OsstitUte - jme.bmj.comjme.bmj.com/content/medethics/22/6/local/admin.pdf · Professor Maurizio...

OsstitUte of Medical Ethics

VirpOiglas Black

0CE ,Syii)FNTSF.Ofessor G R Dunstan

rOfessor Sir Raymond Hoffenberg

Wg p Sellspofessor R B Welbourn

,oVljRNIN( BODY

professor M Brazier

Brendan Callaghan SJ

Alan Chappelll)r Colin Curriel)r Donald Evansprofessor Raanan Gillon(Editor7oirnal of iAlfedical Elhics'professor Roger Higgspr Tony Hope

professor Bryan jennett

Professor D Morton

Professor Thomas Oppe

Professor Richard West

(Gnc',w/d1Secretanv)

Director of Research and ScottishDirectorDr Kenneth BoydResearch FellowDr Hazel MIcHaffie

IME Amulree FellowThe Very Reverend Edward ShotterDean of Rochester

Honorary Research AssociatesDr Andrew FraserDr Jane Smith

rsulul Gallagher

Ann I loyd. Technical Edi'tor, jotirnal ofMledv.i( c.i T'IhicsNMaureen lHannatyne, Editorial AssistaW

The Institute of Medical Ethics is an independent, non-partisanorganisation for the multidisciplinary study of medico-moral issuesraised by the practice of medicine, and concerned with research, edu-cation and information. It is financed by grants and donations frompublic and private sources.

The institute aims to help improve the quality of both professionaland public discussion of medico-moral questions; to promote thestudy of medical ethics; to promote high academic standards for thisever developing subject; to encourage a multidisciplinary approach to

discussion of the consequences of clinical practice; to stimulateresearch into specific problems, and to remain non-partisan andindependent of all interest groups and lobbies.

Institute reports include: The Ethics of Resoturce Allocation in HealthCare by Kenneth Boyd, and Dilemm^elas of DyJing by Ian Thompson,Edinburgh University Press (both 1979); Medical Research withChildren: Ethics, Law and Practice by Richard Nicholson, and Lives inthe Balance: the Ethics of Using Animlals in Biomttedical A4edical Researchby Jane Smith and Kenneth Boyd, Oxford University Press (1986 and1991); Life Before Birth by Kenneth Boyd, Brendan Callaghan andEdward Shotter, SPCK (1986); Teaching and Learning Niursing Ethicsby Ursula Gallagher and Kenneth Boyd, Scutari (1991) and SorbonaMilan (1 993); The Ponzd Report on the Teaching ofMedical Ethics editedby Kenneth Boyd, and The Care of Patients with HlV and AIDS: ASurvey of Nurse Educationz in the UK1, by Hazel McHaffic, publisheddirectly for the institute (1987 and 1994).

Shorter institute reports include: Assisted Death, Lancet, 1990; AIDS,ethics and clinical trials, British Medical journal, 1992; AIDS and theethics of medical care and treatment, Quarterly J7ournal of Medicine,1992; Advance directives: partnership and practicalities, BritishJournial of General Practice, 1993; Implications of HIV infection andAIDS for medical education, Medical Educationz, 1994; and Prolonginglife and allowing death: infants, Journal ofMedical Ethics, 1995.

The institute derives from the London Medical Group, a studentgroup for the study of ethical issues raised by the practice of medicinewhich, beginning in 1963, arranged a comprehensive programme oflectures and symposia on such issues. Similar groups associated withthe institute are now established in university teaching hospitalsthroughout the UK.

Professor Richard WestGeneral Secretary, IMEMedical Postgraduate DepartmentUniversity of BristolFrenchay Hospital, FrenchayPark Road, Bristol BS16 ILE

Dr Kenneth BoydDirector of Research andScottish Director, IMEDepartment of MedicineRoyal Infirmary of EdinburghLauriston Place, Edinburgh EH3 9YW

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

SI)1" C': ;ssiv stage paid, Rahlxav N J losiniastcr: scnd address chaniigc to:Journal ofUSedical Ethics c/ \Mercur Airlreight International Ltd Incs 2523 Randolplh Avenue, Avenel, NJ T7001i, t 'SA.

The journal of the Institute of Medical EthicsThe Jourtal of Aldeical Ethics was established in 1975, with a multidisciplinarv editorial board, to promote the studv of contemporary mcd:comoral problems. The editorial board has as its aims the encouragement of a high academic standard for this ever-developing subject and the

enhancement of professional and public discussion. The journal is published six times a year and includes papers on all aspects of health care

ethics, analyses ethical concepts and theories and features case confercnces and comment on clinical practice. Intermittent series focus on

the Teaching of medical ethics; on the medico-moral problems directly experienced bv health care workers (At the coalface); on thepursuit of arguments prompted by papers in the journal (Debate); on medical ethics in literature (Medical ethics and literature): and on

briefly argued often unorthodox opinions related to medical ethics (Point of view). The joumal also contains book reviews and lettcrs.

Editonral BoardEI)TIOR:Professor Raanan Gillon, general practitioncr and philosophecrImperial College, ILondon UniversityCONSULTINcG EDI (ORS:Sir Douglas Black, physician, Manchester University, LKProfessor Robin Downie, moral philosopher. Glasgow Unisersity. UKC(HAI-iRMAN. ED)I ORiA1L BOAR):Professor Thzomas Oppe, pacdiatrician, St Marv's Hospital MedicalSchool, London UKEDI ORIAL ASSO( iA rI.:Dr Tony Hope, psychiatrist, Reader in Medicine and leader, OxfordPractice Skills Project, Oxford Universitv, UKCASE CONFEiRE.NCEF ASSOCIATE:Dr Brian Hurwitz, Senior Lecturer, Department of General Practice,Imperial College School of Medicine at St Marv's, London, UKDr Susan Bewley, Director of Obstretrics, St Thomas's Hospital,London, UKDr Kenneth Boyd, historian, chaplain, Universitv of Edinburgh, UKProfessor Margaret Brazier, medical lawver, Manchester University,UKProfessor Anthony Culyer, Professor of Economics. Universits ofYork, UKLouise de Raeve, nurse, philosopher. Universitv College, Swansea, UKDr Donna Dickenson, medical ethicist and philosopher. The OpenUniversity, Milton Keynes, UKProfessorJohn Haldane, philosopher, University of St Anidrews. UKProfessorJohn Harris, philosopher, Manchester University, UKProfessor Roger Higgs, general practitioner, and Head of Departmentof CGeneral Practice, King's College, London, UKProfessor MargotJefferys, medical sociologist, University of London,UKRt Hon Sir Patrick Nairne, Chair of the Nuffield Council on BioethicsRabbijulia Neuberger, Chair, Camden Community Health Council,London. UKDr Allyson Pollock, public hcalth physician, St George's Hospital,London, UKProfessor Alain Pompidou, pathoiogist, mcmber of European parlia-ment, FranceDr Octavi Quintana, Chairman. Council of European SteeringCommittee for Bioethics, Madrid. SpainThe Very Reverend Fdward Shotter, D)ean of Rochester. Institute ofMedical Ethics Amulree Fellow, UKProfessor Bob Williamson, molecular biochemist. Murdoch InstiLute,Roval Children's Hospital, Melbournc, Australia

E.X-OF'F'ICIt:Dr Richard Smith, editor, Bntiisi MA'di al_Jouernal, UKProfessor Richard West, postgraduate mcdical dean, lBristolUniversity, UK, general secretary, Institute of Medical Ethics, UKAnn Lloyd, Technical Editor, JMEMaureen Bannatyne, Editorial Assistant, JME

Editorial Advisory BoardProfessor Kare Berg, phvsician, Chairman, Institute of MedicalGenetics, University of Oslo, NorwavDr Bela Blasszauer, medical lawyer, Medical University of Pecs,HungaryDr Mudr Martin Bojar, neurologist, CCharles University. Prague,Czech RepublicJudge Christian Byk, mcdical lawyer and magistrate, I'aris, France

Professor Alastair Campbell, theologian, Director, Centre forBioethics, University of Otago, New ZealandProfessor Fernando da Rocha, philosopher. Universidade Fcdcral doRio Grande do Sul, Brazil

Dr Dolores Dooley, philosopher, University College, Cork, IrclandProfessor H E Ernson, pathologist, Royal University Hospital.Saskatoon, CanadaDr Calliope C S Farsides, philosopher, University of Keele, UKMs 7ina Garanis-Papadotos, medical laywer, Athens SchoolPublic Health, GreeceDr Shimon Glick, physician, Ben Gurion University of the Negev, I'raclProfessor Zaki Hasan, physician. Vicc Chanccllor, Baqai Univecrsts.Karachi, PakistanDr Neville Hicks, mcdical sociologist, University of Adclaide. AustraliaMsJenniferJackson, philosopher, Director, Centre for Business andProfcssional Ethics, Unisersity of Leeds, UKProfessor Albert Jonsen, ethicist and historian, Universitvy,fWashington, USAProfessor Ian Kennedy, President, Centre for Medical Lav. and

Ethics, King's College, London, UKProfessor Rihito Kimura, lasvyer, Waseda University, JapanDr Paula Kokkonen, lawyer, Director of the National Board of

Medicolegal Affairs, I lelsinki, FinlandDr Simon Lundy, general practitioner, London, UKProfessor Ruth Mlacklin, philosopher and ethicist, Albert EinsteinCollege of Medicine, New York, USADr Maureen MacMillan, nurse, Edinburgh, UKProfessor Malcolm Macnaughton, obstetrician/gynaecologisi.Glasgow University. UKProfessor Maurizio Mori, philosopher, Consulta di Bioetica diMilano, ItalyProfessor Ben Osuntokun, physician, University of Ibadan, NigcriaDr, Naomi Pfeffer, medical sociologist, University of North London, UKDr Sashka Popova, social scien-tist. Department of Social Medic ine and

IPublic Health, Sofia, BulgariaProfessor Qui Ren-Zong, philosopher, Institute of Philosophs'Beijing, ChinaDrJanet Radcliffe-Richards, philosopher, Open University, MiltorKevnes, UKProfessor Pinit Ratanakul, physician, philosopher, Mahid,olUniversity. Bangkok, ThailandDr Stella Reiter-Theil, physician, Akademie fur Ethik in der Mediizin.Gcorg-August-Univcrsitat, Gocttingen, GermanyProfessor Povl Riis, physician, Herlev University, Chair of NationalEthics Committee, DenmarkProfessor Daniel Serrao, phvsician, University of I'orto MedicalSchool, PortugalMr Robert Sells, transplant surgeon, Director, Renal Transplant Unit.

