Nancy S Jecker, Albert R Jonsen, Robert A Pearlman, editors. Bioethics: an introduction to the history, methods and practice. Second edition. New Delhi: Jones and Bartlett India Private Ltd; 2010. Student edition. 545 pp ISBN 978-93-80108-09-4

This is a textbook on bioethics with contributions from major writers in the field. The editors are professors at the University of Washington and have carried out pioneering research in ethics. Part 1 of the book takes the reader through the history of bioethics, explaining its emergence as a discipline. Part II examines the methods of ethical reasoning and developing justification of moral beliefs. Part III covers ethical concerns related to reproductive decisions such as abortion, prenatal genetic testing and assisted reproductive technologies.

Albert Jonsen sets the tone by providing information on developments in medical ethics. Daniel Callahan comments on the use of technical jargon in the discussion of ethics. He points out that the discipline of bioethics should be so designed as to help physicians and biologists make practical decisions.

The essay by Leon Kass is an attempt to provoke discussion on the meaning of concepts such as “betterment of mankind”, a “good man”, a “good life”, a “good community” and the values that should guide society. According to Kass, all decisions to develop or use biomedical technologies inevitably contain judgments of value. He argues that the very definitions of benefit or risk to individuals or society are based upon value judgments, not simply technical ones

James Childress takes on the question of “who can live when not all can live”, giving examples of moral questions specifically related to scarce life-saving medical resources such as haemodialysis and kidney and heart transplants.

Hans Jonas’s contribution is a philosophical reflection on experimenting with human subjects. This essay, considered a seminal exposition on the ethics of medical research, exhorts us to remember that while slower progress in the conquest of disease will not threaten society, the erosion of moral values most definitely will. This erosion will render the most dazzling research achievements worthless.

The article by Nancy Jecker examines the central methods of ethical reasoning used to support ethical judgments in particular cases. She comments that none of these methods offers ways of dealing with human rights questions such as health inequities between rich and poor nations, a statement that also has serious implications for medical practice in India.

The challenge of caring for patients in multicultural settings and the related philosophical problems of ethical relativism are brought out by Ruth Benedict and James Rachels. They state that different societies have different moral codes which determine what is right in that society. Further, there is no universal truth in ethics and there are no moral truths that hold for all people at all times. Thus, the moral code of any society at any given time has no special status; it is one among many. They conclude that we cannot sit in judgment on the conduct of other people and we should adopt an attitude of tolerance towards the practices of other cultures.

Arguing that women’s moral experience has been discounted in the construction of ethical theories and principles, Virginia Held concludes that the practice of mothering has important perspectives to contribute to ethics. Susan Shermin adds that the critical question of the structure of medical practice and its role in a patriarchal society is largely ignored and is not considered a part of the standard curriculum in textbooks of medical ethics.

Writing on the ethics of reproductive technologies, John Robertson states that theological, social, psychological, economic and feminist perspectives would emphasise different aspects of these technologies. Susan Shermin, discussing the context of the alarming increase in the range of reproductive technologies, argues that in vitro fertilisation should be understood against the backdrop of the social and political structures that have maintained power relationships to the disadvantage of women and people of lower socioeconomic status.

This book is a “must read” for professionals in the human care sector. The writers and editors are senior bioethicists, eminently qualified to discuss these issues. However, it could have benefited from a few additions. An introduction explaining the three-part framework could have been provided by the editors. Although this is a large volume comprising 545 pages, the original articles of certain authors could have been included in place of abridged versions, as these are seminal articles on medical ethics. Though this is the Indian edition of the book, readers who wish to explore specific aspects of Indian ethics or biomedical ethics in India will be disappointed. Finally, the format employed throughout the book could have been made more accessible by the inclusion of introductions and summaries capturing key elements.

Despite these limitations, this textbook is well suited to advanced graduate and undergraduate students who plan to pursue careers in healthcare ethics as well as in the medical and social work professions.