Book review: John Wilkinson, Christian Ethics in Health Care, Edinburgh: The Handsel Press 1988.

Author: Darryl R. J. Macer
This book claims to be the most comprehensive book available on the subject of Christian ethics in health care, and is subtitiled "A source book for Christian doctors, nurses and other health care professionals". It certainly covers a wide range of topics and could serve as a reference book on Christian ethics for health workers, at least being a place to begin to examine the ethical issues in medicine. Dr Wilkinson studied medicine and theology, and has been a practising physician.

At first inspection there seems to be a reasonable number of references, however the references could certainly have been helped by a greater proportion of more recent books on approaches to Christian ethics, and medical dilemmas. The brief reading list at the back of the book provides a few more recent books. The reference list could have been more comprehensive and modern for what is a "Source book". There are three indexes, according to subjects, names and scripture references.

The book is divided into three parts, Christian Ethics in Outline (pp 3-92), Health Care Ethics in History (pp 93-162), and Christian Ethics in Health Care (pp 163-486). After defining ethics, he says that Christian ethics is inseparable from theology. The sources of Christian ethics are natural morality, Biblical ethics, experience, philosophical ethics and ethical situations. The main ideas are discussed adequately for the purpose of the book, which is not to address the deeper discussion of ethical theory, but to arrive at some ethical principles to be applied. The presuppositions of Christian ethics are examined by looking at the aspects of man as created, fallen, redeemed and perfected; then the motives for Christian ethical conduct; then the characterisitics of Christian ethics are described as relational, absolute, comprehensive and redemptive.

There is an historical discussion of health care, which is a good introduction to the subject, in the space given. The profession is described, which is certainly a key feature of medicine, and the various codes of ethics that have been used at different times and in different cultures. Prior to examining individual issues, a Christian approach is outlined, as an "Ethical Questionaire", which is summarised in a page. Perhaps more discussion should have been centred around this summary of ethical principles since this should be at the core of how health care workers can approach ethical dilemmas. It consists of asking many questions in three catergories: What guidance do our sources provide (the five sources above plus the Holy Spirit and prayer, or conscience for the sake of a better word); is one particular solution suggested; and what is the underlying motive? At the end of the book there are some questions for discussion, which may be useful for Christian medical groups to think about.

The rest of the book addresses specific issues, the topics covered include contraception, infertility treatments, abortion, life-sustaining technology, death, organ transplantation, euthanasia, human experimentation, resource allocation, health care relationships, informed consent, confidentiality and AIDS. The major issues that are not covered are genetic screening and selective abortion, and genetic technologies, so that this source book is not complete, though no book really can be. The various arguments concerning each subject are voiced, which is obviously important as we often find people use versions of several basic arguments to support their views on a subject. It is good to know the strengths and weaknesses of each. There are short summaries of orthodox Christian views of underlying ideas such as sex, marriage, and fertility. The historical introductions, legal guidelines and

scientific summaries of available methods used in medicine make the book useful to the layreader who wishes to know more of these medical problems. The writing style is accessible to anyone interested in these topics.

No dramatically new ethical approach is outlined in this book, and it will not shake the foundations of ethical theory, but certainly if we followed the principles outlined it would make medicine more ethical. The way in which it discusses the various viewpoints on issues, including the various Christian positions, it is useful. As it is one of the most comprehensive source books available it would be a useful addition for practitioners of health care and interested layreaders, especially at a time when these issues are more involving the public than they did in the past.

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