Royal Liverpool University Hospital, UKProfessor Gamal Serour, obstetrician/gynaecologist, InternationalIslamic Center for Population Studies and Research, Cairo, EigvptProfessor WShannon, general practitioner. Royal College of Surgconsof Ireland Medical School, Dublin, IrelandProfessor Mark Siegler, physician and ethicist, Universitv Orf ChicagoHospitals, Illinois. USAProfessorJack Stanley, philosopher, Lawrence University, Appletoni,Wisconsin. USAMsJulie Stone, medical lawyer, Hempsons, London. UKDr Per Sundstrom, freelance writer in medical ethics and philosophy.SwedenProfessorJuan Carlos Tealdi, physician and philosopher. FundacionMainetti, Buenos Aires, ArgentinaProfessor Henk Ten Have, physician and philosopher, CatholicUniversity of Nijmegen, the NetherlandsProfessor Dr Guido Van Steendam, philosopher, Internati(onalForumn for Biophilosophv, BelgiumProfessor Francisco Vilardell, physician and prcsident of CIOMYIS.Barcelona, SpainProfessor Jenifer Wilson-Rarnett, nurse, Head of I)epartment of

Nursing Studies, King's College London, UK

Notice to subscribersThe Journal of Medical Ethics is published six times a year. The annual subscription ratc is £ 105 ($165) for institutions and £80.00 ($126)for personal subscribers for all countries. The rate in the USA for subscribers who order directly from the publishers is $158 for institutionsand S 126 for personal subscribers, payable bv cheque or the charge/credit cards listed below. Payment for all other subscriptions mav bcmade by VISA, Mastercard, or American Express or by sterling cheque or draft drawn on a UK bank. All payments should bc made to theBritish Medical Journal. Subscription orders may also bc placed with any leading subscription agent or bookseller. For the convenienceof readers in the USA, orders may be sent to the British Medical Journal, PO Box 48, Franklin, INMA 02038, USA. All other orders andenquiries for airmail rates, single copy sales and advertising should be sent to British Medical Journal, BMA House, Tavistock Square,London WC 1H 9JR, United Kingdom. Website address: http://www.bmj.com/bmj/ISSN 0306-6800

Gopntight ( 1996 J7ournal ofMedical Ethics. All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system,or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission ofthe Jourmal ofMedical Ethics.

Heather Draper 333

Heather Draper, PhD, is Lecturer in Biomedical Ethicsin the Department of Biomedical Ethics, the MedicalSchool, the University of Birmingham, Edgbaston,Birmingham.

References and notes1 Re S Family Division 12th October 1992.2 Thomson J. In defence of abortion. In Singer P, ed.

Applied ethics Oxford: Oxford University Press, 1986.3 Obligation regarding pregnancy and confinement

arise from the choice to continue with the pregnancy.This obligation would be weakened if the woman hadbeen free neither to use contraceptives nor to have atermination of pregnancy, a point stressed by KlugeEH. When court imposed caesarean section opera-tions are justified Journal of Medical Ethics 1988; 14:206-211.

4 Though after only twenty-five weeks' gestation (com-promised by her own illness) the absence of steroids tomature the baby's lungs, and granted the technologyavailable in 1987, there was very little that couldactually have been done.

5 Gillick v West Norfolk and Wisbech AHA [1985] 3 AllE R.

6 It may be argued that parental responsibility can beginbefore conception. For instance, since folic acidreduces the incidence of neuraltube defects in babies,women should, as recommended, increase their intakeof folic acid for three months prior to attempting con-ception. Similar arguments about prenatal parentalresponsibilities have been made about couples who maypass on genetic disorders to their offspring.

7 Beauchamp TL, Childress JF. Principles of bio-medical ethics Oxford: Oxford University Press,1983: 315-7.

8 Ladd R. Women in labor: some issues about informedconsent. In Holmes H, Purdy LM, eds. Feninist per-spectives in medical ethics. Bloomingtom: IndianaUniversity Press, 1992: 216-223.

9 My thanks to Margrit Shildrick for bringing this to myattention and discussing possible solutions.

10 My thanks to Christopher Coope for this analogy.11 Bowes WA, Selfested B. Fetal versus maternal rights:

medical and legal perspectives Anmerican Journal ofObstetrics and Gynaecology 1981; 58: 209-214.

News and notes

New courses

The Centre for Philosophy and Health Care at theUniversity of Wales Swansea is offering new courses -an MA and a Diploma in Medical Humanities (PGEAaccredited) - on either a part-time or a full-time basisin 1997. The courses are designed to supplement thelimitations of an exclusively scientific and reductionistbasis for the teaching of medicine, by bringing candi-dates to an appreciation of a range of perspecitves andmethods of critical reflection within the humanities.

Five key areas are explored: (i) models of mankindand medicine; (ii) sociology and anthropology ofmedicine and health care; (iii) social history and politicsof medicine and health care; (iv) medicine, health care,literature and the arts. and (v) medicine, health careand religion.

For details please write to: Admissions Tutor, Centrefor Philosophy and Health Care, University of Wales,Swansea, Singleton Park, Swansea SA2 8PP.

News and notes

The Ethics ofResearch on Humans

The Centre of Medical Law and Ethics of King'sCollege, London is running courses on the Ethics ofResearch on Humans at King's College, the Strand,London from the 17-19 December 1996, the 23-25April 1997 and the 1-3 July 1997.

For further information please contact: ContinuingEducation Unit, King's College, London, CornwallHouse, Waterloo Road, London SE1 8WA. Tel: 017 1-872 3056/3055; fax: 0171-872 3070.

Moyez J7iwa 343

11 Swanson V, Power K. The stress of being a GP.Psychiatry in Practice 1995; July/Aug: 17-20.

12 Hancock H. High stress levels in 40% of GPs: survey.Pulse 1992; 52: 9.

13 General Medical Council. Duties of a doctor. London:GMC, 1995.

14 Glennester H, Mastaganis M, Owens P. A foothold forfundholding. London: King's Fund Institute, 1992:research report 12.

15 Hodgkinson DW, Gray AJ, Dalal B, et al. Doctors' legalposition in treating temporarily incompetent patients.British Medical Journal 1995; 311: 115-8.

16 Ganapati M. Indian doctors may be tried in consumercourts. British Medical Journal 1995; 311: 1385-6.

17 Emson HE. Confidentiality: a modified value. JournalofMedical Ethics 1988: 14: 87-90.

18 Sandland R. Children and consent to treatment.J7ournal of Forenisic Psychiatry 1991; 31: 45-52.

News and notes

The British Society for Ethical Theory

A new British Society for Ethical Theory was inaugu-rated at a conference at Keele on 28th March this year.Originally called the British Society for Metaethics, thesociety arose as an electronic mailing list organised byDavid McNaughton from Keele with around 50members. The society will seek to promote ethicaltheory in Britain and to foster contact among membersof the ethics research community, primarily in thefirst instance by organising conferences, at least

annually.The society also aims more generally to promote the

exchange of information, drafts of papers, reviews, etcby both electronic and conventional means.

Further information and membership applicationforms may be obtained from the Secretary, Dr JamesLenman, Department of Philosophy, Furness College,Lancaster University, Lancaster LAI 4YG; email:j.lenman(a lancaster.ac.uk.

News and notes

College for children's health founded

The College of Paediatrics and Child Health (CPCH)was created earlier this year with the granting of a royalcharter to the former British Paediatric Association.The CPCH is the thirteenth medical royal college in theUK, but the first to be concerned specifically with theneeds of Britain's children.As the academic body for paediatric medicine and

child health, the CPCH takes over the three RoyalColleges of Physicians' statutory responsibilities in

relation to the training of hospital and community-basedpaediatricians. The objects of the CPCH are: 1 Toadvance the art and science of paediatrics; 2 To raise thestandards of medical care provided to children; 3 Toeducate and examine those concerned with the health ofchildren, and 4 To advance the education of the public(and in particular medical practitioners) in child health.For more information please contact James

Kempton, telephone 0171 486 6151.

News and notes

Fellowship in Clinical Bioethics

The Department of Bioethics at the Cleveland ClinicFoundation invites applications for a one-year bioethicsfellowship residency, beginning July 1st 1997. The pro-gramme has an interdisciplinary focus and includesacademic, clinical and research bioethics components.Each fellowship is tailored to meet individual strengths,needs and interests. Concentrations in medical subspe-cialties (for example, geriatrics, infectious diseases) are

available. Stipend and health care benefits are provided.Completed applications must be received by January15th.For information contact: Martin L Smith, STD

Department of Bioethics, P-3 1 Cleveland ClinicFoundation, 9500 Euclid Avenue, Cleveland, Ohio44195, (216) 444-8720. e-mail address:smith(acesmtp.ccf.org.

350 Debate: Covert video surveillance: The Staffordshire Protocol - a response to Dr Shinebourne

prove their innocence. This would imply not onlythat innocent parents have in the past (in pre-CVSdays) been wrongly accused, but also that there isalmost an onus on parents to prove their innocenceand "refute allegations".

Natural justice has traditionally been premised onthe belief that people are innocent until provedguilty, with the onus being on the accuser makingthe charge or allegation, to prove his or her case. Tosuggest the accused must prove his innocence,makes it easier for the accusers to allege, and turnstraditional justice on its head.

Finally Shineboume suggests that "those who arenot actively involved protecting . . . children shouldperhaps be more reticent about criticising thosewho are endeavouring to do the best possible for thechild even if that means making difficult ethicaldecisions".2 This statement raises a number ofpoints:

(a) the author does have 12 years' professionalexperience of child protection, including three yearsat the Leeds General Infirmary as a senior medicalsocial worker, working with the paediatric depart-ment and the accident and emergency department.(b) the protection of children is not solely a pro-fessional activity but one which should engage allcitizens all of the time.(c) those professionals charged with protectingchildren on behalf of the public, must expect thepublic to have a legitimate interest in scrutinisingtheir work. Covert video surveillance may be (andoften is) the start of judicial proceedings and "justicemust be seen to be done". An open and publicdebate on CVS can only be helpful, both within thepages of academic journals such as this one andindeed on a wider front. And:

(d) the public could take over some of these"difficult ethical decisions" through the medium ofthe courts.

I have elsewhere argued that CVS might properly bethe subject of judicial oversight.5 Leave of the courtcould be sought every time CVS is being consideredand not just when care proceedings have started, asthe protocol currently requires. Applications couldbe "ex parte" to protect the secrecy; the court couldbe empowered to make other orders if it felt theevidence already existed without recourse to CVS. Acourt saying "no" to CVS would not be "criticisingthose who are endeavouring to do the best possiblefor the child" but simply adding a degree of detach-ment and proportionality to those "difficult ethicaldecisions" that have to be made.

Terry Thomas, BA, CQSW, is Senior Lecturer in SocialWork at the Faculty of Health and Social Care, LeedsMetropolitan University, Leeds.

