Journal of medical

The Journal of the Contents Society for the Study of I55 Editorial James C Blackie Editor Janus or looking both ways at once A V Campbell Focus 157 The care of the mentally abnormal offender Consulting Editors and the protection ofthe public A S Duncan Henry R Rollin C M Fletcher The concept ofdangerousness Alan Editorial Board Norton R B Welbourn (Chairman) Main articles Patrick Byrne I63 Medical practice: Defendants and prisoners R Y Calne PaulBowden R D Catterall 173 The place ofmedicine in the American prison: J Dominian Ethical issues in the treatment of offenders G R Dunstan Peter L Sissons Roger Higgs I8o Dilemmas of medical ethics in the Canadian Lord Kilbrandon Penitentiary Service Gordon Horobin CRoy i85 The just provision of health care: A reply to W S Peart Elizabeth Telfer Raymond Plant Hillel Steiner Elizabeth Telfer Dame Muriel Powell I90 Case for a statutory "definition ofdeath' Anthony Thorley P D G Skegg Sir Martin Roth 193 Is geriatrics the answer to the problems of old Cicely Saunders age ? Tony Smith I PH Millard II Brice Pitt III David Hobman Edward Shotter Case conference 200 Retreat from ? Technical Editor Analysis Gunilla Liddle 207 Equality A V Campbell 209 The parliamentary scene Tony Smith 2II Book reviews 213 News and notes 2I4 Correspondence 2I5 Lectures and symposia 2IO The parliamentary scene a depressing ring about it. Much of the current of public concern though it was based on a fictional anxiety about psychiatric treatment has been account of practices over IO years' old in the USA. generated by groups opposed to orthodox We need to remember that the vast majority of who believe that there is no place for drug treatment patients needing psychiatric help retain enough or any form of physical therapy. So much publicity insight to accept informal admission, and that has been given to their clamour that it was, perhaps, treatment given without the patient's consent inevitable that the Medical Research Council should remains the exception even with formal patients. turn down the request by the Royal College of Yet there are a few patients for whom compulsion Psychiatrists for a grant for a controlled trial of is necessary: and to deny this may deprive them of psychosurgery. Fears and misconceptions have been their only hope of returning to sanity. encouraged by films such as 'One Flew Over the TONY SMITH Cuckoo's Nest - quoted in Parliament as evidence

Contents of Volume 2, Copies can be obtained from the Publisher, Journal of medical ethics, Number 3, I976 Tavistock House East, Tavistock Square, London WCiH 9JR Editorial Exorcism: A psychiatric viewpoint Analysis W H Trethowan Liberty Main articles Hillel Steiner , welfare and health care Congenital abnormalities and The parliamentary scene Elizabeth Telfer selective Mary J Seller Tony Smith Correspondence 'Side effects': A misnomer Case conference C R B Joyce 'The soft embalmer of the still Book reviews midnight': A problem of Lectures and symposia The ethics ofanimal experimentation prescribing hypnotics in general W Lane-Petter practice News and notes Journal of medical ethics, I976, 2, 213-214

