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The journal of the Institute of Medical EthicsThe Jrournal of Medical Ethics was established in 1975, with a multidisciplinary editorial board, to promote the study ofcontemporary medico-moral problems. The editorial board has as its aims the encouragement of a high academic stan-dard for this ever-developing subject and the enhancement of professional and public discussion. The journal is publishedquarterly and includes papers on all aspects of health care ethics, analyses ethical concepts and theories and features caseconferences and comment on clinical practice. Intermittent series focus on the Teaching of medical ethics; on themedico-moral problems directly experienced by health care workers (At the coalface); on the pursuit of argumentsprompted by papers in the journal (Debate); on medical ethics in literature (Medical ethics and literature); and onbriefly argued often unorthodox opinions related to medical ethics (Point of view). The journal also contains bookreviews and letters.

Editorial BoardEDITOR:Raanan Gillon, BA (PHILOSOPHY), MB, BS, FRCP. Director,Imperial College Health Service, Visiting Professor of MedicalEthics, St Mary's Hospital Medical School/Imperial College,London University.

CONSULTING EDITORS:Sir Douglas Black, Emeritus Professor of Medicine, ManchesterUniversity.Robin Downie, Professor of Moral Philosophy, GlasgowUniversity.

EDITORIAI BOARD:Thomas Oppe, Chairman: Emeritus Professor of Paediatrics, StMary's Hospital Medical School, London.KM Boyd, Scottish Director and Research Director, Instituteof Medical Ethics, Edinburgh.Alastair Campbell, Professor of Biomedical Ethics, OtagoUniversity Medical School, New Zealand.A W Clare, Professor of Psychiatry and Medical Director, StPatrick's Hospital, Dublin.C M Fletcher, Emeritus Professor of Clinical Epidemiology,London University.John Haldane, Director, Centre for Philosophy and PublicAffairs, University of St Andrews.R M Hare, Professor of Moral Philosophy, University ofFlorida, Gainesville, USA.Roger Higgs, Case conference editor, General Practitioner andProfessor of General Practice Studies, King's College School ofMedicine and Dentistry, London.Margot Jfefferys, Emeritus Professor of Medical Sociology,University of London.

Ian Kennedy, Professor of Medical Law and Ethics, King'sCollege, London University.Sir Malcolm Macnaughton, Professor of Obstetrics andGynaecology, Glasgow University.David Paterson, Executive Producer, Science and Features,BBC Television, London.Sir Martin Roth, Emeritus Professor of Psychiatry, Cambridge.Robert Sells, Director, Renal Transplant Unit, Liverpool RoyalInfirmary, Liverpool.Elliot A Shinebourne, Consultant Paediatric Cardiologist,Brompton Hospital, London.The Very Reverend Edward Shotter, Dean of Rochester (IMEAmulree Fellow).Jenifer Wilson-Barnett, Professor of Nursing Studies, King'sCollege (KQC), London University.

EX OFFICIO:Richard West, Regional Postgraduate Dean, MedicalPostgraduate Department, Bristol University and GeneralSecretary, IMERichard Smith, Editor, British Medical Journal

EDITORIAL ASSOCIATE:Anthony Hope, Leader, Oxford Practice Skills Project, OxfordUniversity Medical School, Oxford

TFCHNICAL EDITOR:Ann Lloyd, London.

EDITORIAL SECRETARY:Maureen Bannatyne, London.

Submitting manuscripts for publication Notice to subscribers

Papers submitted for publication should be sent in quadruplicateto: The Editor, Journal of Medical Ethics, c/o Imperial College ofScience, Technology and Medicine, 14 Prince's Gardens, LondonSW7 1NA. Rejected manuscripts are not returned. Papers shouldbe in double-spaced typewriting on one side of the paper only. Thepreferred maximum length of papers is 3,500 words -absolute maximum 5,500 (including references). A total wordcount (including references) is requested. On a separate sheet somebrief biographical details should be supplied, including the title ofthe author's present post, degrees and/or professional qualifications(if any), and any other relevant information.Two copies of the journal will be sent to authors free of charge

after their papers are published. Offprints of individual papers maybe bought from Yournal of Medical Ethics, BMA House, TavistockSquare, London WC 1H 9JR.

In March 1981 the JME adopted a simplified 'Vancouver style'for references: details are given in various issues, includingDecember 1990. They are also available from the editorial office.The full text of the 'Vancouver Agreement' was published in theBritish Medical Jounial in 1988; volume 296; 401-405. As the'Vancouver style' is incompatible with the long established style ofreferences for legal articles, lawyers should use their own standardstyle, but try to facilitate reference by others. The journal is multi-disciplinary and papers should be in clear jargon-free English,accessible to any intelligent reader.

The Journal of Medical Ethics is published quarterly. The annualsubscription rate is £75.00 for all countries. However, the rate inthe USA for subscribers who order directly from the publishers is$133, payable by cheque or the charge/credit cards listed below.Payment for all other subscriptions may be made by VISA,Mastercard, or American Express or by sterling cheque or draftdrawn on a UK bank. All payments should be made to the BritishMedical Journal. Subscription orders may also be placed with anyleading subscription agent or bookseller. For the convenience ofreaders in the IJSA, orders may be sent to the British MedicalJournal, Box No 560B, Kennebunkport, Maine 04046. All otherorders and enquiries for airmail rates, single copy sales and adver-tising should be sent to British Medical Journal, BMA House,Tavistock Square, London WC 1 H 9JR, United Kingdom.

ISSN 0306-6800

Copyright x 1993 Journal ofMedical Ethics. All Rights Reserved. Nopart of this publication may be reproduced, stored in a retrieval sys-tem, or transmitted, in any form or by any means, electronic,mechanical, photocopying, recording or otherwise, without theprior permission of the Jfountal ofMedical Ethics.

Nairne 199

plans for dissemination and discussion can becarried into effect, we should succeed in enlargingpublic knowledge, and also in promoting the tem-perate climate of understanding that is needed as aresponse to the further scientific advances which lieahead.

Sir Patrick Nairne, GCB, MC is Chairnan of the NuffieldCouncil on Bioethics, was Permanent Secretary to theDepartment ofHealth and Social Securityfrom 1975-1981 andis Chairman of the Institute of Medical Ethics Working Partyon Ethics and AIDS.

References(1) Powell E. Medicine and politics. Tunbridge Wells:

Pitman Medical, 1966, revised 1976.

(2) Wojtas 0. Geneticist slams idea of science to cureall. The Times higher educational supplement 1993 Apr23.

(3) Anonymous. The tiniest transplants. The economist1992 Apr 25: 111.

(4) The Times 1993 Mar 2.(5) Mail on Sunday 1993 May 2.(6) Daily Express 1992 May 12.(7) The Warnock report: Report ofthe committee ofinquiry into

human fertilisation and embryology, chaired by DameMary Wamock, London: HMSO, 1984 (Cmnd 9314).The Polkinghorne report: Review of the guidance on theresearch use offetuses and fetal material, chaired by theRevd John Polkinghome, London: HMSO, 1989 (Cm762).

(8) Highfield R. Why life will never be the same again.Sunday Telegraph magazine 1991 Aug 17: 30-3 1.

News and notes

Philosophical Ethics in Reproductive Medicine

The Third International Conference onPhilosophical Ethics in Reproductive Medicinewill take place at the University of Leeds fromApril 18-21 1994. Invited speakers include:Professor Baruch Brody (USA), ProfessorMargaret Brazier (Manchester), Professor ColinCampbell (Nottingham), Professor HeleenDupuis (Holland), Professor John Harris

(Manchester), Professor Bemdt Kjessler(Sweden), Dr Theresa Marteau (London), andProfessor Zbigniew Szawarski (Poland).

For further information please contact: MrsHilary L Thackray, Department of ContinuingEducation, Continuing Education Building,Springfield Mount, Leeds LS2 9NG.

News and notes

Medical Screening: the Way Forward

Medical Screening provides many opportunitiesfor the prevention of disease and handicap. Whatcan it offer and what are its limitations? Based onseveral case studies, Medical Screening: the WayForward, organised jointly by the BMJ and theJ7ournal of Medical Screening is a one-day confer-ence to be held on 26 January 1994 at the QE2

Conference Centre, London to examine themedical, scientific, ethical, social, psychologicaland economic aspects of screening.

For more information contact: Pru Walters,BMA Conference Unit, BMA House, TavistockSquare, London WC 1H 9JR. Telephone: 071383 6605. Fax: 071 383 6400.

Johannes M van Delden, Paul J van der Maas, Loes Pijnenborg, Caspar WN Looman 205

(2) Aarons E J, Beeching N J. Survey of 'Do not resusci-tate' orders in a district general hospital. Britishmedical journal 1991; 303: 1504-1506.

(3) Stewart K, Abel K, Rai G S. Resuscitation decisionsin a general hospital. British medical journal 1990;300: 785.

(4) Asplund K, Britton M. Do Not Resuscitate orders inSwedish medical wards. fournal of internal nmedicine1990; 228: 139-145.

(5) van der Maas P J, van Delden J J M, Pijnenborg L,Looman C W N. Euthanasia and other MedicalDecisions concerning the End of Life. Lancet 1991;338: 669-674.

(6) van der Maas P J, van Delden J J M, Pijnenborg L.Medical Decisions concerning the End of Life.Amsterdam: Elsevier Science Publishers, 1992.

(7) Central Bureau of Statistics. The end of life in medicalpractice. Voorburg: CBS, 1992.

(8) Office of Technology Assessment (OTA). Life-sustaininig technologies and the elderly. Washington:Office of Technology Assessment, 1987.

(9) SIG. Hospitals 1990 yearbook. (in Dutch) Utrecht:SIG, 1991.

(10) Uhlmann R F, McDonald W J, Inui T S.Epidemiology of No-code orders in an academic hos-pital. Western journal of nmedicine 1984; 140: 114-116.