References1 Thomas T. Covert video surveillance - an assessment of

the Staffordshire Protocol. Jtournal of Medical Ethics1996; 22: 22-5.

2 Shineboume EA. Covert video surveillance and the prin-ciple of double effect: a response to criticism. rournal ofMedical Ethics 1996; 22: 26-8.

3 Thomas T. Child protection, privacy and covert videosurveillance. Journal of Social Welfare and Family Law1995; 17,3:311-324.

4 Evans D. The investigation of life-threatening childabuse and Munchausen's Syndrome by Proxy. Journal ofMedical Ethics 1995; 21: 9-13.

5 Thomas T. Covert video surveillance - a question ofchildren's rights? Childright 1995; 118: 2.

News and notes

American Physicians' Poetry Association

The American Physicians' Poetry Association held itsfirst meeting on June 16 this year in Farmington,Connecticut. The goals of the association are: Toprovide a forum for all physicians who love poetry; tofoster the interactions of medicine and humanity; toallow physicians of similar aspirations to gather togetherand support each other through mututal enrichment.APPA publishes a periodical approximately four

times a year, where members may find room fortheir creations. APPA is a non-profit organisationcurrently supported only by membership fees

($25 annual fee) of its members.All interested physicians should contact either

Dr Rita Iovino or Dr Lodovico Balducci for moreinformation.Dr Balducci is Program Leader, Senior Adult

Oncology Program, Division of Medical Oncology andHaemotology, Dept of Internal Medicine, USF Collegeof Medicine, 12902 Magnolia Drive, Tampa, Florida33612-9497 USA. Dr Iovino, the APPA LiteraryEditor, can be reached at: 34-1 Arnold Way, WestHartford, CT 06119 USA (860) 523-1 100.

Alison E While 355

form may be a helpful adjunct, however, the vari-ability of views espoused by different researchethics committees will continue to challenge thesuccessful execution of national and multi-locationstudies. The case for the establishment of a nationalresearch ethics committee for the review of nationaland multi-location studies now needs urgent con-sideration.

AcknowledgementThis paper draws upon research funded by theDepartment of Health. Responsibility for the viewsexpressed, issues of interpretation, questions ofinclusion and omission, remain as always with theauthor and do not necessarily reflect the views of theDepartment of Health.

Alison E While, BSc, MSc, PhD, RGN, RHV, CertEd,is Professor of Community Nursing, Department ofNursing Studies, King's College, London.

References1 Dept of Health. Local ethics committees. H SG (19) 5.London: Dept of Health, 1991.

2 Kennedy J. Research ethics committees and the law. In:Foster CG, ed. Manualfor research and ethics committees[3rd ed]. London: Centre of Medical Law and Ethics,King's College London, 1994.

3 Gilbert C, Fulford KWM, Parker C. Diversity in thepractice of district ethics committees. British MedicalJ7ournal 1989; 299: 1437-9.

4 Nicholson RH, ed. Medical research on children: ethics,law and practice. Oxford: Oxford Medical Publications,1986.

5 Nott PN, Steel EA. Scrutinising research ethics com-mittees [letter]. British Medical Journal 1988; 297: 1333.

6 Ginzler M, Davies J, McPherson K, Black N. Ethicscommittees and health services research. Journal ofPublic Health Medicine 1990; 12: 190-6.

7 Neuberger J. Ethics and health care: the role of researchethics committees in the United Kingdom. London: King'sFund Institute, 1992.

8 Herxheimer A. The rights of the patient in clinicalresearch. Lancet 1988; 331: 1128-30.

9 Neuberger J. Research ethics committees. In: HarrisonA, ed. Health care UK. London: King's Fund Institute,1990: 24-31.

10 Oakley A. Social support and motherhood. Oxford:Blackwell, 1992: 130.

11 Hemminki E, Kojo-Austin H. Problems of multi-disciplinary research in health care - the case of birthservices. Acta Sociologica 1989: 32(2): 253-60.

12 Berry TJ, Ades TE, Peckham CS. Too many ethical com-mittees [letter]. British Medical Journal 1990; 301: 1274.

13 Local research ethics committees [editorial]. BritishMedical Journal 1995; 311: 639-40.

14 OPCS. The prevalence of disability among children.Surveys of disability in Great Britain. Report No 3.London: HMSO, 1989.

15 Royal College of Physicians. Guidelines on the practice ofethics committees in medical research involving humansubjects. London: Royal College of Physicians, 1990.

16 Benson PR. The social control of human biomedicalresearch: an overview and review of the literature. SocialScience and Medicine 1989; 29(1): 1-12.

17 Cartwright A, Seale C. The natural history ofa survey: anaccount of the methodological issues encountered in a studyof life before death. London: King Edward's HospitalFund, 1990: 38.

18 See reference 10: 129.19 Hotopf M, Wessely S, Noah N. Are ethical committees

reliable? Journal of the Royal Society of Medicine 1995;88: 31-3.

News and notes

Call for abstracts

The 11th annual conference of the EuropeanSociety for Philosophy of Medicine and HealthCare - theme: "Research in health care - philo-sophical, ethical and historical aspects" will beheld from August 21-23, 1997, in Padova,Italy.

Please send abstracts (max 500 words as well on

diskette in Word Perfect or Dos/Sc) before March 1,1997 to Professor dr Henk ten Have, secretariatESPMH, Dept of Ethics, Philosophy and History ofMedicine, Faculty of Medical Sciences, CatholicUniversity of Nijmegen, PO Box 9101, 6500 HBNijmegen, the Netherlands. Fax: 024-3540254, fromabroad: ++31-24-3540254.

Inez de Beaufort 359

EmpirethicsAll this led to the "empirethical" phase.Population polls were used to decide about ethicalissues. If 80% of the population thought thateuthanasia was justified then it was considered to bejustified. Many proposals for medical reseachdevoted a smaller or larger part of their budgets tothese "referenda" in order to "solve" the ethicalissues. An interesting shift from normative theory todescriptive ethics. We tried to explain that one

cannot "prove" arguments in ethics by counting."So what", the proponents would argue, "If themajority of the population already agrees, why havean ethical debate at all? No need to". "Fortunately",on some issues, the public was strongly divided andthe results of polls did not provide any guidance forpolicy-makers. Did that lead to a revived interest inethical argument? Yes, indeed it did. But it came

hand in hand with a development I will call the"Guru-era".

Guru-eraEthicists were replaced by moral gurus. They were

extremely successful. Instead of expressing doubtsand questioning self-evident "truths", they providedclear-cut answers. There was "morally right". Andthere was "morally wrong". No "ifs", "buts", con-

ditions, etc. The public yearned for answers. Theywanted their lives to be made easier, not more diffi-cult. Too much autonomy makes one weary andtired. Gurus profited. ( "The good life according toX"; "All you need to know about ethics"; "Solvingethical problems in six steps".) What a relief not tohave to think things through. Rhetoric and charismareplaced arguments. I have nothing against a dose ofrhetoric. Used it myself. Rarely and tastefully, of

course. But in the guru-case it was an empty shell.The gurus came and went. I forgot their names. Theydidn't last as individuals; they did last as a pheno-menon. Probably that has always been there.What went wrong? It was a combination of many

factors. Society's confusion. Multicultural societiesand the lack of social cohesion. The consumeristmentality. The growing number of new tech-nologies and the ethical issues involved.Expectations that were too high. Methodologicallimbos. The popularity of ethics in political circles. Idon't know. I wrote about it in 1996, I think it was.Wasn't taken seriously, as usual. Such is life. Maybethe view was too gloomy in that era of optimismabout the future of bioethics. "Those were the days.We thought we'd never lose, oh yes, those were thedays."

AcklowledgementI thank Charles Erin, John Harris, Medard Hilhorst,the editor and the referees of the J7ournal of MedicalEthics for their helpful comments on earlier drafts ofthis article.

Author's note

This article is a revised version of a presentation at a

workshop on "Bioethics research: policy, methodsand strategies" held in Rome november 1995,organised by the Psychoanalytic Institute for SocialResearch and supported by the EuropeanCommission, directorate XII.

Inez de Beaufort is Professor of Medical Ethics in theFaculty of Medicine and Health Care at ErasmusUniversity, Rotterdam, the Netherlands.

News and notes

Quality Improvement in Health Care

The Second European Forum on Quality Improvement presentations selected from submissions and ain Health Care will be held from 24-26 April, 1997, in scientific session.Paris, France. For more information contact: BMA, ConferenceThe forum will consist of one-day teaching Unit, PO Box 295, London WC1H 9TE. Tel: +44 (0)

courses, invited presentations, posters and 171 383 6478. Fax: +44 (0) 171 383 6869.

368 Book reviews

obtainable death not a marathon ofmisery, a high-tech horror story.

This is an important text, worthy ofstudy by both the medical team and themanagers. Absorb the detail beforeconcluding it couldn't happen here, forit so easily could. Managerial choice israrely seen as involving an ethicaldecision, and if it is then unexaminedutilitarian principles rule. It is ironicthat Frost's words "take you in" cancarry the scent of a con-trick - to betaken in - though con-tricks only workwhen the victim thinks he or she is get-ting a better than expected deal. Let usnot be conned: high-tech home care, astreamlined parachute? This excellenttext will serve its purpose ifwe stop andconsider before mounting the roller-coaster of high-tech home care.

GORDON LENNOXGeneral practitioner

Ethical Aspects ofHuman ReproductionEdited by Claude Sureau andFrancoise Shenfield, Paris, JohnLibbey Eurotext Paris, 377 pages,160FF

This book of proceedings and paperswas published following the FIGOsymposium on ethics in reproductivemedicine and biology held in Paris in1994. As half the papers are written inEnglish and half in French, it is notthe easiest of books to delve into:papers are written primarily in onelanguage and then summarised in theother. However, the careful editing

and natural overlap between presen-ters allows for adequate coverage of allthe major ethical problems encoun-tered by clinicians in reproductivemedicine.

