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worth being pointed out. This book will indeed, in thehopes of the editors as well, be read by many.

Adrian HoldereggerFreiburg, Switzerland

Rameix, S.: 1996,Fondements philosophiques del’éthique médicale. Paris: Ellipses. 160 pages. ISBN2-7298-9641-4. Price FF 80.

Strategies to teach ethics to medical students varyfrom practical case discussions and clinical decisionanalyses to theoretical expositions and philosoph-ical introductions. Suzanne Rameix, philosopher andteacher of medical ethics in the medical school ofthe University of Paris XII, has developed an inter-esting and carefully composed book, presenting anelegant combination of philosophical reflections andpractical applications. The book is a nice illustra-tion of her point of view that moral reflection always“hesitates” between the search for general principlesand the study of specific individual cases. The objec-tive of the book is to provide conceptual tools andnecessary information to construct moral judgement.Not only the concepts and theories are discussed butalso their origin, foundation and justification. Thebook leads the readers into several layers of think-ing. Starting with the preliminary question whetherethics can be taught at all, various reasons (e.g. thedemise of ideologies, the reign of instrumental think-ing) are given for rational reflection on values. Thena classification and characterisation of the currentmoral problems in medicine and biology is presented.Here Rameix makes an interesting statement: contraryto the principlist approach in the U.S., moral prob-lems in France are formulated explicitly within theframework of teleological and deontological positions,because moral judgements are related to the anthro-pological question: what is the human being? Thisquestion leads to the first major part of the book: theorigin of ethical theories. Rameix discusses succes-sively: heteronomous morals (Aristotle, Augustin),the discovery of man (Descartes), autonomous morals(Kant, Rousseau), man in question (Marx, Nietzsche,Freud). Theoretical expositions are illustrated withpractical examples. The second major part of the bookfocusses on the contemporary foundation of ethics.The distinction between heteronomy and autonomy,teleology and deontology is presented in new forms.Modern heteronomy theories are discussed: eco-ethics(Jonas), utilitarianism, contextualism (Williams),as well as several types of modern autonomytheories: contractual deontology (Engelhardt), proce-dural deontology (Rawls), deontology of language

(Habermas). The conclusion is that a reconciliation ofthe good and the right, consequences and principles,teleological and deontological positions is necessaryas well as at the same time impossible, as an alwaysunfinished task. However, the book does not stophere, but continues with three extended annexes on thedoctor-patient relationship, issues of resource alloca-tion, and neurobiology vs sociobiology, respectively. Itcontinues with a selection of primary texts of discussedphilosophers and documents. Finally, the book endswith an impressive bibliography. Just before closingthe book, the reader can evaluate his or her develop-ment with an exercise of multiple choice questions.The significance of this book is that it seduces thereader very slowly into major philosophical debatesand fundamental problems without disregarding thepractical relevancy. After completing this very stim-ulating and interesting book, the reader will have amuch better insight into major theoretical discussionsin medical ethics. He has also obtained an excellentoverview of the state of medical ethics teaching inFrance. He or she will have no problem in answer-ing one of the MC questions: what are the principlesof North-American moral reflection? a) principle ofjustice; b) principle of beneficence; c) principle of non-maleficence; d) principle of responsibility; e) principleof autonomy.

Henk ten HaveNijmegen, the Netherlands

Shannon, T.A.: 1997,An Introduction to Bioethics(3rd Ed., Revised and updated). New York: PaulistPress. 189 pages. ISBN: 0-8091-3694-5. Price:US$ 14.95.

In the face of an amazingly rapid development withinthe scientific field of biology and medicine, the ques-tion arises as to how man and society will be protectedagainst ethically questionable consequences. Whereactually are the moral or ethical limits for the controlof researchers in case of unbridled scientific curiosity?Are we allowed to simply realize anything possiblein the field of biomedicine? If there are limits, howare they defined? These are the questions increas-ingly gaining, and with good reason, importance in thepublic discussion, especially as they concern both ourindividual life and the whole of society.

With his third, revised and updated edition entitledAn Introduction to Bioethics, Thomas A. Shannon,professor of religion and social ethics in the Depart-ment of Humanities and Arts at Worcester PolytechnicInstitute, takes account of the increased public interestin bioethical questions. Just as with his earlier editions,

300 SHORT LITERATURE NOTICES

in 1979 and 1987, the author offers his readers an over-view of today’s key concept and issues in bioethics.