(11) Lo B, Saika G, Strull W, Thomas E, Showstack J. 'DoNot Resuscitate decisions'. A prospective study atthree teaching hospitals. Archives of internal medicine1985; 145: 1115-1117.

(12) Lipton H L. Do Not Resuscitate decisions in acommunity hospital. Journal of the American MedicalAssociation 1986; 256: 1164-1169.

(13) Schwartz D A, Reilly P. The choice not to be resusci-tated. 3rournal of the Anmerican Geriatric Society 1986;34: 807-811.

(14) Stolman C J, Gregory J J, Dunn D, Ripley B.Evaluation of the Do Not Resuscitate orders at acommunity hospital. Archives of internal nmedicine1989; 149: 1851-1856.

(15) Evans A L, Brody B A. The Do Not Resuscitate orderin teaching hospitals. J7ournal of the Anierican MedicalAssociation 1985; 253: 2236-2239.

(16) Levy M R, Lambe M E, Shear C L. Do NotResuscitate orders in a county hospital. Westernljour-nal of nmedicine 1984; 140: 111-113.

(17) Jonsson P V, McNamee M, Campion E W. The 'DoNot Resuscitate' order. A profile of its changing use.Archives of intenial nmedicine 1988; 148: 2373-2375.

(18) Gleeson K, Wise S. The Do Not Resuscitate order.Still too little too late. Archives of internal nmedicine1990; 150: 1057-1060.

(19) Bedell S E, Pell D, Maher P L, Cleary P D. Do NotResuscitate orders for critically ill patients in the hos-pital. Journal of the Amnerican Medical Association1986; 256: 223-227.

(20) Schneiderman L J, Jecker N S, Jonsen A R. Medicalfutility: its meaning and ethical implications. Annalsof internal medicinle 1990; 112: 949-954.

(21) Doukas D J, McCullough L B. The values history. Theevaluation of the patient's values and advance direc-tives. J7ournal offanmily practice 199 1; 32: 145-153.

(22) Stanley J M. The Appleton International Conference:developing guidelines for decisions to forgo life-prolonging medical treatment. Journal of nmedicalethics 1992; 18: suppl: 1-22.

Cohen and Williamson v Gillon and BMA

In Volume 17 (1991) of the Journal of MedicalEthics we published an editorial entitledPhilosophy and the Teaching of Health CareEthics, written by the Editor, Raanan Gillon. Inthat article he expressed personal views about thedispute at the University College of Swansea(University of Wales) involving the Centre for theStudy of Philosophy and Health Care and thePhilosophy Department. In one sentence Dr

Gillon used the word 'scurrilous' to qualify theabuse which had been directed to certain mem-bers of staff.We have been asked to point out lest any

reader should have thought otherwise that the useof the word 'scurrilous' was not intended to con-vey a meaning that 'obscene abuse' had beenuttered as opposed to the view of Dr Gillon thatabuse had been on occasion 'grossly offensive'.

210 Autonomy and the akratic patient

rational choice rather than just choice? Insofar asthe notion of autonomy is unclear so of course isthat of respect for autonomy. If autonomy trackschoice then respect for autonomy becomes Brody'sprinciple of consumer sovereignty but it is nolonger clear why the consumer has to be aninformed consumer or why his reasons have any-thing at all to do with the matter. If on the otherhand autonomy tracks reasons, respect for Jones'sautonomy requires us to accept his reasoned con-clusion that transfusion is the best thing and ignorehis refusal of it. Ifwe take the second line Jones getsa transfusion; if we take the first he does not. It isunclear to me which of these is required by respectfor his autonomy. I conclude that the notion ofautonomy and the associated principle of respectfor autonomy are not as helpful or illuminating as isoften supposed.

Christopher J McKnight, MA, BPhil, is a Lecturer inPhilosophy in the Department of Philosophy, TheQueen's University of Belfast.

References(1) Hare R M. Freedom and reason. Oxford: OUP, 1963: ch

5.(2) Charlton W. Weakness of will. London: Blackwell, 1988.(3) Wiggins D. Weakness of will, commensurability and

the objects of deliberation and desire. Proceedings of theAristotelian Society 1978-79: 251-277.

(4) Davidson D. Essays on actions and events. Oxford:OUP, 1980: 29.

(5) Brody B. Life and death decision making. Oxford: OUP,1988: 101-102.

(6) See reference (5): 102.(7) See reference (5): 115-118.(8) Gillon R. Philosophical medical ethics. Chichester:

Wiley, 1985: 61.

News and notes

Biomedical periodicals conference

An International Conference on BiomedicalPeriodicals will be held from June 16-18, 1994 inBeijing by the Chinese Medical Association.Any requests for information should be

directed to Dr Jiang Yongmao, Chinese MedicalAssociation, 42 Dongsi Xidajie, Beijing 100710,China. Tel: 5133311 ext 362. Fax: (861)5123754.

News and notes

Fellowship in clinical bioethics

The Department of Bioethics at the ClevelandClinic Foundation invites applications for a one-year bioethics fellowship residency, beginningJuly 1st 1994. The programme has an interdisci-plinary focus and includes academic, clinical andresearch bioethics components.

Each fellowship is tailored to meet individualstrengths, needs and interests. Concentrations inmedical sub-specialties (for example, geriatrics,

infectious disease) are available.Stipend and health care benefits are provided.

Completed applications must be received byJanuary 15th. For information contact: Martin LSmith, STD, Department of Bioethics, P-31Cleveland Clinic Foundation, 9500 EuclidAvenue, Cleveland, Ohio 44195, USA.Telephone: (216) 444-8720.

Louise de Raeve 229

to face increasing questioning of their judgementby nurses. Responding by trying to clarify, ingeneral, the domain of legitimate medical authoritymay not be helpful, for where good collegial rela-tionships already exist between doctors and nurses,such questioning of doctors by nurses and viceversa will be experienced as helpful mutualscrutiny. Where relationships are strained orpeople are simply not used to working together inthis way, such open questioning will probably beexperienced as interfering and unnecessarilyaggressive (4). However, will a generalised clarifi-cation of roles actually help this dynamic? It isperhaps a weakness of May's paper that he writes insuch general terms, without recourse to particularexamples. It may be that these kinds of difficultiesare not best dealt with by prescriptive general state-ments about how people ought to work togetherbut rather by detailed contextual understanding ofwhy particular difficulties occurred. Armed withthis kind of approach, people may well be able to

resolve much for themselves and the rest of us tolearn through example (5).

Louise de Raeve, BA, RGN, is Macmillan Lecturer inNursing Ethics at the Centre For Philosophy and HealthCare, University College ofSwansea, Swansea SA2 8PP.

References(1) Raz J. Practical reasoning. Oxford: Oxford University

Press, 1978: ch IX.(2) UKCC. Exercising accountability, 1989; UKCC Code of

professional conduct, 1992 and UKCC The scope ofprofessional practice, 1992.

(3) Raz J. The morality of freedom. Oxford: ClarendonPress, 1988: 40.

(4) Stein L. The doctor nurse game. In: Dingwall R,McIntosh J eds. Readings in the sociology of nursing.Edinburgh: Churchill Livingstone, 1978.

(5) Pike A W. Moral outrage and moral discourse innurse-physician collaboration. J7ournal of professionalnursing 1991; 7, 6: 351-363.

News and notes

Teaching Research Ethics: a Workshop at Indiana University

Indiana University's Poynter Center for theStudy of Ethics and American Institutions willoffer, annually for the next three years, a work-shop in teaching research ethics to scientists inthe Midwest who train graduate students.The need for explicit training in research ethics

for scientists is widely recognized; mentoring andmodelling ethical behaviour are no longer con-sidered sufficient. Several federal agencies,including the National Institutes of Health (NIH)and the Alcohol, Drug Abuse and Mental HealthAdministration (ADAMHA) now require trainingin the responsible conduct of research as part oftheir National Research Service Awards traininggrants. Many science faculty are eager to includeresearch ethics in their curricula, but their trainingis in science, not in teaching ethics. The PoynterCenter's workshop, entitled 'Teaching ResearchEthics,' will provide the necessary training.The week-long workshop will be conducted in

early summer for twenty to thirty faculty mem-bers drawn from university members of theCommittee for Institutional Co-operation (theBig Ten plus the University of Chicago).The five-day workshop will be followed by a

one-day conference, which will be open to thewider academic community. The conference will

feature a keynote address by a speaker of nationalprominence and panel discussions on a substan-tive issue in research ethics. In years two andthree, alumni/ae of the workshop will report ontheir experiences and progress in incorporatingresearch ethics into their curricula.The workshop has the potential to have a sig-

nificant impact on a number of universities in theMidwest, affecting faculty, students, and theinstitutions as a whole. Faculty participating inthe workshop will be able to design syllabi orcourse units integrating substantive issues inresearch ethics and will gain competence andconfidence in teaching research ethics. Studentsof participating faculty will develop better moralreasoning skills and will be better able to recog-nize and act on ethical issues. Institutions ofparticipating faculty will build a greater commit-ment to, and expertise and history in, incorporat-ing research ethics in science curricula.

For more information: Kenneth D Pimple,PhD, Indiana University, The Poynter Center forthe Study of Ethics and American Institutions,410 North Park Avenue, Bloomington, Indiana47405; Tel: (812) 855-0261; Fax: (812) 855-3315; Bitnet: PIMPLE@INDIANA; Internet:PIMPLE@INDIANA.EDU.

236 Teaching medical ethics: Assessing the clinical ethical competence of undergraduate medical students

BA, BMed (Hons), MPhil, is Clinical Lecturer in theHealth Law and Ethics Programme, Faculty ofMedicine, University ofNewcastle, Australia.

References(1) Boyd K M, ed. Report ofa working party on the teaching

of medical ethics - The Pond report. London: IMEPublications, 1987.