Clearly divided into sessions, topicsincluded are research on pre-embryos;the use of fetal tissue for transplanta-tion; sex selection; surrogacy, and thepractice of female genital mutilation.Debates and discussions between con-tributors following each paper raiseinteresting issues from different partsof the globe.Malcolm Macnaughton's clear

account of surrogacy and gametedonation in the UK is excellent,explaining the differences following theSurrogacy Act of 1985 and the HFEAAct of 1990, the latter clarifying thelegal status of the child and donor. Thepapers on the use of fetal tissue fortransplantation attempt to explore theethical minefield surrounding this area.The question of "when does life begin"is explored, and hence when fetal tissuecan be obtained. One author suggeststhat since the fetus cannot perceivepain until 20-22 weeks, then it wouldseem reasonable to retrieve tissue onlybefore this gestation. A set of guide-lines are offered that should ensure thatthe decision to abort is kept separatefrom the decision to use fetal tissue.The section on female genital mutila-tion is interesting, pointing out thatthis affects 100 million women world-wide. While there appears to be clearconsensus that mutilating operationson unconsenting children are abhor-rent, the question ofwhether re-infibu-lation following childbirth is unethicalis rather different. Although the RoyalCollege of Obstetrics and Gynaecology

has favoured a ban on re-infibulation,one author feels that this operation ona consenting adult is an entirely differ-ent issue and that it is possible tofavour such an operation withoutnecessarily condoning the practice ofgenital mutilation in the first place.This concise book is of value to all

of us working in the field of reproduc-tive medicine, where ethical dilemmasare faced regularly, as well as thoseinterested in medical ethics. It doesnot attempt to provide answers butsucceeds in stimulating discussionand, as such, is a useful addition toany bookshelf.

LESLEY REGANDepartment of Obstetrics and

Gynaecology, Imperial College School ofMedicine at St Mary's, Norfolk Place,

London W2 IPG

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:0171 383 6244. Fax: 0171 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).

J7ournal ofMedical Ethics, 1996; 22: 369

Index by subject matter (thematic review)Journal of Medical Ethics, volume 22, 1996

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 Kennedysystem), which is printed on page 378. In the secondpart authors, reviewers, papers and book reviews arearranged alphabetically, with their Kennedy classifi-cation following.

1.1: Ethics: Philosophical ethics

1996 VOLUME 22/1Bioethics and caring, 83-89,van Hooft, Stan

1.2: Ethics: Religious ethics

1996 VOLUME 22/5Buddhism, euthanasia and the sanctity oflife,309-313Perrett, Roy W

1.3: Ethics: Applied and professionalethics

1996 VOLUME 22/2Limiting risks by curtailing rights: aresponse to Dr Ryan, 100-104,Luttrell, Steven and Somerville, AnnWhat are the limits to the obligations ofthe nurse?, 90-94,Edwards, Steven D

1996 VOLUME 22/3Patient decision-making: medical ethicsand mediation, 164-167,Craig, Yvonne JPlacebos in clinical trials and research,140-146,De Deyn, Peter P and D'Hooge, Rudi

1.3.1: Ethics: Applied and professionalethics: General

1996 VOLUME 22/1Cycle helmets - when is legislationjustified?, 41-45Unwin, Nigel CSymnposium on covert video surveillance:Covert video surveillance: an assessment ofthe Staffordshire Protocol, 22-25Thomas, Terry

1996 VOLUME 22/6Debate: Covert video surveillancecontinues to provoke debate,Shinebourne, Elliot ADebate: Covert video surveillance: theStaffordshire Protocol - a response to DrShinebourne,Thomas, Terry

1.3.8: Ethics: Applied and professionalethics: Law

1996 VOLUME 22/3Guest editonal: Tackling the drug problem -what can doctors do?, 133-134,Robson, Philip

1.3.9: Ethics: Applied and professionalethics: Scientific research

1996 VOLUME 22/4BMJ response to Dr Gupta, 245-246Craft, Naomi and Smith, RichardShould intellectual property bedisseminated by "forwarding" rejectedletters without permission?, 243-244Gupta,Vinod Kumar

2.1: Bioethics: General

1996 VOLUME 22/2Guest editonal: Ethics without abstraction:squaring the circle, 69-71Callahan, Daniel

1996 VOLUME 22/3Do brain tissue transplants alter personalidentity? Inadequacies of some "standard"arguments, 174-180Northoff, GeorgEditorial: Brain transplantation, personalidentity and medical ethics, 131 -132Gillon, RaananPlacebos in clinical practice and research,140-146

De Deyn, Peter P and D'Hooge, RudiEthical reasoning in mixed nurse-physiciangroups, 168-173Holm Soren, Gjersoe Peter,Grode Glenn,Hartling Ole, Ibsen Karen E andMarcussen Henrik

1996 VOLUME 22/4The ethics of complementary medicine,195-196Ernst, E

1996 VOLUME 22/6Those were the days: looking back to thefuture, 356-359de Beaufort, Inez

2.3: Bioethics:Education/programmes

1996 VOLUME 22/1Editonal: Case studies and medicaleducation, 3-4Gillon, RaananTeachinig mledical ethics: Does teachingby cases mislead us about morality?,46-52Coope, Christopher Miles

1996 VOLUME 22/6Editonal: Thinking about a medical schoolcore curriculum for medical ethics and law,323-324Giuest editonal: Medical ethics, teachingand the new genetics, 325-326Williamson, Bob

4.1.1: Philosophy of medicine andhealth: Philosophy of the healthprofessions: General

1996 VOLUME 22/1Reply to Ann Bradshaw, 13-15Allmark, Peter

Journal ofMedical Ethics, 1996; 22: 370

4.1.2: Philosophy of medicine andhealth: Philosophy ofmedicine

1996 VOLUME 22/3Guest editorial: Tackling the drug problem- what can doctors do?, 133-134Robson, Philip

1996 VOLUME 22/5Ethical theory, ethnography anddifferences between doctors and nurses inapproaches to patient care, 292-299Robertson, David WEditorial: Ethnography, medical practiceand moral reflective equilibrium, 259-260Gillon, Raanan

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

1996 VOLUME 22/1Yes! There is an ethics of care: an answerfor Peter Allmark, 8-12Bradshaw, Ann

1996 VOLUME 22/5Ethical theory, ethnography anddifferences between doctors andnurses in approaches to patient care,292-299Robertson, David WEditorial: Ethnography, medical practiceand moral reflective equilibrium, 259-260Gillon, Raanan

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

1996 VOLUME 22/5Needs, preferences and QALYs, 267-272Cohen, Joshua

6: Codes of professional ethics

1996 VOLUME 22/1Ethics of Soviet medical practice, The:behaviours and attitudes of physicians inSoviet Estonia, 33-40Barr, Donald A

7.3: Sociology of medicine:Professional-professional relationship

1996 VOLUME 22/3Ethical reasoning in mixed nurse-physiciangroups, 168-173Holm Soren, Gjersoe Peter,Grode Glenn,Hartling Ole, Ibsen Karen E andMarcussen Henrik

8.1: Professional-patient relationship:General

1996 VOLUME 22/1Symposium on covert video surveillance:Covert video surveillance and the principleof double effect, 26-28Shinebourne, Elliot

1996 VOLUME 22/4Offering patients entry in clinical trials:preliminary study of the views ofprospective participants, 227-231Corbett, Fiona, Oldham, Julia and Lilford,Richard

8.2: Professional-patient relationship:Truth-telling

1996 VOLUME 22/5Communication with the seriously ill:physicians' attitudes in Saudi Arabia,282-285Mobeireek, Abdullah F, Al-Kassimi, FeisalA, Al-Majid, Suliman A and Al-Shimemry,Abdullah

8.3: Professional-patient relationship:Informed consent

1996 VOLUME 22/2Ethical considerations of the perinatalnecropsy, 111- 1 14Khong, T Y

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

1996 VOLUME 22/5Communication with the seriously ill:physicians' attitudes in Saudi Arabia,282-285Mobeireek, Abdullah F, Al-Kassimi, FeisalA, Al-Majid, Suliman A and Al-Shimemry,Abdullah

1996 VOLUME 22/6Women, forced caesareans and antenatalresponsibilities, 327-333Draper, Heather

9.2: Health care: Right to health care

1996 VOLUME 22/2An obligation to provide abortionservices:what happens when physiciansrefuse?, 115-120Meyers, Christopher and Woods Robert

1996 VOLUME 22/6At the coalface: Autonomy: the need forlimits, 340-343Jiwa, Moyez

9.4: Health care: Allocation of healthcare resources

1996 VOLUME 22/4Debate:Another peep behind the veil,216-221McKie, Johh, Kuhse, Helga, Richardson,Jeff and Singer, PeterDouble jeopardy, the equal value of livesand the veil of ignorance: a rejoinder toHarris, 204-208McKie, Johh, Kuhse, Helga, Richardson,Jeff and Singer, PeterEditonral: QALYs, lotteries and veils: thestory so far, 195-196Hope, TonyRandom paired scenarios - a method forinvestigating attitudes to prioritisation inmedicine, 238-242Ryynanen, Olli-Pekka, Myllykangas,Markku,Vaskilampi Tuula and Takala,Jorma

Debate: Would Aristotle have played"Russian Roulette"?, 209-215Harris, John

1996 VOLUME 22/5Needs, preferences and QALYs, 267-272Cohen, Joshua

9.5.2: Health care: Health careprogrammes for specificdiseases/groups: aged

1996 VOLUME 22/3Exercising restraint: autonomy, welfareand elderly patients, 160-163Dodds, Susan

9.5.5: Health care: Health careprogrammes for specificdiseases/groups: Women


9.6: Health care: Quality of healthcare/ethics committees

1996 VOLUME 22/1Synposiun on covert video suirveillance:Covert video surveillance: an assessment ofthe Staffordshire Protocol, 22-25Thomas, TerrySy?nposiu?n on covert video surveillance: Covertvideo surveillance and the principle ofdouble effect: a response to criticism, 26-28Shinebourne, ElliotSyinposiu?n on covert video surveillance:Covert video surveillance - a response toProfessor Southall and Dr Samuels, 29-31Evans, DonSy?nposiu?n on covert video surveillance:Guidelines for the multi-agencymanagement of patients suspected or atrisk of suffering from life-threatening abuseresulting in cyanotic-apnoeic episodes,16-21Southall, David P and Samuels, Martin PSymposium on covert video surveillance:Reply to Dr Evans re covert videosurveillance, 32Southall, David P and Samuels, Martin P

1996 VOLUME 22/2Research ethics committee audit:differences between committees, 78-82Redshaw, M E, Harris, A and Baum, J D

1996 VOLUME 22/5Delays and diversity in the practice oflocal research ethics committees,263-266Ahmed, Ala'Eldin H and Nicholson,Karl G

1996 VOLUME 22/6Debate: Covert video surveillancecontinues to provoke debate, 351Shinebourne, Elliot ADebate: Covert video surveillance: theStaffordshire Protocol - a response to DrShinebourne, 349-350Thomas, Terry


12.1: Abortion:General

1996 VOLUME 22/4Potential and the early human, 222-226Watt, Helen

12.4.1: Abortion: Legal aspects:General

1996 VOLUME 22/5Selective reduction of pregnancy: a legalanalysis, 304-308Hall, Alison

12.4.3: Abortion: Legal aspects:Interests of healthpersonnel/institutions

1996 VOLUME 22/2An obligation to provide abortionservices:what happens when physiciansrefuse?, 115-120Meyers, Christopher and Woods Robert

