HANDBOOK FOR HEALTH CARE ETHICS COMMITTEES Linda Farber Post, Jeffrey Blustein, and Nancy Neveloff Dubler Baltimore: Johns Hopkins University Press, 2006, 327 pp., $29.95 (softcover).
Scenarios created by the delivery of modern medical care increasingly present ethical quandaries too complex to be handled successfully just by the involved providers, patients, and families on their own. Although the direct participants in these complicated medical dramas often may need assistance to achieve clinically and morally satisfactory outcomes, formal resort to the judicial system for a legally definitive adjudication is very rarely desirable from anyone's perspective. Thus, the intermediate, voluntary but structured mechanism of institutional ethics committees (IECs) has developed. Emanating from a concept first proposed in the 1970s and spurred on by a number of well-publicized court decisions (summarized in part VI of the book under review), the IEC device has become a common and valuable fixture throughout the current American health care enterprise.
The potential virtues and shortcomings of IECs and the functions they seek to fulfill have generated a great deal of literature and discussion by experts in clinical care, health care administration, bioethics, and legal medicine. The coauthors of Handbook for Health Care Ethics Committees have been significant contributors to the rapid growth and development of IECs, both as key players in the clinical ethics apparatus of Montefiore Medical Center in New York and as major national (indeed, inter-national) writers and educators about the topic. The prior work of Post, Blustein, and Dubler (particularly the latter) is very familiar to those who have toiled for any length of time in the clinical ethics vineyards. In this new book, the authors assemble and share their substantial accumulated wisdom for the benefit of other health care institutions, their professional staffs, and especially their IEC members.
The intended audience is IEC members, to whom the authors speak directly in the second person: "The goal of this handbook is to help your committee be a knowledgeable, skillful, and effective ethics resource for your institution" (p. 12). This book certainly accomplishes that stated purpose. Moreover, despite the authors' disclaimer that they did not set out to produce a comprehensive textbook on clinical ethical principles and how they are applied in practice by IECs, this volume could serve as a very useful background tool for introductory instruction in bioethics, particularly for courses geared to health care professionals and students. Readers can either study this book as a whole (clearly the authors' intent) or chew on its separate parts.
Following an introduction setting out the fundamental functions (case consultation, policymaking on both the individual bedside and broader organizational levels, and professional and public education) and structural possibilities of IECs, part I presents a foundational clinical ethics curriculum, consisting of some brief theoretical explanation as well as illustrative case vignettes, discussion questions, and suggested strategies. Both the ethical substance or principles (the "what") implicated by a particular case and matters of decision-making process (the "how") receive careful attention. Although not without a bit of moral hectoring in spots, the tone for the most part is instructional, persuasive, and practical, recognizing that all the parties to ethical discussions are real people characterized by the whole range of human biases, emotions, and weaknesses. The ethical complexities are made manageable without undue simplification, reflecting the authors' prevailing attitude of optimism that consensus about good ethical responses to difficult conundrums almost always can be reached eventually. …