(2) Evans D. Health care ethics: a pattern of learning.J7ournal of medical ethics 1987; 13: 127-131.

(3) Calman K C, Downie R S. Practical problems in theteaching of ethics to medical students. Journal ofmedical ethics 1987; 13: 153-156.

(4) Burling S J, Lumley J S P, McCarthy L S L et al.Review of the teaching of medical ethics in Londonmedical schools. 3ournal of medical ethics 1990; 16:206-209.

(5) Culver C M, Clouser K D, Gert B et al. Basiccurricular goals in medical ethics. New Englandjournal of medicine 1985; 312: 253-256.

(6) Walker R M, Lane L W, Siegler M. Development of ateaching program in clinical medical ethics at theUniversity of Chicago. Academic medicine 1989; 64:723-729.

(7) Seedhouse D F. Health care ethics teaching formedical students. Medical education 1991; 25:230-237.

(8) Mitchell K R, Myser C, Lovat T J. Teaching bioethicsto medical students: The Newcastle experience.Medical education (in press).

(9) Hebert P C, Meslin E M, Dunn E V, Byrne N, ReidS R. Evaluating ethical sensitivity in medicalstudents: using vignettes as an instrument. Journal ofmedical ethics 1990; 16: 141-145.

(10) Health law and ethics strand. Clinical ethics andlaw: introductory document. Newcastle: Faculty ofMedicine, 1992.

(11) Pellegrino E D, Siegler M, Singer P A. Teachingclinical ethics. Journal of clinical ethics 1990; 1, 3:175-180.

(12) Siegler M, Rezler A G, Connell K J. Using simulatedcase studies to evaluate a clinical ethics course forjunior students. Journal of medical education 1982; 57:380-385.

(13) Spooner H J, Haight K R, Emson H E, To T.Assessment of medical students' learning and perfor-mance in an introductory medical ethics course.Teaching and learning in medicine. 1989; 3: 167-170.

(14) Norman G. Can an examination predict competence?The role of recertification in maintenance of compe-tence. Annals of the Royal College of Physicians andSurgeons of Canada 1991; 24: 121-124.

(15) Weatherall D J. Examining undergraduate examina-tions. Lancet 1991; 338: 37-39.

(16) Hebert P C, Meslin E M, Dunn E V. Measuring theethical sensitivity of medical students: a study at theUniversity of Toronto. Journal of medical ethics 1992;18: 142-147.

(17) Miller G E. The assessment of clinical skills, compe-tence, performance. Academic medicine [suppl] 1990;65: 563-568.

(18) Harden R M, Gleeson F A. Assessment for clinicalcompetence using an objective structured clinicalexamination. Medical education 1979; 13: 41-47.

(19) Cohen R. Comprehensive assessment of graduates offoreign medical schools. Annals of the Royal College ofPhysicians and Surgeons ofCanada 1989; 21: 505-509.

(20) Cohen R, Singer P A, Rothman A I, Robb A.Assessing competency to address ethical issues inmedicine. Academic medicine 1991; 66, 1: 14-15.

News and notes

Association for the Advancement of Philosophy and Psychiatry

The Association for the Advancement ofPhilosophy and Psychiatry (AAPP) is dedicatedto philosophical inquiry in psychiatry. TheAAPP aims to enhance the effectiveness of the psy-chiatrist as teacher, researcher, and practitioner byilluminating the philosophical issues embedded inthese activities. The association also aims toencourage philosophical inquiry by making psychi-atric phenomena more accessible to philosophers.The AAPP is now five years old, and is seeking

to expand its membership. In conjunction withthe Royal College of Psychiatrists' philosophygroup, the AAPP will begin publication of a new

journal, Philosophy, Psychiatry, and Psychology(PPP) in 1994. This international joumal, to bepublished by the Johns Hopkins University Press,is singular in its focus on philosophical aspects ofpsychiatry and clinical psychology. The journal isnow seeking manuscript submissions.

Inquiries about both the AAPP and the PPPshould be directed to: Linda Muncy,Administrative Secretary, AAPP, Departmentof Psychiatry, The University of TexasSouthwestern Medical Center, 5323 Harry HinesBlvd, Dallas, TX 75235-9070. Telephone: (214)648-3390.

244 Book reviews

Primarily directed to a nursingaudience, the book has much to offerany reader with an interest in healthcare ethics. A brief imaginative stepwill enable the reader to recognise thecommonalities between nurse-clientethical concerns and those of anyhealth care worker. Similarly thediscussion of the context of ethicalissues between nurses and physicianswould prove a useful resource forboth parties. The position of 'whistle-blowers' and the background to theOregon proposal regarding a rationingsystem for health care are of perti-nence to many health care systemstoday. Whilst of general utility thebook does not ignore the unique con-stellation of factors affecting nursesand the ethical dilemmas this maypose, nor does it fail to recognise, forexample, nurses' care-work. Theseand other special concerns of nursingare seriously addressed.

It was somewhat disappointing tosee that although broader non-individual ethical concerns wereaddressed at the end of the book inexamining policy and resource issues,the thorny issues raised by healthpromotion or the new public healthmovement received only a cursorymention. Only one scenario explicitlyaddresses health promotion and thereaders are invited to analyse this forthemselves. Given the internationalconcern with health promotion andthe emergence of the new publichealth movement, together with thefervour with which many health pro-fessionals are encouraged to partici-pate, this treatment can only bedescribed as wanting. The focus ofhealth promotion and public health onthe population as a whole, and theconcern with probable outcomes makethe area difficult to assess morally andworthy of far greater attention.Though erudite, the book is also

practical. Thus the reader is directedto a rich seam of further reading. Inthe body of the text, for example,practical responses to the scope ofindividual responsibility in situationsof ethical uncertainty are to 'examinethe most alterable possibilities first'.At times the American terminology isan advance, thus 'parentalism' is usedin place of paternalism with its advan-tage of sexual neutrality.The authors see a principal aim of

their book as being to enable nurses tocontribute more effectively to a wide-ranging debate about contemporaryethical issues. In large part they have

achieved their goal admirably whilst atthe same time providing a potentialresource for others with an interest inthe field. One remaining confusion iswhat exactly is it to 'hang out shingles'(page 96!)?

ALISON DINESLecturer, Departmenit of Nursinlg

Studies,King's College,

University of London.

The politics ofpsychiatry inrevolutionary Cuba

Charle Brown and Armando MLago, New Brunswick, USA,Transaction Publishers, 1991, 217pages, $16.20 sc or $27.95 hc

This short book is an impressivelydetailed account of the use of psy-chiatry in Cuba as a means of politicalrepression.

Published by Freedom House, anindependent human rights organisa-tion, it draws on a wide range ofsources, including Amnesty Inter-national, to document the Castroregime's use of electro-shock, psy-chotropic drugs, isolation and physi-cal beatings, against those it regards asdissidents.The historical and political back-

ground to these practices are describedin an introductory section; there is auseful appendix of relevant reports,articles and documents, and an intro-duction by the leading Soviet dissident,Vladimir Bukovsky. But the real heartof the book is a series of case-reports.These are presented in a direct, clinicalstyle which contrasts sharply with theatrocities they describe. The casesspeak for themselves...

Ariel Hidalgo Cuillen, HistoryProfessor: '... I had to stand - not onlybecause of the lack of space, but alsobecause the floor ... was covered withexcrement, saliva, sperm, etc.'

Orestes Martineez Hayden, MedicalStudent: '... forced to accept a rubberbit in (his) mouth and held down on awet floor covered with urine, vomitand excrement ... electrical currentapplied until (he) went into convul-sions...'

Jose Martin1ez Hayden, Truck Dnrver:'... placed in a water tank and givenelectric shock...'

3ruan Peniate Fernandez, Historian:'... forced to watch three times perweek while the orderly, HeribertoModeros, gave electric-shocks to pol-itical dissidents strapped on a wetfloor'...As Bukovsky comments, this is not

the political abuse of psychiatry as itwas practised in the Soviet Union.There is little attempt to justifytorture, to redefine it as treatment.'Diagnoses' are sometimes indicatedbut they are largely redundant. It isenough that the accused is 'danger-ous', a diagnostic concept under thecontrol of State Security.The outrages described in this book

may seem remote from psychiatricpractice in the western democracies.The problems are also closer to home,however. This is evident in theoccasional cause celbre which makesthe headlines. But it is also apparentin the experiences of individualpatients (poignantly described in TheCatch of Hanids (1), for example), and,more generally, in the inadequacies ofcommunity care provisions whichabandon patients to the streets. It isthus not by contrast but byidentification that this book comes asa timely reminder of the vulnerabilityof psychiatry to abuse.

ReferenceLee, B. 7he catch of hands. London:

Virago, 1992.

DR KW M FULFORDResearch Fellow,

Greeni College,Oxford.

Books: information and orders

If you wish to order or require furtherinformation regarding the titlesreviewed here, please write to ortelephone the BMJ Bookshop, POBox 295, London WC1H 9JR. Tel:071 383 6244. Fax: 071 383 6662.Books are supplied post free in theUK and for BFPO addresses.Overseas customers should add 15per cent for postage and packing.Payment can be made by cheque insterling drawn on a UK bank or bycredit card (Mastercard, Visa, orAmerican Express), stating card num-ber, expiry date, and full name. (Theprice and availability are occasionallysubject to revision by the publishers).

Journal of medical ethics 1993; 19: 245

Index by subject matter (thematic review)Journal of Medical Ethics, volume 19, 1993

Editor's NoteThis combined index and thematic review was intro-duced in the hope that it would be more useful toreaders than the old system. In the first part, papersand book reviews are classified using the AmericanNational Reference Center for Bioethics Literature

Library Classification Scheme (the Kennedy sys-tem), which is printed on page 252. In the secondpart authors, reviewers, papers and book reviews arearranged alphabetically, with their Kennedy classifi-cation following.