14.1: Reproductive technologies:General


14.4: Reproductive technologies: Invitro fertilisation and embryo transfer

1996 VOLUME 22/4Potential and the early human,222-226Watt, Helen

1996 VOLUME 22/5Selective reduction of pregnancy: a legalanalysis, 304-308Hall, Alison

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

1996 VOLUME 22/2Genetic testing and early diagnosisand intervention: boon or burden?,105-110Hepburn, Elizabeth R

18.1:Human experimentation: General

1996 VOLUME 22/6Research ethics committees at work: theexperience of one multi-location study,352-355While, Alison E

18.3: Human experimentation:Informed consent

1996 VOLUME 22/3Equipoise as a means of managinguncertainty: personal, communal andproxy, 135-139Alderson, Priscilla

1996 VOLUME 22/4Consent to clinical research - adequatelyvoluntary or substantially influenced?,232-237Hewlett, Sarah

19.1: Artificial and transplantedorgans/tissues: General

1996 VOLUME 22/1Guest editorial: Medical and scientific usesof human tissue, 5-7O'Neill, Onora

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

1996 VOLUME 22/2Non-therapeuitic (elective) ventilation ofpotential organ donors: the ethical basis forchanging the law, 72-77Shaw, A B

1996 VOLUME 22/ 6Bodily integrity and the sale of humanorgans, 334-339Wilkinson, Stephen and Garrard, Eve

20.1: Death and dying: General

1996 VOLUME 22/2Ethical considerations of the perinatalnecropsy, 111-114Khong, T Y

1996 VOLUME 22/5Buddhism, euthanasia and the sanctity oflife, 309-313Perrett, RoyW

20.2.2: Death and dying:Definitions/determination of death:Bills, laws and cases

1996 VOLUME 22/5Guest editorial: End-of-life decisions andthe law, 261-262McLean, Sheila

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

1996 VOLUME 22/6Do the ward notes refelct the quality ofend-of-life care? 344-348Sulmasy, Daniel P, Dwyer, Maureen andMarx, Eric

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

1996 VOLUME 22/3On withholding artificial hydration andnutrition from terminally ill sedatedpatients. The debate continues, 147-153Craig, Gillian M

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

1996 VOLUME 22/2Betting your life: an argument againstcertain advance directives, 95-99

Ryan, Christopher JamesEditonal: Advance directives, 67-68Hope, Tony

1996 VOLUME 22/3Resuscitating the elderly: what do thepatients want?, 154-159Bruce-Jones Peter, Roberts Helen, BowkerLesley and Cooney Veneta

1996 VOLUME 22/5Futility and death in paediatric medicalintensive care, 279-281Balfour-Lynn, Ian M, and Tasker,Robert CResuscitation decisions in the elderly: adiscussion of current thinking, 286-291Bruce-Jones, Peter

20.5.3: Death and dying: Prolongationof life and euthanasia: Bills, laws andcases

1996 VOLUME 22/ 5The legalisation of active voluntaryeuthanasia in Australia: will the slipperyslope prove fatal?, 273-278Kerridge, Ian H and Mitchell, Kenneth R

22.1: Animal welfare: General

1996 VOLUME 22/4At the coalface: Should a doctor prescribehormone replacement therapy derivedfrom mare's urine? 199-203Cox, Dennis

22.2: Animal welfare: Animalexperimentation

1996 VOLUME 22/5Animal rights v animal research: a modestproposal, 300-301Bernstein, JosephA reply to Josepth Bernstein, 302-303Sprigge, Timothy

BOOK REVIEWS

1.1: Philosophical ethics

1996 VOLUME 22/2Moral philosophy by D D Raphael, 121-122Cartwright, Will

1996 VOLUME 22/5Rethinking life and death. The collapse ofour traditional ethics by Peter Singer, 315Pritchard, Jane

1.3: Ethics: Applied and professionalethics

1996 VOLUME 22/1Ethics, law and nursing by N Fletcher, JHolt and M Brazier, 57-58de Raeve, Louise

1996 VOLUME 22/2Community ethics and health careresearch edited by I C Henry and GPashley, 122-123McHaffie, Hazel E

3tournal ofMedical Ethics, 1996; 22: 372

1996 VOLUME 22/5Rethinking life and death. The collapse ofour traditional ethics by Peter Singer, 315Pritchard, Jane1996 VOLUME 22/6Health information ethics by P A Cunniffe,365-366Gatherer, Alex

1.3.5: Ethics: Applied and professionalethics: Government

1996 VOLUME 22/1Death and deliverance - 'euthanasia' inGermany 1900-1945 by Michael Burleigh,59-60Forrest, Duncan

1.3.8 Ethics: Applied and professionalethics: Law

1996 VOLUME 22/2AIDS: a guide to the law (2nd ed)edited by Richard Haigh and Dai Harris,122Cooper, Jonathan C

2.1: Bioethics: General

1996 VOLUME 22/1Bioethics for the people by the people byDarryl R J Macer, 61Neuberger, JuliaEthical foundations of health careresponsibilities in decision making by JaneSingleton and Susan McLaren, 58Dines, AlisonEthics and perinatology edited byA Goldsworth, W Silverman,D K Stevenson, E W D Young andR Rivers, 125-126Oppe, T EMoral matters: ethical issues in medicineand the life sciences by Arthur Caplan,61-62Mahon, JosephPrimum non nocere today: a symposiumon paediatric bioethics edited byG R Burgio and J D Lantos, 187- 188Oppe, TE

1996 VOLUME 22/2Buddhism and bioethics by DamienKeown, 123-124Florida, Robert E

1996 VOLUME 22/5Ethics and biotechnology edited byA Dyson and J Harris, 316-317Bangham, C R M

1996 VOLUME 22/6Ethical aspects of human reproductionedited by Claude Surreau and FrancoiseShenfield, 368Regan, Lesley

2.3: Bioethics: Education/programmes

1996 VOLUME 22/6Ethics for everyone - a practical guide tointerdisciplinary biomedical ethicseducation by L C Grafius, 362-363Fairbairn, Gavin J

4.1.1: Philosophy of Medicine andHealth: Philosophy of the HealthProfessions: Genereal

1996 VOLUME 22/6Zur verantwortung des arztes by UrbanWiesing, 366-367Herych, Eckhard

4.2: Philosophy of medicine andhealth: Concept of health

1996 VOLUME 22/2The Healing arts - an Oxford illustratedanthology by R S Downie, 125West, Richard

1996 VOLUME 22/4The international assessment of health-related quality of life: theory, translation,measurement and analysis edited by SallyShumaker and Richard Berzon, 248-249Fitzpatrick, Ray

4.3: Philosophy of medicine andhealth: Concept of mental health

1996 VOLUME 22/4Philosophy, psychology and psychiatry,edited by A Phillips Griffiths, 253-254Radden, Jennifer

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

1996 VOLUME 22/3Concepts and measurement of quality oflife in health care edited by LennardNordenfelt, 187Williams, Andrew

1996 VOLUME 22/4The international assessment ofhealth-related quality of life: theory,translation, measurement and analysisedited by Sally Shumaker and RichardBerzon, 248-249Fitzpatrick, Ray

5.3: Science/technology and society:Social control of science/technology

1996 VOLUME 22/6Health data in the information age: use,disclosure and privacy edited by Molla SDonaldson and Kathleen N Lohr, 362Jarvis, Rupert

8.1: Professional-patient relationship:General

1996 VOLUME 22/4Humane medicine by Miles Little,247-248Black, Sir Douglas

8.3.1: Professional-patientrelationship: Informed consent:General

1996 VOLUME 22/6Assessment of mental capacity: guidancefor doctors and lawyers by the BritishMedical Association and the Law

Society, 364-365Series, HughThe older person: consent and care by theBritish Medical Association and the RoyalCollege of Nursing, 364-365Series, Hugh

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

1996 VOLUME 22/2Advance statements about medicaltreatment by the British MedicalAssociation, 126Dunstan G R

1996 VOLUME 22/5Therapy abatement, autonomy and futility:ethical decisions at the edge of life byDavid Lamb, 317-318Draper, Heather

9.1: Health care: General

1996 VOLUME 22/1Doctors, dilemmas, decisions by BenEssex, 60Hull, Robin

1996 VOLUME 22/3Science and the quiet art. Medical researchand patient care by David Weatherall,188-189Miles, Caroline

1996 VOLUME 22/4Chronic illness: from experience to policy,edited by s K Toombs, D Barnard and R ACarson, 249-250Greaves, David

1996 VOLUME 22/6Long-term care decisions: ethical andconceptual dimensions edited by LaurenceB McCullough and Nancy L Wilson,363-364May, Thomas

9.4: Health care: Allocation of healthcare resources

1996 VOLUME 22/4Justice and health care: comparativeperspectives, edited by Andrew Grubb andMaxwell J Mehlman, 250-251McHale, J VReforming health care, edited by DavidSeedhouse, 253Reddoch, Margaret


9.5.1: Health care: Health careprogrammes for specificdiseases/groups: General

1996 VOLUME 22/6Bringing the hospital home: ethical andsocial implications of high-tech home careedited by John D Arras, 367-368Lennox, Gordon


9.5.6: Health care:Health careprogrammes for specificdiseases/groups: HIV infection andAIDS

1996 VOLUME 22/2AIDS: a guide to the law (2nd ed) editedby Richard Haigh and Dai Harris, 122Cooper, Jonathan CParliament and screening: ethical andsocial problems arising from testing andscreening for HIV and genetic disease,edited by Wayland Kennet, 366Miller, David

14.1: Reproductive technologies:General

1996 VOLUME 22/1The family in the age of biotechnologyedited by Carole Ulanowsky, 58-59Dunstan, G R

1996 VOLUME 22/4Children of choice freedom and the newreproductive technologies by John ARobertston, 247McHale, J V

15.3: Genetics, molecular biology andmicrobiology: Genetic screening

1996 VOLUME 22/6Parliament and screening: ethical andsocial problems arising from testing andscreening for HIV and genetic disease,edited by Wayland Kennet, 366Miller, David

17.2: The neurosciences and mentalhealth therapies: Psychotherapy

1996 VOLUME 22/5The illusion of psychotherapy by WilliamM Epstein, 314-315Holmes, Jeremy

18.1: Human experimentation: General

1996 VOLUME 22/4The ethics of animal and humanexperimentation edited by Peter D DeDeyn, 252-253Frey, R G

1996 VOLUME 22/5Ethics in epidemiology and clinicalresearch, annotated readings, edited bySteven S Coughlin, 317Lamb, David