News and notes

Annual conference Medical weekend for students Newcastle Medical Group, Human sexuality is the subject of Cumberland Lodge, Windsor Department of Family and the 14th annual conference of Great Park, is arranging a further Community Medicine, University the London Medical Group, medical weekend from Friday of Newcastle, St Thomas Street, which will be held in conjunction to Sunday, 25 to 27 March 1977. Newcastle. (SAE). with the Society for the Study of Further details from the Conference Medical Ethics, on Friday and Secretary, London Medical Group, James Blackle Memorial Fund Saturday, ii and I2 February I977. Tavistock House East, Woburn The first editorial in this issue is a The conference will be held at the Walk, WCiH 9LG. (SAE). tribute to James Royal College of Surgeons of Blackie, The Director in Poland a member from its inception of England, Lincoln's Inn Fields, the Editorial Board of this Journal. London WCi. Following a visit of some Polish One of his major interests was The conference will examine medical students to London in the restoration of old property for past and present attitudes to 1975, Edward Shotter, the Director those with particular housing human sexuality and their of Studies of the Society, visited needs, including the disabled. implications for members of the Warsaw, Lublin and Cracow in And as this would have pleased him medical and other caring professions. June 1976 to meet doctors and more than any lectureship or Chairmen and speakers will others interested in promoting other memorial, it is proposed to include: Professor R B Welbourn, the study of medical ethics in establish a fund to make possible Director of the Department of Poland. a good restoration of such an Surgery, Royal Postgraduate Communication with the patient old building in Edinburgh, and Medical School; Professor Robin Du call the house James Blackie House. Boulay, Professor of Medieval The southern medical groups' Contributions, however small, History, Bedford College; Dr conference on 'Communication should be sent to the Hon Jack Dominian, consultant with the patient' will be arranged Treasurer, Edinvar Housing psychiatrist, Central Middlesex by the Bristol Medical Group on Association, New College, Hospital; Mr P D Trevor Roper, Saturday, 23 April I977. Further The Mound, Edinburgh. consultant ophthalmic surgeon, information from the Hon Westminster Hospital; Dr Roy Secretary, Bristol Medical Group, Strong, Director, Victoria & Albert Dr Chris Lovell, Department of The Editor of the Journal of Museum; Professor Norman Morris, Medicine, Bristol Royal Infirmary, medical ethics visits South Dean of the Faculty of Medicine, Bristol BS2 8HW. (SAE). Africa University of London; Professor In September the Editor of the Marshall Marinker, Professor of First northern conference of Journal of medical ethics visited the Community Medicine, University the Society for the Study of Republic of South Africa at the of Leicester; Dr Malcolm Pines, Medical Ethics invitation of the Medical Faculty consultant psychotherapist, The first northern conference of of the University of Stellenbosch Maudsley Hospital; Sir Denis Hill, the Society for the Study of Medical in order to attend a conference Professor of Psychiatry, Institute of Ethics will be held in the marking the official opening of Psychiatry; Dr R D Catterall, University of Edinburgh on 21 the Faculty's teaching hospital Director, James Pringle House, and 22 January I977. The at Tygerberg. The theme of the Middlesex Hospital; Mrs Claire conference will deal with the subject conference was 'Mankind and Rayner, medical journalist and of human birth. Further details medicine in the third millenium'. agony columnist; Mr Peter Righton, and application forms from the Throughout the conference it was author of Counselling Homosexuals; Secretary, EMG Project Office, stressed that priorities in health Professor Enda McDonagh, Top Flat Right, 24 Buccleuch care must be reallocated in the moral theologian, St Patrick's Place, Edinburgh. (SAE). Republic of South Africa. In his College, Maynooth. paper, which was widely reported Further information (SAE) and Children, medicine and the law in the South African press, application forms (available after The Newcastle Medical Group is Dr Campbell indicated the dangers 3 January I977) from the arranging a conference on 'Children, inherent in creating a system Conference Convenor, London medicine and the law' on which would result in an Medical Group, Tavistock House Saturday, 12 March 1977. Further escalating health problem for the East, Woburn Walk, WCiH 9LG information from the Secretary, majority of the population. Journal of medical ethics, 1976, 2, 214

Correspondence

The utilization of animals animal associations and assumes industrializedsocieties,thesystematic that the human understanding of ill treatment of animals in great SIR, animals which genuinely character- varieties of ways is economically and In the 'Ethics of animal experi- izes some of these associations must technologically most efficient and mentation' (Journal ofmedical ethics, somehow characterize all of them, a therefore most profitable. The under- 2, I19-I26), Lane-Petter writes: risky assumption about matters of standing of animals necessary to 'But there is a positive advantage fact which the facts themselves do produce and utilize them on a com- in man exercising his domiance m not support. mercial scale is precisely an under- dealing with animals in this [experi- It is certainly true that some standing of these efficiencies, in- ments) as in most other ways that understanding of animals is neces- cluding an understanding of the bring him into intimate contact with sary in order to raise them success- profits to be made by systematic animals. Whether in the laboratory, fully, to maintain them in zoos and ill treatment. The production and on the farm, in the zoo or the circus, circuses, and in the case of wild utilization of expermental animals hunting with gun or camera, harpoon animals to find and kill them. But on a commercial scale is probably or net, the people thus involved have the kind of understanding which is no better and no worse than our to study and understand their sub- necessary for the effective realization production and utilization ofanimals ject. Understanding, among people of these ends is scientific and for food, but the human under- of goodwill, brings respect, and technical and not at all the kind standing exercised in all of the respect is likely to be followed by which includes or engenders respect human-animal associations is not considerate treatment and a general for animals and considerate treat- even implicity considerate and hu- enrichment of life for both man and ment of them. If the ill treatment of mane. To remind ourselves of this animal.' animals always had serious economic we need only consider the ethical As Clark notes in his comment costs with no compensating benefits, problems posed by our use of (Ibid, p 125), this exhibits a con- then of course ill treatment would be humans as research subjects. siderable degree of naivet6. But a much rarer phenomenon than it in STUART M. BROWN, JR, more than this, the argument as an fact is. Unfortunately, at the vast Program on Science, Technology and argument is spurious. It lumps to- commercial scale on which animals Society, 628 Clark Hall, Cornell gether a range of different human- are produced and utilized in modem University, Ithaca, New York I4853