PAPERS

1.1: Ethics: Philosophical ethics

1993 VOLUME 19/4Autonomy and the akratic patient,McKnight, Christopher J, 206- 10Fdaorial: Autonomy, respect for autonomyand weakness of will, 195-196,Gillon, Raanan

1.2: Ethics: Religious ethics

1993 VOLUME 19/3Ethics of postmortem examinations incontemporary Islam (The), 164-168Rispler-Chaim, Vardit

1.3 Ethics: Applied and professionalethics

1993 VOLUME 19/4Deciding not to resuscitate in Dutchhospitals, 200-205vani Delden, Johannes J M, van der Maas,Paul J, Pignenborg Loes and Looman,Caspar W N

1.3.3: Ethics: Applied and professionalethics: Education

1993 VOLUME 19/37IcahLinlig nediLcal cthir.s: A randomized trialot ethics education for medical houseofficers, 157-163Sulmasy, Daniel P, Geller, Gail, Levine,David M and Faden, Ruth R

1.3.6: Ethics: Applied and professionalethics: International affairs

1993 VOLUME 19/1European Convention ori bioethics (The),13-16Byk, C

Medical ethics in the EuropeanCommunity, 7-12Riis, Povl

1.3.8: Philosophical ethics: Appliedand professional ethics: Law

1993 VOLUME 19/2Appropriate care of the newnborn: ethicaldilemmas, 82-84Dunn, Peter NI

1.3.9: Ethics: Applied and professionalethics: Scientific research

1993 VOLUME 19/4,S'nipsiiulli o)i ethics aid c/limpical t`als:Ethics and statistical methodology inclinical trials, 219-222Palmer, Christopher R

2.1: Bioethics: General

1993 VOLUME 19/1NMedical ethics in the EuropeanCommunits, 7- 12Riis, Povl1993 VOLUME 19/2(Gitest edtoial: Is medical ethics lost? 69-70Hare, R M1993 VOLUMNE 19/3(hicst editorial: Demystifying bioethics: alav perspective, 197-199Nairne, Sir Patrick

2.3: Bioethics: Education/programmes

1993 VOLUME 19/4Teachiling mledical ethics: Assessing theclinical and ethical competence of under-graduate medical students, 230-236Mitchell, Kenneth R, Myser, Catherineand Kerridge, Ian HTeaching mtiedical ethics: A randomized trialof ethics education for medical house

officers, 1 57- 163Sulmasy, Daniel P, Geller, Gail, Levine.Dav id 1M and Faden, Ruth R

4.1.2: Philosophy of medicine andhealth: Philosophy of healthprofessionals: Philosophy of medicine

1993 VOLUME 19/2Appropriate care of the newborn: ethicaldilemmas, 82-84Dunn, Peter MN

4.4: Philosophy of medicine andhealth: Quality/value of life

1993 VOLUME 19/1Relevance of health state after treatment inprioritising betwveen dilfl'ercnt patients,(I'he) 37-42Nord, Erik1993 VOLUME 19/2Appropriate care of the newborn: ethicaldilemmas, 82-84Dunn, Peter NI

5.2: Science/technology and society:Technology assessment

1993 VOLUMIE 19/4Svin}pooni/El (ii ethiiCS aiidi cliiiiLal trails:Nceonatal extracorporeal membraneoxvgenation (ECNO): clinical trials andthe ethics of ev,idence, 2 1 -2 8Ml1ike, Valeric, Krauss, Alfred N and Ross,Gail R

6: Codes of professional ethics

1993 VOLUME 19/1

Fditopnial: Biomedical ethics in Europe - aneed for the POBS?, 3-4Gillon, Raanan

3'ournal of medical ethics, 1993, 19: 246

Guest editorial: International bioethics? Therole of the Council of Europe, 5-6Quintana, Octavi

7.2: Professional-patient relationship:Medical education

1993 VOLUME 19/1Point of view: After ethics and towardsvirtue, 17- 18Toon, Peter D

7.3: Sociology of medicine:Professional-professional relationship

1993 VOLUME 19/4Debate: The nurse under physicianauthority, 223-227May, ThomasDebate: Commentary on the nurse underphysician authority, 228-229de Raeve, Louise

8.1: Professional-patient relationship:General

1993 VOLUME 19/1Medical ethics in the EuropeanCommunity, 7-12Riis, Povl1993 VOLUME 19/2Words: What is wrong with compliance?,108-110Holm, Soren

8.2: Professional-patient relationship:Truth-telling

1993 VOLUME 19/3Editorial: Is there an important moraldistinction for medical ethics between lyingand other forms of deception?, 131-132Gillon, RaananHippocratic contract (The), 154-156Rosalki, JOn the morality of deception - doesmethod matter? A reply to DavidBakhurst, 183- 187Jackson, Jennifer

8.3.2: Professional-patientrelationship: Informed consent:Minors and consent to treatment

1993 VOLUME 19/4Deciding not to resuscitate in Dutchhospitals, 200-205van Delden, Johnannes J M, van der Maas,Paul J, Pignenborg, Loes and Looman,Caspar W N

8.3.4: Professional-patientrelationship: Informed consent: Rightto refuse treatment

1993 VOLUME 19/4Deciding not to resuscitate in Dutchhospitals, 200-205van Delden, Johannes J M, van der Maas,Paul J, Pignenborg, Loes and Looman,Caspar W N

9.2: Health care: Right to health care

1993 VOLUME 19/1

Relevance of health state after treatment inprioritising between different patients,(The) 37-42Nord, Erik

9.4: Health care: Allocation of healthcare resources

1993 VOLUME 19/1Relevance of health state after treatment inprioritising between different patients,(The) 37-42Nord, Erik

9.5.2: Health care: Health careprogrammes for specificdiseases/groups

1993 VOLUME 19/1Debate: A critique of using age to rationhealth care, 19-23Hunt, Roger WDebate: Response to Roger W Hunt, 24-27Callahan, Daniel

9.6: Health care: Quality of healthcare/ethics committees

1993 VOLUME 19/4Symposium on ethics and clinical trials:Clinical trials: two neglected ethical issues,211, 218Herxheimer, Andrew

12.4.4: Abortion: Legal aspects: Bills,laws and cases

1993 VOLUME 19/1Disposal of the aborted fetus (The) - newguidelines: ethical considerations in thedebate in Sweden, 32-36Kallenberg, Kjell

15.2: Genetics, molecular biology andmicrobiology: Genetic counselling andprenatal diagnosis

1993 VOLUME 19/1What counts as success in geneticcounselling?, 43-46Chadwick, Ruth FResponse to: What counts as success ingenetic counselling?, 47-49Clarke, Angus

15.3: Genetics, molecular biology andmicrobiology: Gene therapy

1993 VOLUME 19/1Response to: What counts as success ingenetic counselling?, 47-49Clarke, Angus

18.1: Human experimentation:General

1993 VOLUME 19/2Ethics of research with psychiatricpatients: principles, problems and theprimary responsibilities of researchers,85-91Fulford, KW M and Howse, K

18.2: Human experimentation: Policyguidelines

1993 VOLUME 19/2Beyond voluntary consent: Hans Jonas onthe moral requirements of humanexperimentation, 99-103Fethe, Charles1993 VOLUME 19/3Ethics of experimental heroin maintenance(The), 175-182Ostini, Remo, Bammer, Gabriele,Dance Phyll R and Goodin, Robert E1993 VOLUME 19/4Symposium on ethics and clinical trials:Clinical trials: two neglected ethical issues,211, 218Herxheimer, Andrew

18.5.2: Human experimentation:Research on special populations:Children

1993 VOLUME 19/3Maturity of children to consent tomedical research: the babysitter test,142-147Koren, Gideon, Birenbaum Carmeli,Daphna, Carmeli, Yoram S and Haslam,Robert

18.5.4: Human experimentation:Research on special populations:Fetuses and neonates

1993 VOLUME 19/2The Polkinghorne Report on FetalResearch: nice recommendations, shameabout the reasoning, 114-120Keown, John

18.5.6: Human Experimentation:Research on special populations:Mentally handicapped persons

1993 VOLUME 19/2Ethics of research with psychiatricpatients: principles, problems and theprimary responsibilities of researchers,85-91Fulford, K W M and Howse, K

18.6: Human experimentation: Socialcontrol ofhuman experimentation

1993 VOLUME 19/1Medical ethics in the EuropeanCommunity, 7-12Riis, PovlMedical ethics (The) of the 'Father ofGynaecology', Dr J Marion Sims, 28-31Ojanuga, Durrenda

19.3: Artificial and transplantedorgans: Kidneys

1993 VOLUME 19/2On discontinuing dialysis, 71-76Wight, Jeremy

19.5: Artificial and transplantedorgans/tissues: Donation/procurementof organs/tissues

1993 VOLUME 19/3Attitudes of the healthcare profession andthe public towards the sale of kidneys fortransplantation, 148-153

3rournal of medical ethics, 1993, 19: 247

Guttmann, Astrid and Guttmann,Ronald D

20.1: Death and dying: General

1993 VOLUME 19/2Postmortem procedures in the emergencydepartment: using the recently dead topractise and teach, 92-98Iserson, Kenneth V

20.5.1: Death and dying: Prolongationof life and euthanasia: General

1993 VOLUME 19/1Fditonral: a personial view: Persistentvegetative state and withdrawal of nutritionand hydration, 67-68Gillon, Raanan1993 VOLUME 19/2Altruism towards the end of life, 111- 113Davies, JeanMedical futility, treatment withdrawaland the persistent vegetative state,71-76Mitchell, Kenneth R, Kerridge, Ian H andIovat, Terence JResuscitation and senility: a study ofpatients' opinions, 104- 107Robertson, George S1993 VOLUME 19/3The great slippery slope argument,169-174Burgess, John1993 VOLUME 19/4Deciding not to resuscitate in Dutchhospitals, 200-205van Delden, Johannes J M, van der Maas,Paul J, Pignenborg, Loes and Looman,Caspar W N