18.2: Human experimentation: Policyguidelines

1996 VOLUME 22/1The ethics of IVF by Anthony Dyson, 57Dunstan, G R

1996 VOLUME 22/4Good clinical practice and ethics inEuropean drug research edited by PeterBennett, 249Frith, Lucy

18.5.2: Human experimentation:Research on special populations:Children

1996 VOLUME 22/2Children as research subjects: science,ethics and law edited by M A Grodin andL H Glantz, 124-125Nicholson, Richard

18.6: Human experimentation: Socialcontrol ofhuman experimentation

1996 VOLUME 22/5Ethics in epidemiology and clinicalresearch, annotated readings, edited bySteven S Coughlin, 317Lamb, David

19.1: Artificial and transplantedorgans/tissues: General

1996 VOLUME 22/1Procuring organs for transplant: the debateover non-heart-beating cadaver protocolsedited by Robert M Arnold, Stuart JYoungner, Renie Schapiro and CarolMason Spicer, 60-61Lamb, David

20.1: Death and dying: General

1996 VOLUME 22/1Procuring organs for transplant: the debateover non-heart-beating cadaver protocolsedited by Robert M Arnold, Stuart JYoungner, Renie Schapiro and CarolMason Spicer, 60-61Lamb, David

1996 VOLUME 22/5Rethinking life and death. The collapseof our traditional ethics by Peter Singer,315Pritchard, Jane

20.2: Death and dying:Definition/determination of death


20.3: Death and dying: Attitudestoward death


20.5: Death and dying: Prolongation oflife and euthanasia

1996 VOLUME 22/3Least worst death, The, by MNargaret PabstBattin, 183-187Savulescu, Julian


20.7: Death and dying: Suicide

1996 VOLUME 22/2Contemplating suicide: the language andethics of self harm by Gavin J Fairbairn,123Macnaughton, Jane

1996 VOLUME 22/3Least worst death, The, by Margaret PabstBattin, 183-187Savulescu, Julian

21.4: International and politicaldimensions of biology and medicine:Torture

1996: VOILUME 22/4Torture: human rights, medical ethics andthe case of Israel edited by Neve Gordonand Ruchama Marton, 251-252Forrest, Duncan

22.2: Animal welfare: Animalexperimentation

1996 VOLUME 22/4The ethics of animal and humanexperimentation, edited by Peter P DeDeyn, 252-253Frey, R G

Journal ofMedical Ethics, 1996; 221: 374

Alphabetical index

PAPERS

A

Animal rights v animal research: a modestproposal, 22, 300-301: 22.2An obligation to provide abortionservices:what happens when physiciansrefuse?, 22, 115-120: 1.4.3; 9.2A reply to Joseph Bernstein, 22, 302-303:22.2.At the coalface: Autonomy: the need forlimits, 22, 332-338: 9.2At the coalface: Should a doctor prescribehormone replacement therapy which hasbeen manufactured from mare's urine?, 22,199-203: 22.1

B

Betting your life: an argument againstcertain advance directives, 22, 95-99:20.5.1Bioethics and caring, 22, 83-89: 1.1BMJ response to Dr Gupta, 22, 245-246:1.3.9Bodily integrity and the sale of humanorgans, 22, 334-339: 19.5Buddhism, euthanasia and the sanctity oflife, 22, 309-313: 1.2; 20.1

C

Communication with the seriously ill:physicians' attitudes in Saudi Arabia, 22,282-285: 8.2; 8.3.4Consent to clinical research - adequatelyvoluntary or substantially influenced?, 22,232-237: 18.3Cycle helmets - when is legislationjustified?, 22, 41-45: 1.3.1

D

Debate: Another peep behind the veil, 22,216-221: 9.4Debate: Covert video surveillancecontinues to provoke debate, 22, 351:1.3.1; 9.6Debate: Covert video surveillance: theStaffordshire Protocol - a response to DrShinebourne, 22, 349-350: 1.3.1; 9.6Debate: Double jeopardy, the equal valueof lives and the veil of ignorance: arejoinder to Harris, 22, 204-208: 9.4Debate:Would Aristotle have played"Russian Roulette"?, 22, 209-215: 9.4

Delays and diversity in the practice of localresearch ethics committees, 22, 263-266:9.6Do brain tissue transplants alter personalidentity? Inadequacies of some "standard"arguments, 22, 174-180: 2.1Do the ward notes reflect the quality ofend-of-life care?, 22, 344-348: 20.4.1

E

Editorial: Advance directives, 22, 67-68:20.5.1Editon'al: Brain transplantation, personalidentity and medical ethics, 22, 132-133:2.1Editorial: Case studies and medicaleducation, 22, 3-4: 2.1Editorial: Ethnography, medical practiceand moral reflective equilibrium 22, 259-260: 4.1.2, 4.1.3Editorial: Ethical considerations of theperinatal necropsy, 22, 111-114: 8.3; 20.1Editorial: QALYs, lotteries and veils: thestory so far, 22, 195-196: 9.4Editorial: Thinking about a medical schoolcore curriculum for medical ethics and law,22, 323-324: 2.3.Ethical reasoning in mixed nurse-physiciangroups, 22, 168-173: 2.1; 7.3Ethical theory, ethnography anddifferences between doctors and nurses inapproaches to patient care, 22, 292-299:4.1.2; 4.1.3Ethics of complementary medicine, The,22, 197-198: 2.1Ethics of Soviet medical practice, The:behaviours and attitudes of physicians inSoviet Estonia, 22, 33-40: 6Equipoise as a means of managinguncertainty: personal, communal andproxy, 22, 135-139: 18.3Exercising restraint: autonomy, welfareand elderly patients, 22, 160-163: 9.5.2

F

Futility and death in paediatric medicalintensive care, 22, 279-281: 20.5.1

G

Genetic testing and early diagnosis andintervention: boon or burden?, 22,105-110: 15.2Guest editonal:End-of-life decisions and thelaw, 22, 261-262: 20.2.2

Guest editonral: Ethics without abstraction:squaring the circle, 22, 69-71: 2.1Guest editorial: Medical and scientific usesof human tissue, 22, 5-7: 19.1Guest editorial: Medical ethics, teachingand the new genetics, 22, 325-326: 2.3Guest editorial: Tackling the drug problem -what can doctors do?, 22, 133-134: 4.1.2;1.3.8

L

Legalisation of active voluntary euthanasiain Australia, The: will the slippery slopeprove fatal?, 22, 273-278: 20.5.3Limiting risks by curtailing rights: aresponse to Dr Ryan, 22, 100-104: 20.5.1

N

Non-therapeutic (elective) ventilation ofpotential organ donors: the ethical basis forchanging the law, 22, 72-77: 19.5

0

Offering patients entry in clinical trials:preliminary study of the views ofprospective participants, 22, 227-231: 8.1On withholding artificial hydration andnutrition from terminally ill sedatedpatients. The debate continues, 22,147-153:20.5

p

Patient decision-making: medical ethicsand mediation, 22, 164-167: 1.3Placebos in clinical practice and research,22, 140-146: 1.3; 2.1Potential and the early human, 22,222-226: 12.1; 14.4Preferences, needs and QALYs, 22,267-272: 4.4; 9.4

R

Random paired scenarios - a method forinvestigating attitudes to prioritisation inmedicine, 22, 238-242: 9.4Reply to Ann Bradshaw, 22, 13-15: 4.1.1Research ethics committees at work: theexperience of one multi-location study, 22,:18.1Research ethics committee audit:differences between committees, 22,78-82: 9.6

3rournal ofMedical Ethics, 1996; 22: 375

Resuscitating the elderly: what do thepatients want?, 22, 154-159: 20.5.1Resuscitation decisions in the elderly: adiscussion of current thinking, 22,286-291: 20.5.1

S

Selective reduction of pregnancy: a legalanalysis, 22, 304-308: 12.4.1; 14.4Should intellectual property bedisseminated by "forwarding" rejectedletters without permission?, 22, 243-244:1.3.9Sy?nposiu?n orn covert video surveillance:Covert video surveillance: an assessment ofthe Staffordshire Protocol, 22, 22-25:1.3.1; 9,6Symnposiumz on covert video surveillance:Covert video surveillance and the principleof double effect: a response to criticism,22, 26-28: 8.1; 9.6Synposiumn on covert video surveillance:Covert video surveillance - a response toProfessor Southall and Dr Samuels, 22,29-31: 9.6Sy?nposiumn on covert video surveillance:Guidelines for the multi-agencymanagement of patients suspected or atrisk of suffering from life-threatening abuseresulting in cyanotic-apnocic episodes, 22,16-21: 9.6Symnposiumn on covert video surveillanice:Reply to Dr Evans re covert videosurveillance, 22, 32: 9.6

T

Teaching mnedical ethics: Does teaching casesmislead us about morality?, 22, 46-52: 2.1Those were the days: looking back at thefuture, 22, 356-359: 2.1

w

What are the limits to the obligations ofthe nurse?, 22, 90-94: 1.3Women, forced caesareans and antenatalresponsibilities, 22, 327-333: 8.3.4; 9.5.5;14.1

y

Yes! There is an ethics of care: an answerfor Peter Allmark, 22, 8-12: 4.1.3

AUTHORS

A

Ahmed, Ala'Eldin H, 22, 263-266: 9.6Alderson, Priscilla, 22, 135-139: 18.3Al-Kassimi, Feisal A, 22, 282-285: 8.2;8.3.4Allmark, Peter, 22, 13- 15: 4.1.1Al-Majid, Suliman A, 22, 282-285: 8.2;8.3.4Al-Shimemry, Abdullah, 22, 282-285: 8.2;8.3.4

B

Balfour-Lynn, Ian M, 22, 279-281: 20.5.1

Barr, Donald A, 22, 33-40: 6Baum, J D, 22, 78-8 2: 9.6Bernstein, Joseph, 22, 300-301: 22.2Bowker, Lesley, 22, 154-159: 20.5.1Bradshaw, Ann, 22, 8-12: 4.1.3Bruce-Jones, Peter, 22, 154-159: 20.5.1;286-291:20.5.1

C

Callahan, Daniel, 22, 69-7: 2.1Cohen, Joshua, 22, 267-272: 4.4; 9.4Cooney, Veneta, 22, 154-159: 20.5.1Coope, Christopher Miles, 22, 46-52: 2.1Corbett, Fiona, 22, 227-231: 8.1Cox, Dennis, 22, 199-203: 22.1Craft, Naomi, 22, 245-246: 1.3.9Craig, Gillian M, 22, 147-153: 20.5Craig, Yvone J, 22, 164-167: 1.3

