48 Book reviews J Med Ethics: first published as 10.1136/jme.12.1.48 on 1 March 1986. Downloaded from

The of interests not only health-care profes- realistic appraisal of some of the scien- Management sionals directly involved with the allevi- tific and medical advances that have Terminal Malignant ation of subfertility, but many others accrued as a result of the clinical prac- also because of the moral and legal tice of the discipline, and those that Disease accrue if research in Dame Cicely Saunders, 250 pages, implications of establishing the precur- could, and should London, £22.50, Edward Arnold, 1984 sors of human life in the laboratory. the field is not prematurely and This book, edited by two pioneers in unnecessarily halted. For those Presentation of the material of this edi- the field of , Profes- unfamiliar with the possibilities for the tion is essentially the same as previ- sor Carl Wood and Dr future, this chapter will be revealing; ously, with up-dated references and of the Monash group in Australia, is for those inherently against the idea of statistics, but it has been rearranged to comprised offifteen chapters written by using human pre-embryos for research, make study easier. The major additions internationally acknowledged experts. this chapter will probably merely rein- to the clinical content are in line with It is divided into three parts and covers force their prejudices. For both how- current emphasis on home care and most aspects of this highly specialised ever, there is much to deliberate on. there is some interesting new material subject. Part one is concerned with Thus, rather than a treatise on the on paediatric terminal care. In particu- basic physiology of in vitro fertilisation moral or ethical debates about in vitro lar, Dr Twycross's chapter on pain and draws heavily on animal models to fertilisation, the bulk of the book is relief has been much improved. There demonstrate the principles involved. devoted to the biological bases of, and is a new chapter by Robert Baxter which Part two, Human Physiology, specifi- the therapeutic use of in vitro fertilisa- deals with specialised techniques for cally deals with aspects of ovulation tion and embryo replacement. Being a pain control. Mary Baine's chapter on induction, the fertilisation process, the book written in 1982/83 much of the the control of other symptoms has been assessment of pre-embryo viability, the data about the therapeutic results of in extensively rewritten and is much ultrastructure of pre-embryos and vitro fertilisation are now obsolete. clearer. It was a delight to read Profes- aspects of their long-term preservation This is not a failing of the authors or sor Dunstan's chapter on discerning the at low temperatures. Highly recom- the editors, but a function of the inhe- duties and of particular importance are mended are the chapters on the endoc- rent obsolescence of books about his comments on the duties of the doc- rinology offollicular growth (Healy and rapidly changing fields. However, this tor and nurse, although I think it would Hodgen) and stimulation of ovulation should in no way detract from its merit, have been fascinating had he expanded (Kerin and Seamark) which are the for as it stands it is probably the best his short discursion on the duties of the most lucid that I have read on these book on the subject currently availablecopyright. patient. His comment that the patient is somewhat involved topics. They will be although, with the explosion of know- in no condition to be lectured on ethics of particular help to the non-clinician ledge in this field, is unlikely to remain implies a number of value judgements, trying to fathom the empirical nature of so for long. for instance, that the rightness of many of the stimulation regimes cur- actions changes with physical state. His PETER BRAUDE rently being applied to in vitro fertilisa- Senior Research Associate, comments on the patient's right to die, I tion to try and attain or improve clinical am sure, will provoke much thought. Department ofObstetrics success. Part three is the How to do it http://jme.bmj.com/ In summary, this revised edition will and , University section of the book, and covers patient ofCambridge Clinical School prove an even more valuable vade- selection, techniques for oocyte mecum for those working in the field of recovery, embryo replacement and the terminal care. As the general editor says management ofensuing pregnancies. Selective in the foreword, there is some controv- Of interest to the ethicist are the ersial material and it is well known that opening and closing chapters. John Big- Nontreatment of the area of terminal care receives much gers's excellent introduction puts into Handicapped stimulus from the strength of the per- historical perspective the attempts to sonalities involved. However, the state- alleviate tubal , and the his- Newborns on September 28, 2021 by guest. Protected ment 'it is extremely important to treat tory of in vitro fertilisation and embryo Robert Weir, 292 pages, New York, restlessness actively because of the transfer. It will come as a surprise to £25.00, Oxford University Press, 1984 stress it causes family and staff, if not many, that the first embryo transfer This is an uncomfortable book for a the patient himself' is a very difficult occurred as early as 1890, and the first paediatrician to review. By exploring one to understand and I think high- attempts at in vitro fertilisation in the the areas of ethical dilemma for the lights how ethical considerations may 1930s. It is also not commonly acknow- practising doctor involved in the care of help to clarify what has often been ledged that the first human pregnancy the newborn, many questions which obscured by emotion. following in vitro fertilisation and conveniently (or perhaps deliberately) DR ROBIN PUGSLEY embryo replacement occurred in 1975 have remained dormant, are thrust into MedicalDirector, StJroseph's Home Care although it was not until 1978 that the life. The arrangement of the material, Service, first live birth was reported. Professor with its case histories and personal StJoseph's Hospice, Mare Street, Biggers's chapter re-emphasises the views, brings the reader into a decision- Hackney, London E8 4SA inappropriateness of the current politi- making role. These decisions, as repor- cal hysteria about research which ted in the book, can then be compared In Vitro Fertilisabton utilises fertilisation in vitro when con- with those of the experts, allowing the and Embryo Transfer trols have been called for by involved reader a very active - though exhausting scientists and clinicians for well over a - experience of the difficulties. Editors, Alan Trounson and Carl decade. Wood, 254 pages, Great Britain, £25, The book starts with a review of the Churchill The final chapter by the doyen of the history of infanticide which, although Livingstone, 1984 subject, Bob Edwards, provides a morbidly fascinating, perhaps suggests In vitro fertilisation is a subject which perspective of a different kind. It is a to the reader that the author has come to