Ethical complexity versus simple presentation: A tightrope
Published online: May 11, 2018
Robert F Phalen, Core ethics for health professionals: principles, issues, and compliance Springer International Publishing, 2017, 145 pp, INR 3446 (hardcover), Kindle INR 3556 ISBN: 978-3-319-56088-5
Taking a cue from the author, I ventured into searching Amazon’s website for the number of books written on ethics. To my amazement, I found more than 200,000 and out of these about 2000 were books on healthcare ethics. Robert Phalen has made an interesting addition to this list. The book is a “survivor’s guide” to research ethics, written as crisp, concise notes on various aspects of the subject, in a manner that is easy to understand and assimilate. The book caters largely to an American readership, with examples and anecdotes from the American research context. It serves as a good handbook for those seeking research ethics certifications mandated by the United States National Institutes of Health for holding their research grants.
At first glance, the book felt like any other one on healthcare ethics. But as I read further I realised that some of the chapters are different and unique. The book begins with a narration of prominent scandals in medical research such as the Nazi prisoner experiments and the Tuskegee syphilis trials. Through his presentation of these scandals the author lays a foundation for the philosophy of research ethics. The book then moves on to regulations and guidelines. Some of the unique chapters in this book are on crimes against science, public perceptions and trust in research, and the ethical dilemmas associated with new and emerging advances in healthcare. The chapter on public perceptions and trust in research highlights the importance of trustworthiness of healthcare research as an ethical imperative. The final chapter is a “survivor’s guide” that gives practical tips to medical researchers on how to steer clear of ethical misconduct.
Coming from a medical background, I have always found it difficult to engage with scholarly literature on the philosophy of healthcare and healthcare ethics. Most of this difficulty arose from the difference between a fact-based, empirical form of knowledge inherent to medical science and the theoretical strengths of philosophical literature. Phalen’s book makes healthcare ethics digestible to the medical reader. It breaks down complex philosophical theories into bite-sized chunks of reading material, without losing the actual meaning of the philosophy behind it. The book has a smooth and easy flow and one can easily read the whole book in one go.
Though it serves the purpose of being a beginner’s manual, the book reduces certain complex issues in healthcare ethics into simplified check-lists, thus running the risk of over simplification of certain concepts. For example, by presenting the ethical issues related to end-of-life in just over 250 words, the actual complexity of the issue is diluted. The issue here is not just that of word count, but also of depth and breadth of coverage of the topic. Between keeping the book concise and easy to use for a beginner and presenting important ethical issues without losing complexity is a very fine line. This is something that the author could have paid more attention to. In some chapters, especially those on “Regulation, Guidelines and Policies”, “Compliance and Online Training” and “A better future (A survival guide)”, the author sounds as if he is prescribing certain behaviours to the readers. Such a prescriptive approach may again restrict the capacity to engage in ethical reasoning and debate. However, to compensate for this, the author has provided questions for reflection and discussion at the end of each chapter.
The book will be very useful for young and mid-career researchers in healthcare ethics and anybody involved in research ethics or healthcare research in the United States. However, its applicability for researchers from a global context is doubtful. For example, the Indian research environment is very different from that presented in this book, making it difficult for an Indian reader to directly apply the concepts presented to their own settings. However, the book does provide useful insights to an international reader on the research ethics regulations, guidelines and policies in the United States. Robert Phalen should consider expanding his book for a wider global readership, elaborating some key ethical issues and bringing the much-needed balance between complexity of research ethics and simplicity of presentation. The book in its current form is a useful addition to beginners’ manuals on research ethics in the US context.