D

de Beaufort, Inez, 22, 356-359: 2.1De Deyn, Peter P, 22, 140-146: 1.3; 2.1D'Hooge, Rudi, 22, 140-146: 1.3; 2.1Dodds, Susan, 22, 160-163: 9.5.2Draper, Heather, 22, 327-333: 8.3.4;9.5.5; 14.1Dwyer, Maureen, 22, 344-348: 20.4.1

E

Edwards, Steven D, 22, 90-94: 1.3Ernst, E 22, 197-198: 2.1Evans, Don, 22, 29-31: 9.6

G

Garrard, Eve, 22, 334-339: 19.5Gillon, Raanan, 22, 3-4: 2.1; 131-132:2.1; 259-260: 4.1.2, 4.1.3; 323-324: 2.3.Gjersoe, Peter, 22, 168-173: 2.1; 7.3Grode, Glenn, 22, 168-173: 2.1; 7.3Gupta, Vinod Kumar, 22, 243-244: 1.3.9

H

Hall, Alison, 22, 304-308: 12.4.1; 14.4Harris, A, 22, 78-82: 9.6Harris, J, 22, 209-215: 9.4Hartling, Ole, 22, 168-173: 2.1; 7.3Hepburn, Elizabeth R, 22, 105-110: 15.2Hewlett, Sarah, 22, 232-237: 18.3Holm, Soren, 22, 168-173: 2.1; 7.3Hope, Tony, 22, 67-68: 9.4; 195-196:9.6

1

Ibsen, Karen I, 22, 168-173: 2.1; 7.3

J

Jiwa, Moyez, 22, 340-343: 9.2

K

Kerridge, Ian H, 22, 273-278: 20.5.3Khong, T Y, 22, 111-114: 8.3; 20.1Kuhse, Helga, 22, 204-208; 216-221: 9.4

L

Lilford, Richard, 22, 227-231: 8.1Luttrell, Steven, 22, 100-104: 1.3

M

Marcussen, Henrik, 22, 168-173: 2.1; 7.3Marx, Eric, 22, 344-348: 20.4.1McLean, Sheila, 22, 261-262: 20.2.2Meyers, Christopher, 22, 115-120: 12.4.3;9.2Mitchell,Kenneth R, 22, 273-278: 20.5.3McKie, John, 22, 204-208; 216-221: 9.4Mobeireek, Abdullah F, 22, 282-285: 8.2;8.3.4Myllykangas, Markku, 22, 238-242: 9.4

N

Nicholson, Karl G, 22, 263-266: 9.6Northoff, Georg, 22, 174-180: 2.1

0

Oldham, Julia, 22, 227-231: 8.1O'Neill, Onora, 22, 5-7: 19.1

p

Perrett, Roy W, 22, 309-313: 1.2; 20.1

R

Redshaw, M E, 22, 78-82: 9.6Richardson, Jeff, 22, 204-208; 216-221:9.4Roberts, Helen, 22, 154-159: 20.5.1Robertson, David W, 22, 292-299: 4.1.2;4.1.3Robson, Philip, 22, 133-134: 4.1.2; 1.3.8Ryan, Christopher James, 22, 95-99:20.5.1Ryynanen, Olli-Pekka, 22, 238-242: 9.4

S

Samuels, Martin P, 22, 15-21; 32: 9.6Shaw, A B, 22, 72-77: 19.5Shinebourne, Elliot, 22, 26-28: 8.1; 9.6;1.3.1; 9.6

Singer, Peter, 22, 204-208; 216-221: 9.4Smith, Richard, 22, 245-246: 1.3.9Somerville, Ann, 22, 100-104: 1.3Southall, David P, 22, 15-21; 32: 9.6Sprigge, Timothy, 22, 302-303: 22.2Sulmasy, Daniel P, 22, 344-348: 20.4.1

T

Takala, Jorma, 22, 238-242: 9.4Tasker, Robert C, 22, 279-281: 20.5.1Thomas, Terry, 22, 22-25: 1.3.1; 9.6;

1.3. 1; 9.6

U

Unwin, Nigel C, 22, 41-45: 1.3.1

V

van Hooft, Stan, 22, 83-89: 1.1Vaskilampi, Tuula, 22, 238-242: 9.4

w

Watt, Helen, 22, 222-226: 14,4; 12.1While, Alison E, 22, 352-355: 18.1Wilkinson, Stephen, 22, 334-339: 19.5Williamson, Bob, 22, 325-326: 2.3


Woods, Robert, 22, 115-120: 12.4.3; 9.

BOOK REVIEWS

A

Advance statements about medicaltreatment, 22, 126: 8.3.4AIDS: a guide to the law (2nd ed), 22,122: 9.5.6, 1.3.8Assessment of mental capacity:guidancefor doctors and lawyers, 22, 364-365: 8.3.1

B

Bioethics for the people by the people, 22,61: 2.1Bringing the hospital home: ethical andsocial implications of high-tech home care,22, 367-368: 9.5.1Buddhism and bioethics, 22, 123-124: 2.1

C

Children as research subjects: science,ethics and law, 22, 124-125: 18.5.2Children of choice: freedom and thenew reproductive technologies, 22, 247:14.1Chronic illness: from experience to policy,22, 249-250: 9.1Community ethics and health careresearch, 22, 122-123: 1.3Concepts and measurement of quality oflife in health care, 22, 187: 4.4Contemplating suicide: the language andethics of self harm, 22, 123: 20.7

D

Death and deliverance - 'euthanasia' inGermany 1900-1945, 22, 59-60: 1.3.5Doctors, dilemmas, decisions, 22, 60: 9.1

E

Ethical aspects of human reproduction, 22,368: 2.1Ethical foundations of health careresponsibilities in decision making, 22, 58:2.1Ethics and biotechnology, 22, 316-317:2.1Ethics and perinatology, 22, 125-126: 2.1Ethics for everyone - a practical guide tointerdisciplinary biomedical ethicseducation, 22, 362-363: 2.3Ethics in epidemiology and clinicalresearch, annotated readings, 317Lamb, DavidEthics, law and nursing, 22, 57-58: 2.1Ethics of animal and humanexperimentation, The, 22, 252-253: 18.1;22.2Ethics of IVF, The, 22, 57: 14.4

F

Family in the age of biotechnology, The,22, 58-59: 14.1

G

Good clinical practice and ethics inEuropean drug research, 22, 249: 18.2

H

Healing arts, The, - an Oxford illustratedanthology, 22, 125: 4.2Health data in the information age: use,disclosure and privacy, 22, 362: 5.3Health information ethics, 22, 365-366: 1.3Humane medicine, 22, 247-248: 8.1

I

Illusion of psychotherapy, The, 22,314-315: 17.2International assessment of health-relatedquality of life: theory, translation,measurement and analysis, The, 22,248-249: 4.2; 4.4

J

Justice and health care: comparativeperspectives, 22, 250-251: 9.4

L

Least worst death, The, 22, 183-187: 20.5;20.7Long-term care decisions: ethical andconceptual dimensions, 22, 363-364: 9.1

M

Moral matters: ethical issues in medicineand the life sciences, 22, 61-62: 2.1Moral philosophy, 22, 121-122: 1.1

0

Older person, The: consent and care, 22,364-365: 8.3.1

p

Parliament and screening: ethical andsocial problems arising from testing andscreening for HIV and genetic disease, 22,366: 9.5.6; 15.3Philosophy, psychology and psychiatry, 22,253-254: 4.3Primum non nocere today: a symposiumon paediatric bioethics, 22, 187-188: 2.1Procuring organs for transplant: the debateover non-heart-beating cadaver protocols,22, 60-61 19.1, 20.1

R

Reforming health care, 22, 253: 9.4Rethinking life and death. The collapse ofour traditional ethics, 22,3 15: 1.1; 1.3;201; 20.2; 20.3.

S

Science and the quiet art. Medical researchand patient care, 22, 188-189: 9.1

T

Therapy abatement, autonomy and futility:

ethical decisions at the edge of life, 22,317-318 20.5; 8.3.4; 9.4Torture: human rights, medical ethics andthe case of Israel, 22, 251-252: 21.4

z

Zur verantwortung des arztes by UrbanWiesing, 22, 366-367: 4.1

BOOK REVIEWERS

B

Bangham, C RM, 22, 316-317: 2.1Black, Sir Douglas, 22, 247-248: 8.1

C

Cartwright, Will, 22, 121-122: 1.1Cooper, Jonathan P, 22, 122: 9.5.6,1.3.8

D

de Raeve, 22, 57-58: 1.3Dines, Alison, 22, 58: 2.1Draper, Heather, 22, 317-318: 8.3.4; 9.4;20.5Dunstan, G R, 22, 58-59: 14.1; 57: 14.4;126: 8.3.4

F

Fairbairn, Gavin J, 22, 362-363: 2.3Fitzpatrick, Ray, 22, 248-249: 4.2; 4.4Florida, Robert E, 22, 123-124: 2.1Forrest, Duncan, 22, 59-60: 1.3.5;252-253: 21.4Frey, R G, 22, 252-253: 18.1; 22.2Frith, Lucy, 22, 249: 18.2

G

Gatherer, Alex, 22, 365-366: 1.3Greaves, David, 22, 249-250: 9.1

H

Herych, Eckhard, 22, 366-367: 4.1Holmes, Jeremy, 22, 314-315: 17.2Hull, Robin, 22, 60: 9.1

J

Jarvis, Rupert, 22, 362: 5.3

L

Lamb, David, 22, 60-61: 19.1, 20.1: 22,317: 18.1; 18.6Lennox, Gordon, 22, 367-368: 9.5.1

M

Macnaughton, Jane, 22, 123: 20.7Mahon, Joseph, 22, 61-62: 2.1May, Thomas, 22, 363-364: 9.1McHaffie, Hazel E, 22, 122-123: 1.3McHale,JV, 22, 247:14.1; 250-251: 9.1

3rournal ofMedical Ethics, 1996; 22: 377

Miles, Caroline, 22, 188-189: 9.1 PMiller, David, 22, 366: 9.5.6; 15.3

Pritchard, Jane, 22, 315: 1.1; 1.3; 20.1;N 20.2; 20.3.