21.4: International and politicaldimensions of biology and medicine:Torture

1993 VOLUME 19/3(Guest editorial: Medical involvement intorture, 133- 134Hoffenberg, Sir RaymondSyp;iposiumpi: Ethics of medical involvementin torture (The), 135- 137Downie, R S.5Svposili;l: Ethics of medicalinvolvement in torture (The):commentary, 138- 140Hare, R M

BOOK REVIEWS

1.1: Ethics: Philosophical ethics

1993 VOLUME 19/4Moral luck in medical ethics and practicalpolitics by Donna Dickenson, 242-243Crisp, Roger

1.2: Ethics: Religious ethics

Bioethics yearbook, vol 1: theologicaldevelopments in bioethics 1988-1990edited by R Andrew Lustig and others,198Preston, Ronald

1.3: Ethics: Applied and professionalethics

1993 VOLUME 19/4Moral luck in medical ethics and practicalpolitics by Donna Dickenson, 242-243Crisp, RogerThe nature of moral thinking by FrancisSnare, 242Brownsey, Paul F

1.3.1: Ethics: Applied and professionalethics: general

1993 VOLUME 19/1Inside the ethical expert: problem-solvingin applied ethics by Theo vanWilligenburg, 54Almond, Brenda1993 VOLUME 19/4Down the slippery slope: arguing inapplied ethics by David ILamb, 240-241Telfer, ElizabethPharmacy ethics edited by Mickey Smith,Steven Strauss, H John Baldwin and KellyT Alberts, 240Sickness and health by Colin Douglas, 241Hockey, Lisbeth

1.3.8: Ethics: Applied and professionalethics: Law

Child psychiatry and the law: secondedition, edited by Dora Black, StephenWolkind and Jean Harris Hendriks, 126Graham, Philip

1.3.9: Ethics: Applied and professionalethics: Scientific research

1993 VOLUME 19/1Created from animals: the moralimplications of Darwinism by JamesRachels, 57-58Foster, Cheryl

2.1: Bioethics: General

1993 VOLUME 19/2Wonderwoman and superman: the ethicsof human biotechnology by John Harris,124Dupuis, Heleen MPractical medical ethics by DavidSeedhouse and Lisetta Lovett, 189-190Upton, Hugh1993 VOLUME 19/4Moral luck in medical ethics and practicalpolitics by Donna Dickenson, 242-243Crisp, RogerEthics in nursing- third edition, by MartinBenjamin and Joy Curtis, 243-244Dines, Alison

2.2: Bioethics: History of medicalethics

1993 VOLUME 19/1Biomedical politics edited by Kathi Hanna,54-55Chappell, T D J

2.3: Bioethics: Education/programmes

1993 VOLUME 19/1Nuffield video library (The) in medicalethics and law by Len Doyal, 58Hope, Tony

3.2: Philosophy of biology: evolutionand creation

1993 VOLUME 19/1Created from animals: the moralimplications of Darwinism by JamesRachels, 57-58Foster, Cheryl

4.1.2: Philosophy of medicine andhealth: Philosophy of the healthprofessions: Philosophy ofmedicine

1993 VOLUME 19/2Greening of medicine (The) by PatrickPietroni, 126- 127Parker, Malcolm

4.1.3: Philosophy of medicine andhealth: Philosophy of the healthprofessions: Philosophy of nursing

1993 VOLUME 19/1Aging and ethics, edited by Nancy SJecker, 61-62Foster, Cheryl1993 VOLUME 19/4Challenges in caring: explorations innursing and ethics by J M Brown, A LKitson and T J McKnight, 241-242Hayward, Jack

4.4: Philosophy of medicine andhealth: Quality/value of life

1993 VOLUME 19/1Created from animals: the moralimplications of Darwinism by JamesRachels, 57-58Foster, Cheryl

6: Codes of professional ethics

1993 VOLUME 19/3Regulating British medicine: the GeneralMedical Council by Margaret Stacey,188-189Jefferys, Margot

7.2: Sociology of medicine: Medicaleducation

1993 VOLUME 19/2Into the valley: death and the socializationof medical students by F W Hafferty,125-126Elston, Mary Ann

8.1: Professional-patient relationship:General

1993 VOLUME 19/1Treat me right: essays in medical law andethics by Ian Kennedy, 55-56Dunstan, G R1993 VOLUME 19/2Child psychiatry and the law edited byDora Black, Stephen Wolkind and JeanHarris Hendriks, 126

7ournal of medical ethics, 1993, 19: 248

Graham, Philip1993 VOLUME 19/4Doctors, patients and the law, edited byClare Dyer, 243Devereux, John

8.3: Professional-patient relationship:Informed consent

1993 VOLUME 19/4Moral luck in medical ethics and practicalpolitics by Donna Dickenson, 242-243Crisp, Roger

8.3.3: Professional-patientrelationship: Informed consent: Thirdparty consent/incompetents

1993 VOLUME 19/1Protecting the vulnerable: autonomy andconsent in health care edited by MargaretBrazier and Mary Lobjoit, 59Matthews, Eric

9.1: Health care: General

1993 VOLUME 19/3Philosophy and health care edited by EricMatthews and Michael Menlowe, 190Telfer, Elizabeth

9.4: Health care: Allocation of healthcare resources

1993 VOLUME 19/3Human needs and the market by MaureenRamsay, 190- 191Williams, Alan1993 VOLUME 19/4Moral luck in medical ethics and practicalpolitics by Donna Dickenson, 242-243Crisp, Roger

9.5.2: Health care: Health careprogrammes for specific diseases/groups: Aged

1993 VOLUME 19/1

Aging and ethics edited by Nancy S Jecker,61-62Foster, Cheryl

9.5.6: Health care: Health careprogrammes for specific diseases/groups: HIV infection and AIDS

Perspectives on AIDS: ethical and socialissues edited by Christine Overall andWillian P Zion, 124-125King, Edward

12.1: Abortion: General

1993 VOLUME 19/2Wonderwoman and superman: the ethicsof human biotechnology by John Harris,124Dupuis. Heleen

14.1 Reproductive technologies:General

1993 VOLUME 19/2Wonderwoman and superman: the ethicsof human biotechnology by John Harris,124Dupuis, Heleen1993 VOLUME 19/1Philosophical ethics in reproductivemedicine edited by David R Bromham,Maureen E Dalton and Jennifer C Jackson,58-59Kingdom, Elizabeth

15.2: Genetics, molecular biology andmicrobiology: Genetic counselling andprenatal diagnosis

1993 VOLUME 19/1Antenatal diagnosis of fetal abnormalitiesedited by J 0 Drife and D Donnai, 62-63Bromham, David RIntroduction to risk calculation in genetic

counselling by Ian D Young, 56-57Ellis, Ian H

15.5: Genetics, molecular biology andmicrobiology: Eugenics

1993 VOLUME 19/2Wonderwoman and superman: the ethicsof human biotechnology by John Harris,124Dupuis, Heleen

17.2: The neurosciences and mentalhealth therapies: Psychotherapy

1993 VOLUME 19/1Values of psychotherapy, (The) by JeremyHolmes and Richard Lindley, 60-61Pick, Rachel

19.1: Artificial and transplantedorgans/tissues: general

1993 VOLUME 19/1Organ replacement therapy: ethics, justice,commerce edited by W Land and J BDossetor, 59-60Pickering, Neil

20.4.1: Death and dying: Care of thedying patient: General

1993 VOLUME 19/1Aging and ethics edited by Nancy S Jecker,61-62Foster, Cheryl

21.4: International and politicaldimensions of biology and medicine:Torture

1993 VOLUME 19/4The politics of psychiatry in revolutionaryCuba by Charle Brown and Armando MLago, 244Fulford, KW M

J7oirnal of niedical ethics 1993; 19: 249

Alphabetical index

PAPERS

A

Appropriate care of the newborn: ethicaldilemmas, 19, 82-84: 1.3.8; 4.1.2; 4.4Attitudes of the health-care profession andthe public towards the sale of kidneys fortransplantation, 19, 148- 153: 19.5Autonomy and the akratic patient, 19,206-210: 1.1

B

Beyond voluntary consent: Hans Jonas on

the moral requirements of humanexperimentation, 19, 99-103: 18.2

D

Debate: A critique of using age to ration

health care, 19, 19-23: 9.5.2Debate: Response to Roger W Hunt, 19,24-27: 9.5.2Debate: The nurse under physicianauthority, 19, 223--227: 7.3Debate: Commentary on: The nurse underphysician authority, 19, 228-229: 7.3Deciding not to resuscitate in Dutchhospitals, 19, 200-205: 1.3; 8.3.2: 8.3.4;20.5.1Disposal of the aborted fetus (The) - new

guidelines: ethical considerations in thedebate in Sweden, 19, 32-36: 12.4.4

E

Edito)ial: a pe.sonpal viewz: Persistentvegetative state and withdrawal of nutrition

and hydration, 19, 67-68: 20.5.1Editorial: Biomedical ethics in Europe - a

need for the POBS?, 19, 3-4: 6Editorial: Is there an important moraldistinction for medical ethics between lyingand other forms of deception? 19,131-132: 8.2Fditotrial: Autonomy, respect for autonomyand weakness of will, 19: 195-196: 1.1Ethics of experimental heroin maintenance(The), 19, 175-182: 18.2Ethics of postmortem examinations in

contemporary Islam (The), 19, 164- 168:1.2Ethics of research with psychiatric patients:principles, problems and the primaryresponsibilities of researchers, 19, 85-91:18.1; 18.5.6

European Convention on bioethics (The):19, 13-16: 1.3.6

G

Great slippery slope argument (The): 19,169-174: 20.5.1Giuest editorial: International bioethics?The role of the Council of Europe, 19,5-6: 6Giuest editorial: Is medical ethics lost? 19,69-70: 2.1GieCst editorial: Medical involvement intorture 19, 1 3 3- 1 34: 21.4GuIest editoDial:Demystifying bioethics: alay perspective, 19: 197- 199: 2.1

