It is nearly half a century since I qualified in medicine and it needs no preface to describe the vast changes which have come about during that period in the diagnosis, prevention and treatment of disease. Medical practice has become scientifically based and offers the patient an expertise that would have been regarded as science fiction before the Second World War. At the same time, while doctors' work has become more time-consuming and stressful, patients have become more demanding and it would be idle to deny that the doctor/patient relationship has become relatively impersonal -- at least, in the hospital environment.
A further inevitable result of the modern, scientific approach to medicine is that it leads to a quest for human perfection and that, along the road to that goal, those who are irrevocably imperfect tend to get left behind -- this includes the congenitally deformed, the neonate and the terminally ill. Attitudes to the value of life must change and it is well to stand back occasionally to see where we are going.
I admit to being concerned that we are becoming too ready to devalue the imperfect and, for that reason, I have wanted to write this book for some time. But it must be regarded as no more than a cautionary review; it may, at times, appear critical but that is not its primary intention. No one is more conscious than I am of the devotion which goes into caring for the newborn, for the paralysed or for the patient with disseminated cancer; what one would hope is that the whole profession would be motivated by the ideals of these specialists. This book will have served its purpose if it indicates ways or means by which this could come about.
The subjects covered are very emotional and must inevitably be subjectively coloured. It is important that authors in this field show their colours and I think it only fair to readers to say that I am a practising Roman Catholic; but this does not mean that I can have no individual conscience. In any case, what I am trying to speak of is the ethical practice of medicine, not the application of religious precept. Any bias in my conclusions is, I hope, attributable to reasonable deduction only.
I owe a debt of gratitude to those who have helped me with temporary typing -- in particular, Mrs Liz MacDonald and Mrs Sheila Smith. Dr R. A. McCall Smith has given me valuable criticism of parts of the manuscript. Dr Kenneth Boyd was kind enough to point me to the thematic quotation which exactly matches my feelings of inadequacy in an area which is of profound significance for the law, the public and the medical . . .