Neuberger, Julia, 22, 61: 2.1 R

o Radden, Jennifer, 22, 253-254: 4.3Reddoch, Margaret, 22, 253: 9.4

Oppe, T E, 22, 125-126: 2.1; 187-188: 2.1 Regan, Lesley, 22, 368: 2.1

S

Savulescu, Julian, 22, 183-187 : 20.5;20.7Series, Hugh, 22, 364-365: 8.3.1; 9.4

w

West, Richard, 22, 25: 4.2Williams, Andrew, 22, 187: 4.4

J7ournal ofMedical Ethics 1996; 22: 378

American National Reference Center for Bioethics Literature

Library classification scheme (the KennedySystem)

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

1.3.1 General1.3.2 Business1.3.3 Education1.3.4 Engineering1.3.5 Government1.3.6 International Affairs1.3.7 Journalism1.3.8 Law1.3.9 Scientific Research1.3.10 Social Work

2 Bioethics2.1 General2.2 History of Medical Ethics2.3 Education/Programmes

3 Philosophy of Biology3.1 General3.2 Evolution and Creation

4 Philosophy of Medicine and Health4.1 Philosophy of the Health Professions

4.1.1 General4.1.2 Philosophy of Medicine4.1.3 Philosophy of Nursing

4.2 Concept of Health4.3 Concept of Mental Health4.4 QualityNalue of Life

5 Science/Technology and Society5.1 General5.2 Technology Assessment5.3 Social Control of Scienceifechnology

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 Consent to Treatment8.3.3 Third Party Consent/Incompetents8.3.4 Right to Refuse Treatment8.3.5 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/Groups9.5.1 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 Committees9.7 Pharmaceutical Industry

10 Sexuality

11 Contraception1 1.1 General11.2 Availability of Contraceptives to Minors1 1.3 Sterilisation11.4 Failure of Contraception/Wrongful Birth

12 Abortion12.1 General12.2 Position Statements12.3 Moral and Religious Aspects12.4 Legal Aspects

12.4. 1 General12.4.2 Interests of Woman/Fetus/Father12.4.3 Interests of Health P'ersonnel/

Institutions12.4.4 Bills, Laxvs and C(ases

12.5 Social Aspects12.5.1 General12.5.2 Demographic Surveys12.5.3 Abortion Counselling

13 Population13.1 General1 3.2 Population Growth13.3 Population l'olicy

14 Reproductive Technologies14.1 General14.2 Artificial Insemination and Surrogacv14.3 Sex Predetermination14.4 In Vitro Fertilisation and Embryo TIransfer14.5 Cloning14.6 Cryobanking of Sperm, Ova, or Embryos

15 Genetics, Molecular Biology andMicrobiology15.1 General15.2 Genetic Counselling and Prenatal

Diagnosis15.3 Genetic Screening15.4 Gene Therapy15.5 Eugenics15.6 Behavioural Genetics15.7 Biohazards of Genetic Research15.8 Patenting Organisms15.9 Sociobiology

16 Environmental Quality16.1 General16.2 Nuclear Power16.3 Occupational Health

17 The Neurosciences and MentalHealth Therapies17.1 General17.2 Psychotherapy17.3 Operant Conditioning17.4 Psychopharmacology17.5 Electnical Stimulation of the Brain

17.6 Psychosurgery17.7 Involuntary Civil Commitment17.8 Right of the institutionalised to

Treatment

18 Human Experimentation18.1 General18.2 Policv Guidelines18.3 Informed Consent18.4 Behavioural Research18.5 Research on Special Plopulations

18.5.1 General18.5.2 (Children18.5.3 IPregnant Women18.5.4 Fetuses and Neonates18.5.5 Prisoners18.5.6 Mentally Handicapped Persons18.5.7 Elderly and Terminally III

Persons18.5.8 Military and Government

l'ersonnel18.5.9 Foreign Nationals

18.6 Social Control of Human Experimentation

19 Artificial and TransplantedOrgans/Tissues19.1 General19.2 Hearts19.3 Kidneys19.4 Blood19.5 Donation/Procurement of

Organs/Tissues19.6 Allocation of Organs%/ issues

20 Death and Dying20.1 General20.2 Definition/Determination of Death

20.2.1 General20.2.2 Bills, Laws and Cases

20.3 Attitudes TIoward Death20.3.1 General20.3.2 Health P'ersonnel20.3.3 Family20.3.4 Death Education

20.4 Care of the Dying Patient20.4.1 General20.4.2 Care of the Dying Child

20.5 Iarolongation of Life and Euthanasia20.5.1 General20.5.2 Allowing Infants to D)ie20.5.3 Bills, Laws and Cases

20.6 Capital Punishment20.7 Suicide

21 International and PoliticalDimensions of Biology and Medicine21.1 General21.2 War21.3 Chemical and Biological Weapons21.4 Torture21.5 Forced Feeding of Prisoners21.6 International Migration of Physicians

22 Animal Welfare22.1 General22.2 Animal Experimentation22.3 Animal Production

JOURNAL OF

MEDICAL ETHICSJfournal of the Institute ofMedical Ethics

VOLUME 22- 1996

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

EDITORIAL BOARDThomas Oppe (Chairman)Susan BewleyK M BoydMargaret BrazierAnthony CulyerLouise de RaeveDonna Dickenson

John HaldaneJohn HarrisRoger HiggsMargot JefferysRt Hon Sir PatrickNaime

Julia NeubergerAllyson PollockAlain PompidouOctavi QuintanaThe Very ReverendEdward Shotter

Bob Williamson

EX OFFICIORichard SmithRichard West

BMJ PUBLISHING GROUP

J7ournal ofMedical Ethics 1996; 22: 383

Notice for contributors to the Journal ofMedical Ethics

Submitting manuscripts forpublication

Four copies of papers submitted forpublication should be sent to: The Editor,Journal of Medical Ethics, Analytic EthicsUnit, Imperial College of Science,Technology and Medicine, LondonSW7 2AZ. The journal considers papers onlyif they are not under consideration by any

other journal at the same time. Rejectedmanuscripts are not returned. Papers,including references, should be in double-spaced typewriting on one side of the paper

only. A total word-count is required, andpages should be numbered sequentially. On a

separate sheet brief details of the author'spresent post, an address for readers'correspondence and any other relevantinformation should be supplied.

The J7ME uses a simplified 'Vancouver style'for references. The full text of the'Vancouver Agreement' was published in theBntish Medical Joutrial in 1991; 302; 338 41.As the "Vancouver style" is incompatiblewith the long established style of referenccsfor legal articles, lawyers should use theirown standard style, but avoid abbreviationsso as to facilitate reference by others. Thejournal is multidisciplinary and papers

should be in clear jargon-free English,accessible to any intelligent reader.

Authors are asked to avoid footnotes. Thepreferred maximum length of papers is 3,500words - absolute maximum 5,500 (includingreferences). Book reviews should be between600 and 1,000 words. Abbreviations should beavoided. The names of joumals, organisationsetc should be given in full in the text.

Two copies of the journal will be sentto authors free of charge after theirpapers are published. Offprints ofindividual papers may be bought fromThe Publisher, Journal of MedicalEthics, BMJ Publishing Dept, BMAHouse, Tavistock Square, LondonWC1H 9JR.

Simplified 'Vancouver style'All papers submitted for publication shouldcontain the following:1 On page one of the manuscript:

a) the title of the article which should beconcise but informative and designed toattract the reader. The Editor reserves theright to change titles to achieve these ends.b) names, initials or forenames andacademic degrees (if any) of author or

authorsc) names of department(s) and

institution(s) to which the work should beattributed, if anyd) disclaimers, if anye) source(s) of support, if any.

2 On page two:a) an initeresting abstract or summary ofnot more than 150 words. Emphasiseimportant and/or new aspects of the articleto attract the potential reader. Ensure theabstract contains a statement of the aim,key points and conclusion of the paper.Papers reporting the author's empiricalresearch should contain a structuredabstract summarising the research underthe headings: objectives; design; setting;patients or participants; interventions;main measurements; results; conclusions.Structured abstracts should not be longcrthan 250 words.b) key (indexing) terms below theabstract. Provide and identify as such,three to six key words or short phrases thatwill assist indexers in cross-indexing yourarticle and that may be published with theabstract.Where appropriate, use terms from theMedical Subject Headings List fromINDEX Mediclus.

3 Acknowledgements:Acknowledge only persons who have madcsubstantive contributions to the study.Authors are responsible for obtainingwritten permission from everyoneacknowledged by name because readersmay infer the latter's endorsement of dataand conclusions.

4 References:Number these consecutively in the order inwhich they are first mentioned in the text,tables, and captions, by arabic numerals,superscript, no brackets, for example,according to Jones.3 The list of referencesat the end of the paper should benumbered in the order in which eachreference appears in the text. Try to avoidusing abstracts as references. 'Unpublishedobservations' and 'personalcommunications' may not be used asreferences, although references to written,not verbal, communications may be inserted(in parenthesis) in the text. Manuscriptsaccepted but not yet published may be usedas references - designate the joumalfollowed by 'in press' (in parenthesis).Information from manuscripts submittedbut not accepted should be cited in the textas 'unpublished observations' (inparenthesis).

Where a further reference is made to aprevious reference, but to a different pagenumber or numbers, this should have a newreference number of its own and it should

then refer back to the original reference, thus:I May T. The nurse under physician

authority. Journial ofMedical Ethics 1993;19: 223-7.

2 See reference 1: 225.

Please note also that the names of journalsshould be in italics. The volume numbershould be in bold.

References must be verified by theauthor(s) against the originaldocuments.The following scheme, a simplification of the'Vancouver style' for biomedical joumals,should be followed for each reference: in thetext - number in superscript, followingpunctuation; in the list - author (list all authorsif six or less; if seven or more, list only the firstsix and add 'ct al'.), title, name of publication ifdifferent from title - in italic; place ofpublication and publisher (where appropriate);year of publication; and, where appropriate,volume number in bold and page references ofarticle or chapter referred to. Examples ofcorrect forms of reference are given below:

a) Standard journal article:1 Teasdale K, Kent G. The use ofdeception in nursing. Journial ofMedical Ethiics 1995; 21: 77 81

b) Corporate author:2 General Medical Council.7'Iiii,rrow 's doctors recoiiniendatiMIS (01

undergraduiate nedical educatin)1.London: General Medical Council,1993.

c) No author given:3 Anonymous [editorial]. AnonymousHIV testing. Lancet 1990; 335: 575 6.

d) Personal author(s):4 Singer P, Kuhse J. Sholuld the bab' lihve?Oxford: Oxford University Press, 1985.

e) Editor, compiler, chairman as author:5 Phillips CE, Wolfe JN, eds. Clinlicalpractice and econoynics. Tunbridge Wells:Pitman Medical, 1977.

f) Chapter in book:6 Hope T. Ethics and psychiatry. In:Rose N, ed. Essenitial p.sschiatnr [2nded]. Oxford: Basil Blackwell ScientificPublications, 1994: 45-51.

g) Agency publication:7 The Linacre Centre for the Study ofEthics and Health Care. Paper 1: TIheprinciple of respect for human life. In:Prolongation of life. London: TheLinacre Centre for the Study of Ethicsand Health Care, 1978.

h) Newspaper article:8 Dinwoodie R. Volunteers die asheart drug results baffle doctors.The Scotsmnan 1980 Sept 5: 1 1 (cols1-6).

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