H

Hippocratic contract (The): 19, 54 155:8. 1

M

Maturity ot children to consent to medicalresearch: the babysitter test, 19, 142- 147:18.5.2Medical ethics (The) of the 'Father ofGynaecology', 19, 28-31: 18.6Medical ethics in the EuropeanCommunits, 19, 7-12: 1.3.6; 2. 1; 8. 1;18.6Medical futility, treatment withdrawal andthe persistent vegetative state, 19, 7 1 -76:20.5.1

0

On discontinuing dialysis, 19, 77-8 1:19.3On the morality of deception - doesmethod matter? A reply to DavidBakhurst, 183- 187: 8.2

p

PIoint ofiw: After ethics and towardsvirtue, 19, 17- 18: 7.2Po'lint ofview: Altruism towards the end oflife, 19, 111 -13: 20.5.1Polkinghorne Report on Fetal Research(The): nice recommendations, shameabout the reasoning, 19, 114- 120:18.5.4Postmortem procedures in the emergencydepartment: using the recently dead topractise and teach, 19, 92-98: 20. 1

R

Relevance of health state after treatment inprioritising betws een dif'ferent patients,(The) 19, 37-42: 9.4; 9.2: 9.4Response to: WXhat counts as success ingenetic counselling?, 19, 47-49: 15.2;15.3Resuscitation and senility: a study ofpatients' opinions, 19, 104- 107: 20.5.1

S

,Ssn,iipoosuiiii: Ethics of medical involvementin torture (The) 19, 135- 1 37: 21.4SsinpoZsnn: Ethics of medical involvementin torture (The): commentary 19,138-140: 21.455n'i;iposnlo iii .tliics andclliiiOtl trials:(Ciwlnitlal trials: twit' n1egleLted LtliiCal iSsl# s, 19,211, 218: 9.6; 18.2Ss'n191pooii'n stlieies anid tlin'1ia'al trials:Ethics and statistical methodology inclinical trials, 19, 219-222: 1.3.9Ssmiiipi)siiion 001i ethioes and LliEiecal tri'als:Neonatal extracorporeal membraneoxygenation (ECMN(O): clinical trials andthe ethics of evidence, 19, 212 218: 5.2

T

Tea.l/iwzg snedicLal ethics: Assessing theclinical and ethical competence ofundergraduate medical students, 19,230-236: 2.3Teacloling med.(lical etlhics: Randomized trial ofethics education for medical house officers(A), 157-163: 1.3.3

W

XWhat counts as success in geneticcounselling?, 19, 43-46: 15.2Words:What is wrong with compliance?,

19, 108 110: 8.1

AUTHORS

B

Bammer, Gabriele, 19, 175 -182: 18.2Birenbaum Carmeli, Daphna, 19,142-147: 18.5.2Burgess, John, 19, 169- 174: 20.5.1Bvk, C, 19, 13- 16: 1.3.6

Journal of medical ethics, 1993, 19: 250

C

Callahan, Daniel, 19, 24-27: 9.5.2Carmeli, Yoram S, 19, 142- 147: 18.5.2Chadwick, Ruth F, 19, 43-46: 15.2Clarke, Angus, 19, 47-49: 15.2; 15.3

D

Dance, Phyll R, 19, 175-182: 18.2Davies, Jean, 19, 111-113: 20.5.1de Raeve, Louise, 19, 228-229: 7.3Downie, R S, 19, 135-137: 21.4Dunn, Peter M, 19, 82-84: 1.3.8; 4.1.2;4.4

F

Faden, Ruth R, 19, 157-163: 1.3.3Fethe, Charles, 19, 99-103: 18.2Fulford, K W M, 19, 85-91: 18.1; 18.5.6

G

Geller, Gail, 19, 157- 163: 1.3.3Gillon, Raanan, 19, 3-4: 6; 67-68: 20.5.1;131-132: 8.2; 195-196: 1.1Goodin, Robert E, 19, 175-182: 18.2Guttmann, Astrid, 19, 148-153:19.5Guttmann, Ronald D, 19, 148-153:19.5

H

Hare, R M, 19, 69-70: 2.1; 138-140:21.4Haslam, Robert, 19, 142-147: 18.5.2Herxheimer, Andrew, 19, 211, 218: 9.6;18.2Hoffenberg, Sir Raymond, 19, 133- 134:21.4Holm, Soren, 19, 108- 110: 8.1Howse, K, 19, 85-91: 18.1; 18.5.6Hunt, Roger W, 19, 19-23: 9.5.2

I

Iserson, Kenneth V, 19, 92-98: 20.1

J

Jackson, Jennifer, 19, 183-187: 8.2

K

Kallenberg, Kjell, 19, 32-36: 12.4.4Keown, John, 19, 114-120: 18.5.4Kerridge, Ian H, 19, 71-76: 20.5.1;230-236: 2.3Koren, Gideon, 19, 142- 147: 18.5.2Krauss, Alfred N, 19, 212-218: 5.2

L

Levine, David M, 19, 157-163: 1.3.3Looman, Caspar W N, 19, 200-205: 1.3;8.3.2; 8.3.4; 20.5.1Lovat, Terence J, 19, 71-76: 20.5.1

M

May, Thomas, 19: 7.3McKnight, Christopher J, 19, 206-210:1.1Mike, Valeric, 19, 212-218: 5.2

Mitchell, Kenneth R, 19, 71-76: 20.5.1;230-236: 2.3Myser, Catherine, 19, 230-236: 2.3

N

Nairne, Sir Patrick 19, 197-199: 2.1Nord, Erik, 19, 37-42: 9.4; 9.2; 4.4

0

Ojanuga, Durrenda, 19, 28-31: 18.6Ostini, Remo, 19, 175-182: 18.2

p

Palmer, Christopher R, 19, 219-222: 1.3.9Pijnenborg, Loes, 19, 200-205: 1.3; 8.3.2;8.3.4; 20.5.1

R

Riis, Povl, 19, 7-12: 1.3.6; 2.1; 8.1; 18.6Rispler-Chaim, Vardit, 19, 164- 168: 1.2Robertson, George S, 19, 104-107:20.5.1Rosalki, J, 19, 154-156: 8.1Ross, Gail S, 19, 212-218: 5.2

Q

Quintana, Octava, 19, 5-6: 6

S

Sulmasy, Daniel P, 19, 157-163: 1.3.3

T

Toon, Peter D, 19, 17- 18: 7.2

V

van Delden, Johannes J M, 19, 200-205:1.3; 8.3.2; 8.3.4; 20.5.1van der Maas, Paul J, 19, 200-205: 1 .3;8.3.2; 8.3.4; 20.5.1

W

Wight, Jeremy, 19, 77-81: 19.3

BOOK REVIEWS

A

Aging and ethics, 19, 61-62: 9.5.2; 4.1.2;20.4.1Antenatal diagnosis of fetal abnormalities,19, 62-63: 15.2

B

Bioethics yearbook, vol 1: theologicaldevelopments in bioethics 1988- 1990,188: 1.2Biomedical politics, 19, 54-55: 2.2

C

Challenges in caring: explorations innursing and ethics, 19, 241-242: 4.1.3Child psychiatry and the law: secondedition 19, 126: 1.3.8; 8.1

Created from animals: the moralimplications of Darwinism, 19, 57-58:1.3.9; 3.2; 4.4

D

Doctors, patients and the law, 19, 243:8.1Down the slippery slope, 19, 240-241:1.3.1

E

Ethics in nursing, third edition, 19,243-244: 2.1

G

Greening of medicine (The), 19, 126-127:4.1.2

H

Human needs and the market, 19,190-191: 9.4

I

Inside the ethical expert: problem solvingin applied ethics, 19, 54: 1.3Into the valley: death and the socializationof medical students, 19, 125-126: 7.2Introduction to risk calculation in geneticcounselling, 19, 56-57: 15.2

M

Moral luck in medical ethics and practicalpolitics, 19, 242-243: 1.1; 1.3; 2.1; 8.3; 9.4

N

Nature of moral thinking (The), 19, 242:1.1Nuffield video library (The) in medicalethics and law, 19, 58: 2.3

0

Organ replacement therapy: ethics, justice,commerce, 19, 59-60: 19.1

p

Perspectives on AIDS: ethical and socialissues, 19, 124-125: 9.5.6Pharmacy ethics, 19, 240: 1.3Practical medical ethics, 19, 189- 190:2.1Philosophical ethics in reproductivemedicine, 19, 58-59: 14.1Philosophy and health care, 19, 190: 9.1Politics of psychiatry in revolutionary Cuba(The), 19, 244: 21.4Protecting the vulnerable: autonomy andconsent in health care, 19, 59: 8.3.3

R

Regulating British medicine: the GeneralMedical Council, 19, 188-189: 6

S

Sickness and health, 19, 241: 1.3.1

Journal of medical ethics, 1993, 19: 251

T

Treat me right: essays in medical law andethics, 19, 55-56: 8

V

Values of psychotherapy (The), 19, 60-61:17.2

W

Wonderwoman and superman: the ethicsof human biotechnology, 19, 124: 2.1;12.1; 14.1; 15.5

BOOK REVIEWERS

A

Almond, Brenda, 19, 54: 1.3.1

B

Bromham, David R, 19, 62-63: 15.2Brownsey, Paul F, 19, 242: 1.1

C

Chappell, T D J, 18, 54-55: 2.2Crisp, Roger, 19, 242-243: 1.1; 1.3; 2.1;9.4; 8.3

D

Devereux, John, 19, 243: 8.1Dines, Alison, 19, 243-244: 2.1Dunstan, G R, 19, 55-56: 8Dupuis, Heleen M, 19, 124: 2.1; 12.1;14.1; 15.5