The selection of the questions being dealt within the individual chapters answer to those topicsprevailing in the public discussion. In Part I, GeneralIssues, Shannon defines bioethics, deals with therightful role and place of technology, and outlines coreethical themes and moral methods. In Part II, BirthTechnologies, he discusses the ethical dimensionsof abortion, reproductive technologies and prenataldiagnosis. Part III, Death and Dying, includes chapterswith the definition of death, foregoing and with-drawing treatment, euthanasia and physician-assistedsuicide. In Part IV, Specific Problems, Shannon offersinsights to genetic engineering (plants, animals andhuman beings), organ transplantation, research onhuman subjects, and patients’ right and concludes byproposing “a whole earth ethic”.

Its language being transparent and well-under-standable, its presentation of the different ethicalpoints of view being well-balanced and fairlyunbiased, Shannon’s edition with its summarizingquestions and additional recommendations for furtherreading at the end of each chapter presents an idealliterary basis for both the individual analysis of therelevant bioethical questions as well as the teaching ofbioethics at university and school.

Alfred SimonGermany

Skocpol, T.: 1996,Boomerang; Clinton’s HealthCare Reform and the Turn Against Government.NewYork: W.W. Norton & Company. 230 pages. ISBN:0-393-03970-6. Price: $9.95.

The United States is the only industrialized countrywhich lacks universal (or virtually universal) coveragefor health care. Through the history of the twentieth-century there have been many sporadic and generallyhalf-hearted attemps to remedy what many (includingmyself) consider to be a national shame. The latestattempt to create a national health care system was, ofcourse, the Clinton proposal. It shattered in Congressand has not been revised. It is debatable whetherthis specific proposal (which many of us feel wasall too rapidly developed) was really sufficiently wellworked out to deserve adoption. Regardless of that: itseems evident that some sort of universal health-carecoverage is needed.

Theda Skocpol’s book does an excellent and read-able job in reviewing the broad outlines of the Clintonproposal, suggests why it failed and then goes on to

predict that a new proposal which stands a chance ofbeing adopted is not in the cards. Skocpol discussesthe political struggle and the inter- and intraparty diffi-culties which led to the downfall of this proposal.Part of the problem is that in the American systemCongress and President frequently belong to oppositeparties so that a gridlock often occurs. Part of the prob-lem undoubtedly lies in the extreme individualism ofAmerican culture and part of the problem, as Skocpolpoints out lies in the anti-government attitude of theAmerican public, which sees government not as partof the solution but often as a large part of the prob-lem. In a government allegedly of, by and for thepeople such a state of affairs is disturbing. Part ofthe problem, as Navaro has previously pointed out,in addition, may lie in the lack of the type of cohe-sive labour movement built by the socialists in Europe(Soc. Science and Medicine 28, 1989: 887–898). Notonly does this book provide a highly readable analysisof the Clinton programme but it also discusses someof the events since. The current attempt to approachthe problem in an incremental fashion, stopping a leakhere and polishing a joint there as well as the rise ofmanaged care organizations (which many of us feelhave compounded the problem) is briefly discussed.Some criticisms: the book would have done better andhad perhaps been more useful if there had been a morethorough discussion of the problem history and of thevarious prior attempts to provide better access to healthcare. Furthermore, the book neglects proposals foraddressing the problems which have been made. Someof the plans proposed by organizations like the Amer-ican College of Physicians were and perhaps still arenoteworthy. It also would have been useful to provide asketch of health-care systems emphasizing differencesin government administered systems (Great Britain),government supervised systems (Germany) and othermodels. Brief attention should, in this reviewer’s view-point, also have been given to sketching the differencebetween single tiered (everyone has access to the sameand no one can buy more) and multi-tiered (everyonereceives a basic minimum and those who are able canbuy more) type of system. The system in the UnitedStates, some of us claim tongue in cheek, is in factmultiple tiered: however, the lowest tier gets nothingat all!

In summary: this book is the story of the rise andfall of Clinton’s attempt to introduce a health-caresystem throughout the country. It is informative, well-written and highly readable but could, in my opinion,have been strengthened by a more thorough discussionof history and various other world health-care systems.

Erich Loewy, DavisUnited States of America