's anthology does include some first-person accounts, but little case material, which limits its utility for medical and nursing students. Sometimes the legal references are out of date, as in Purdy's 1989 article on enforced Caesarean sections, which are now banned by both US and UK law. Kuhse and Singer make it plain in their introduction that this is not a medical-law anthology, but one would have expected an editorial note to avoid misleading students. The section on nursing ethics is a useful addition, but the readings are likewise rather old. The section on the new genetics is really about eugenics, saying little or nothing about stem-cell technologies, pre-implantation genetic testing and the other issues that dominate bioethical literature and public policy-making rather than the popular press.

The authors have succeeded, nevertheless, in bringing together many of the most widely cited texts in bioethics: Judith Jarvis Thomson's A Defense of Abortion , Daniel Callahan's condemnation of euthanasia, and sections from influential books by Jonathan Glover, Ronald Dworkin, Richard Titmuss and James Rachels. The limitations of this volume are most serious if students are only assigned one textbook, less serious if this is to be one text among many.

Donna Dickenson is head of the medical ethics unit school of medicine, Imperial College, London.