E

Ellis, Ian H, 19, 56-57: 15.2Elston, Mary Ann, 19, 125-126: 7.2

F

Foster, Cheryl, 19, 57-58: 1.3.9; 3.2; 4.4:61-62: 9.5.2; 4.1.2; 20.4.1Fulford, K W M, 19, 244: 21.4

G

Graham, Philip, 19, 126: 1.3.8; 8.1

H

Hayward, Jack, 19, 241-242: 4.1.3Hockey, Lisbeth, 19, 241: 1.3.1Hope, Tony, 19, 58: 2.3

J

Jefferys, Margot, 19, 188 189:6

K

King, Edward, 19, 124-125: 9.5.6Kingdom, Elizabeth, 19, 58-59: 14.1

M

Matthews, Eric, 19, 59: 8.3.3

p

Parker, Malcolm, 19, 126- 127: 4.1.2Pick, Rachel, 19, 60-61: 17.2Pickering, Neil, 19, 59-60: 19.1Preston, Ronald, 19, 188: 1.2

R

Rowson, Richard, 19, 240: 1.3

T

Telfer, Elizabeth, 19, 190: 9.1; 240-241:1.3.1

U

Upton, Hugh, 19, 189- 190: 2.1

W

Williams, Alan, 19, 190- 191: 9.4

Jfournal of medical ethics 1993; 19: 252

American National Reference Centre for Bioethics Literature

Library classification scheme (the KennedySystem)

1 Ethics1.1 Philosophical Ethics1.2 Religious Ethics1 .3 Applied and Professional Ethics

1.3.1 (ieneral1.3.2 Business1.3.3 Education1.3.4 Engineering1.3 S Government1.3.6 International Affairs1.3.7 Journalism1.3.8 Lasw1.3.9 Scientific Research1.3.10 Social Work

2 Bioethics2 1 Cieneral2.2 Histor! of Medical Ethics2.3 Education/Programmes

3 Philosophy of Biology3. General3.2 Evolution and Creation

4 Philosophy of Medicine and Health4.1 Philosophy ot' the Health P'rofessions

.1 1 General4.1.2 P'hilosophs of Medicine1.1.3 Philosophy cf Nursilig

4.2 Concept of Health4.3 Concept of Mental Health4.4 Quality/Value of Life

5 Science/Technology and Society5.1 GCeneral5.2 1Technology Assessment5.3 Social Control of ScienceflIechnologs

6 Codes of Professional Ethics

7 Sociology of Medicine7.1 General7.2 Medical Education7.3 Professional-Professional Relationship

8 Professional-Patient Relationship8.1 General8.2 Truth-Telling8.3 Informed Consent

8.3.1 General8.3.2 Minors and C onsent to TIreatment8.3.3 Third Party Consent/Incompetents8.3.4 Right to Refuse Ireatment8.3.5 Bills, Laws and Cases

8.4 Confidentiality8.5 Malpractice

9 Health Care9.1 General9.2 Right to Health Care9.3 Cost of Health Care9.4 Allocation of Health Care Resources9.5 Health Care Programmes for Specific

Diseases/Giroups9.5.1 General9.5.2 Aged9.5.3 Handicapped Persons

9.5.4 Minority Groups9.5.5 Women9.5.6 HIV Infection and AIDS

9.6 Quality of Health Care/Ethics C(ommittees9 7 IPharmaceutical Industrn

10 Sexuality

1 1 Contraception11 (General11.2 Availahilitv of C'ontraceptives to Minors11 .3 Sterilisation1.4 F4ailure of C ontraception/A'rongful Birth

12 Abortion12.1 (iencral12 2 Position Statements12 3 Moral and Religious Aspects12 1 l1egal Aspects

12 4 (ieneral12.1.2 Interests of'W'oman/lFtus/Father12 4.3 Interests of Health Personnel/

Institutions12.1.1 Bills, ILaws and C ases

12.5 Social Aspects12.5. (eneral12 5 2 IDemographic Sunreys12 5 3 Abortion Counselling

13 Population13. (iencral1 3 2 Plopulation Girowth13.3 lIopulation lPolicy

14 Reproductive Technologies14 Ginenral11.2 Artificial Insemination and Surrogacs14.3 Sex liredetermination14 4 li Vitin) Fertilisation and E,mbrvo Transfer14.5 Cloning11.6 (,Cryobanking of Sperm, Ova, or Embryos

15 Genetics, Molecular Biology andMicrobiology15.1 CGeneral152 Gienctic Counselling and P'renatal

DSiagnosis15 3 (ienetic Screening15.4 Gene Theraps1 5.5 ugenicsI S Behavioural Gienctics15 7 Biohazards of Genetic Research15.8 Platentinig C)rganisms15.() Sociohiologp

16 Environmental Quality16.1 Ceneral16 2 Nuclear Power16 3 Occupational Health

17 The Neurosciences and MentalHealth Therapies17.1 General17 .2 P'sychotherapy17.3 Operant Conditioning17.4 Psychopharmacology17.5 Electrical Stimulation of the Brain

17.6 P'sychosurgery17.7 Involuntary Civil C,ommitment1 7.8 Right of the institutionalised to

Ireatment

18 Human Experimentation18. Ceneral18.2 Policy Guidelines18.3 Informed Consent18.4 Behavioural Research18.5 Research on Special Populations

18.5.I General18.5.2 Children18.5.3 P'regnant Women18.5.4 Fetuses and Neonates18.5.5 Prisoners18.5.6 Mentally Handicapped Pelrsons18.5.7 Elderly and Terminally Ill

lPersons18.5.8 XMilitary and Government

lPersontnel18.5.9 Foreign Nationals

1 8.6 Social Control of Human Experimentation

19 Artificial and TransplantedOrgans/Tissues19. (eneral19.2 Hearts19.3 Kidneys19.4 Blood19.5 LDonation/Procurement of

Organs/Tissues19.6 Allocation of Organsfl'issues

20 Death and Dying21). Ceneral2(.2 1)efinition/Determination of Death

2(0.2.1 (General210.2.2 Bills, Laws and Cases

20.3 Attitudes loward Death2). 3.1 (General20.3.2 Health Personnel2(). 3. 3 Family2). 3. 1 leath Education

21) C are of the Dying lPatient21)..1 ( encral2(1 1.2 Care of the Dving Child

2(0 5 Iirolongation of life and Euthanasia2(1.5. 1 (encral2(0.5.2 Allowing Infants to DSie211.5.3 Bills, Laws and C.ases

2(0.6 C(apital l'unishment2(1 7 Suicide

21 International and PoliticalDimensions of Biology and Medicine21.1 General21 2 War21.3 Chemical and Biological Weapons21.4 TIorture21.5 Forced Feeding of Prisoners21.6 International Migration of Physicians

22 Animal Welfare22.1 GIeneral22.2 Animal Experimentation22.3 Animal Production

Journal of medical ethics 1993; 19: 253

JOURNAL OF

MEDICAL ETHICSJfournal of the Institute ofMedical Ethics

VOLUME 19- 1993

Editor: Raanan GillonConsulting Editors: Sir Douglas Black, Robin DownieEditorial Associate: Anthony HopeTechnical Editor: Ann LloydEditorial Secretary: Maureen Bannatyne

EDITORIAL BOARD

Thomas Oppe (Chairman)K M BoydAlastair CampbellA W ClareC M Fletcher

John HaldaneR M HareRoger HiggsMargot JefferysIan Kennedy

Sir Malcolm MacnaughtonDavid PatersonSir Martin RothRobert SellsElliot A Shinebourne

The Very ReverendEdward Shotter

Jenifer Wilson-BarnettEX OFFICIORichard SmithRichard West

BMJ PUBLISHING GROUP

Journal of medical ethics 1993; 19: 256

The Institute of Medical Ethics: workingparties and medical groups

Working partiesThe institute currently has two workingparties, one on the ethics of prolonging lifeand assisting death and the other on theethical implications of AIDS. The workingparty on the ethics of prolonging life andassisting death has produced twodiscussion papers: Assisted death, Lanzcet1990; 336: 610-613; and Withdrawal oflife support from patients in a persistentvegetative state, Lancet 1991; 337: 96-98.

Medical groups

ABERDEEN MEDICAL GROUPDr M D McArthur, Department ofMedicine for the Elderly, Wood EndHospital, Aberdeen AB9 2YS

BIR,MINGHAM MEDICAL GROUPMr R Sawers,Birmingham Maternity Hospital,Queen Elizabeth Medical Centre,Edgbaston, Birmingham B 15 2TG

BRIS[OIt MEDICAL GROUPDr Oliver Russell, Reader in MentalHealth, Bristol University,Department of Mental Health,41 St Michael's Hill,Bristol BS2 8DZ

DUNDEE MEDICAL GROUPDr David B Walsh,Consultant in Biochemical Medicine,Ninewells Hospital,Dundee DD I 9SY

EDINBURGH MEI)ICAL GROUPDr Brian Chapman,Royal Infirmary of Edinburgh,Lauviston Place,Edinburgh EH3 9YW

GLASGOW MEDICAL GROUPDr E Hillan,Department of Nursing Studies,Glasgow University,Glasgow G1 2 8QQ

LEEDS MEDICAL GROUPMr Brian Bentley, Principal of the Schoolof Radiography,General Infirmary, Belmont Grove,Leeds LS2 9NS

The working party on the ethicalimplications of AIDS has produced fourdiscussion papers: HIV infection: theethics of anonymised testing and testingpregnant women,3ournal of mnedical ethics1990; 16: 173-178; AIDS and the ethicsof clinical care and treatment, Quiarterlyjournal of mnedicine 1992; 302: 419-426;AIDS, ethics and clinical trials, Britishmnedical journal 1992; 305: 699-701, and

IEICESTER MEDICAL GROUPDr R K McKinley,Department of General Practice,University of Leicester,Leicester General Hospital,Gwondolen Road,Leicester LE5 4PW

LIVERPOOL. MEDICAI. GROUPDr Heather Draper,Lecturer in Health Promotion,Department of General Practice,Liverpool University, PO Box 147,Liverpool L69 3BX

LONDON'[HE UNITED MEDICAI ETHICS GROUP(GUY'S AND ST THOMAS'S HOSPITAI.S)Dr Graham Clayden,Reader in Paediatrics,St Thomas's Hospital,Lambeth Palace Road,London SE I 7EH

THE ROYAI FRE ElTHI(CS GROUPSDr Margaret Lloyd,Department of Public Health andPrimary Care, The Royal FreeHospital School of Medicine,Pond Street, London NW3 2PF

ST GEORGE S MEDICAI. GROUPDr N Eastman,St George's Hospital Medical School,London SW17 ORE

ST MARY'S HOSPITAL FTHICS FORUMJane Tessier-Denham,St Mary's Hospital Ethics Forum,St Mary's Hospital Medical School,Praed Street, London W2

AIDS and the ethics of medical confiden-tiality, Journal of nedical ethics 1992; 18:173-179.

Each discussion paper was written onbehalf of the relevant working party by theinstitute's Research Director, KennethBoyd.

MANCHESTER MEDICAL GROUPDr Geoffrey Jessup,27 Oakwood Lane,Bowden, Altrincham,Cheshire WA 14 3DL

NEWCASTLE MEDICAL GROUPThe Revd Bryan Vernon, AnglicanChaplain, Newcastle University,Department of Primary Health Care,School of Health Care Sciences,The Medical School, FramlingtonPlace, Newcastle upon Tyne NE2 4HH

NOlI'INGHAM MEDICAt ETHICS GROUPDr T C O'Dowd,Department of General Practice,University Hospital and MedicalSchool, Clifton Boulevard, NottinghamNG7 2UH

SOUTHAMPTON MEDICAL GROUPThe Revd T Pinner,8 Bassett Close, Southampton S02 3FP

Medical groups associated with theInstitute of Medical Ethics have beenestablished in British university teachinghospitals. Each academic year they arrangeprogrammes of lectures and symposia onissues raised by the practice of medicinewhich concern other disciplines. Althoughthese programmes are addressed primarilyto medical, nursing and other hospital stu-dents they are open to all members of themedical, nursing and allied professions.There is no fee for attendance. Lecturelists are available by direct application tothe appropriate co-ordinating secretarynamed above. A stamped addressed A4envelope would be appreciated.

----1m

RIGHTS ANDRESPONSIBILITIES IOF DOCTORSSecond edition I

I This practical guide to the laxx as itaffects doctors co-ers the main areas that I

Hare of interest and concern to the medicalprofession. As well as doctors, medical I

I students, health service administrators,lawyers with an interest in medical law,local authority officers, and otherswith an interest in the legal aspectsof medicine wvill find this hookinvaluable. ITopics include: Consent: Medical

malpractice: Confidentiality: Medicalrecords; Death; Drugs.

I ISBN 0 -279 0-53 0 226 pages 1992UK ,10 95. Overseas ,13.00

I (BMA members A9.90:12 00)

I Availablefron B1IJ Pt BIISIII.AG GROI P. P.O BOX 295.LOANDOA\ WrC1H 9TE (TEL. 071 383 6185 6245)anY leaditng bookseller or thle B.MJ Booksliop in BMIAHouse. I

British Postgraduate Medical Federation(University of London)

RANDOMISEDCONTROLLED TRIALS:

ETHICAL AND LEGAL ISSUES1-2 March 1994

A two-day course for doctors, nurses andmembers of Research Ethics Committees toconsider the ethical and legal implications ofundertaking randomised controlled trials.

Sessions will cover the rationale and needs forcontrolled trials, how they impinge on thedoctor/patient relationship, and the ethical andlegal considerations which result.

Fee: £194

Application forms are available from:The Education Department,

British Postgraduate Medical Federation,33 Millman Street, London WC1N 3EJ.

Tel: 071-831 6222, ext 156 or 071-405 5660(24 hr answerphone). Fax: 071-831 1387.

F ------------__ n1MEDICAL ETHICS TODAYITS PRACTICE AND PHILOSOPHYThe BMA has been publishing advice on ethical issues for over forty years. This bookis its most comprehensive attempt to answer the wide range of questionscommonly raised and relates the long accepted standards which have governedprofessional behaviour to newly emerging situations. The approach is patient- |centred and the aim has been to produce a working tool for doctors whilstrecognising that debate of ethical issues extends far beyond the medicalprofession. I

Topics covered include: Consent and Refusal; Confidentiality and Medical Records;Disclosure; Children and Young People; Reproduction and Genetic Technology; Caringfor the Dying; Treatment and Prescribing; Research; Inter-Professional Relations;Rationing and Allocation of Health Care Resources. I

ISBN 0 7279 0817 0 374 pages 1993UK £12.95; Overseas £15.95 (BMA members £.11.95; £.14.95) I

Available from: BMJ Publishing Group, P 0 Box 295, London WC1H 9TE(Tel: 071 383 618516245), any leading bookseller or the BMJ Bookshop in BMA House.Please enclose payment with order, or send us full details ofyour Mastercard, Visa orAmerican Express Card. 7

- - - ---- --- £

Institute of Medical Ethics

-PRESIDENT The Institute of Medical Ethics is an organisation for research,SADouglas Black, MD FRCP education and information in the broad area of health care ethics. It isVICE PRESIDENTS financed by grants from charitable bodies, government sources and

members' subscriptions.Professor G R Dunstan, CBE MA DD FSA

Professor RB Welbourn, MA MD (Hon) It was established as the Society for the Study of Medical Ethics, andDSc FRCS (Hon) FACS is an independent, non-partisan organisation for the dispassionate

multidisciplinary study of medico-moral issues raised by the practiceGOVERNING BODY of medicine.Brendan Cailaghan, sJ, MA, MPhil MTh The institute aims to help improve the quality of both professional

Allan Chappell, CIPFA, (Treasurer) and public discussion of medico-moral questions; to promote the

Colin Currie, BSc MB ChB FRCPE study of medical ethics; to promote high academic standards for thisDonald Evans, JP BA PhD (Wales) ever developing subject; to encourage a multidisciplinary approach toRaanan Gillon, BA (Phil) MB BS FRCP discussion of the consequences of clinical practice; to stimulate(Editor, Journal ofMedical Ethics) research into specific problems, and to remain non-partisan andProfessor Roger Higgs, MBE MA MB FRCP independent of all interest groups and lobbies.FRCGP Institute include: The Ethics of Resource Allocation in Health

Professor Bryan Jennett, MD FRCS Care by Kenneth Boyd, on ethical issues arising from scarcity of health

Professor Ian Kennedy, LLM . care resources; Dilemmas of Dying by Ian Thompson, on ethical issues

Stephen Lock, MA MB FRCP arising in the care of the dying, both published by the EdinburghProfessor John Mahoney,sJ MA DD University Press; Medical Research with Children: Ethics, Law andCaroline Miles, MA Practice by Richard Nicholson, an analysis of the ethics of clinical

research investigations on children, published by the Oxford(Chairman) University Press; Life Before Birth by Kenneth Boyd, BrendanRobert Sells, MA FRCS Callaghan and Edward Shotter, published by SPCK; Lives in the

Balance: the Ethics of Using Animals in Biomedical Research, edited byProfessor Richard West, MD FRCP DCH Jane Smith and Kenneth Boyd, published by Oxford University Press;

DrostrOG (GenieraWl secretarnett)sRNTeaching and Learning Nursing Ethics, edited by Ursula Gallagher and

ProfessorJeferWFlson-Barnett,SN Kenneth Boyd, published by Scutari, and The Pond Report on theTeaching of Medical Ethics,. which was published directly for theinstitute.

Director ofResearch and ScottishDirector Among shorter recent institute reports are: Assisted Death, Lancet,Kenneth Boyd, MA BD PhD 1990; HIV infection: the ethics of anonymised testing and of testing

IME Amulree Fellow pregnant women, 7ournal of Medical Ethics, 1990; and HIV infectionThe Very Reverend Edward Shotter, and AIDS: the ethics of medical confidentiality, Journal of MedicalDean of Rochester Ethics, 1992, each written by the institute's Research Director,

Honorary Research Associates Kenneth Boyd, on behalf of institute working parties.Dr Andrew FraserDr Jane Smith The institute derives from the London Medical Group, a studentMiss Ursula Gallagher group for the study of ethical issues raised by the practice of medicine

which, beginning in 1963, arranged a comprehensive programme of

Medical Ethics lectures and symposia on such issues. Similar groups associated with

Maureen Bannatyne, EditorialeSecretay the institute are now established in university teaching hospitals atAberdeen, Birmingham, Bristol, Cambridge, Dundee, Edinburgh,Glasgow, Leeds, Leicester, Liverpool, London, Manchester,Newcastle and Southampton.

Professor Richard WestGeneral Secretary, IMEMedical Postgraduate DepartmentUniversity of BristolCanynge HallWhiteladies Road, Bristol BS8 2PR

Dr Kenneth BoydDirector of Research andScottish Director, IMEDepartment ofMedicineRoyal Infirmary ofEdinburghLauriston Place, Edinburgh EH3 9YW

Published by the BMJ Publishing Group on behalf of the Institute of Medical Ethics and the British Medical Association.Typesetting by Bedford Typesetters Ltd, Bedford. Printed in Great Britain by Derry & Son Ltd, Nottingham.The Institute of Medical Ethics is a registered charity, No 261876.

Second class postage paid, Rahway N J Postmaster: send address changes to:Journal of Medical Ethics cdo Mercury Airfreight International Ltd Inc, 2323 Randolph Avenue, Avenel, NJ 07001, USA.