News and notes-continued New subscip rates for the may be appointed to part-time the topics to be discussed may be Jourtnal of medical ethics positions in New York teaching of interest to the readers of Due to increased production hospitals for six months ending the Journal of medical ethics. costs and postage rates, the annual on 30 June 1977. Those so In particular the papers on subscription for subscribers in appointed will work with medical 'Abortion, contraception and the the United Kingdom and the staff, nursing and medical students fetal rights', should continue the Irish Republic will be £12.00 and patients to encourage interest debate which has had so much and US $25.00 in all countries in and knowledge of medical publicity in Britain. Among the overseas. The information relating ethics and related philosophical bodies sponsoring the meeting is to the purchase of the Joumal topics. This interest and under- the Society for Medicine and is set out in full in the notice to standing will be aroused by Law in Israel. subscribers on the page facing means of lectures, symposia, the Editorial. notes in hospital newsletters and Digest informal discussion. The programme A new publication concerned with will be directed by the Bio-Ethics medical ethics is the Bioethics Philosophers join New York Committee of the Society for Digest which is published monthly t Ing hospitals Public Affairs. by Information Planning From the Harvard Bulletin comes Associates Inc, Post Office Box I523, the interesting news that the Society Medical ethics debate in Israel Rockville, Maryland, USA. for Philosophy and Public Affairs In a conference on 'Clinical research It costs $48 a year, single copy $6. has received a grant from the problems in endocrinology' to be Basically the Digest is an abstracts New York Council for the held in Tel-Aviv, Israel, from journal, but it also has feature Humanities so that philosophers 14 tO 24 January I977, some of articles. Journal of medical ethics, 1976, 2, 215-217

Lectures and symposia

Tuesday iI January Thursday zo January senior lecturer in obstetrics and LMG symposium: DETENTION AND LMG symposium: RENAL gynaecology, University of RELEASE OF MENTAL PATIENTS 5.45 pm FAILURE IN CHILDREN: TH Sheffield St Bartholomew's Hospital CONSEQUENCES OF DIALYSIS OR Monday 31 January Professor C J Dickinson, TRANSPLANTATION 5.45 pm St EMG lecture: PATIENTS' RIGHTS Professor of Medicine, St Bartholo- Thomas's Hospital 5.15 pm Edinburgh University mew's Hospital Medical College, Professor Jon Scopes, Professor Medical School His Honour Judge Eric Stockdale; of Paediatrics, St Thomas's Dr Henry Rollin, consultant Hospital; Dr Cyril Chantler, Tuesday I February psychiatrist, Horton Hospital; consultant paediatrician, Guy's LMG symposium: THE BEREAVE- Professor Desmond Curran, Emeri- Hospital; Dr T Martin Barratt, MENT OF STILLBIRTH 6 pm Charing tus Professor of Psychiatry, senior lecturer in paediatric Cross Hospital, Fulham University of London nephrology, Hospital for Sick Dr Hugh Jolly, consultant Children; Mr Barry Hulme, paediatrician, Charing Cross Thursday I3 January consultant nephrologist, St Mary's Hospital; Dr Sandy Bourne, LMG symposium: AGE OF Hospital consultant psychotherapist, Tavis- CONSENT: TIME FOR A CHANGE? Thursday 20 January tock Clinic; Dr David Morris, 6 pm St George's Hospital, GMG symposium: THE APARTHEID consultant paediatrician, British Tooting OF TIE DISABLED 7.30 pm Western Hospital for Mothers and Babies Professor A H Crisp, Professor Infirmary, Glasgow Wednesday 2 February of Psychiatry, St George's Hospital EMG symposium: NuRSS: Medical School; The Revd Dr Monday 24 January EDUCATED OR TRAINE)? I pm Anthony Bird, Principal, Queen's NMG symposium: HOW SAFE ARE Western General Hospital, College, Birmingham; Miss Jane YOU IN TE CASUALTY DEPARTMENT? Edinburgh Cousins, Secretary, Sexual Law 5.15 pm Royal Victoria Infirmary., Reform Society Newcastle-upon-Tyne Thursday 3 February LMG lecture: A DEATH IN THE MondaY 17 January Tuesday 25 January FAMILY 5.45 pm Guy's Hospital EMG lecture: IS GERIATRIcs THE LMG symposium: PAID FRIENDS Medical School ANSWER TO OLD AGE? 5.I5 pm FOR THE OLD: A CONSEQUENCE OF Dr Cicely Saunders, Medical Edinburgh University Medical COMMUNITY GERIATRIC CARPE? Director, St Christopher's School 5.45 pm UCH Hospice Professor C G Clark, Professor Monday 17 January of Surgery, UCH Medical School; Tuesday 8 February Sir W Ferguson Anderson, SMG lecture: MORALE IN MMG symposium: THE ETHCS OF HOSPITALS: WHO CARES? 8 pm STERILIZATION 5.30 pm Stopford Professor of Geriatric Medicine, University of Glasgow; Miss Medical School Sheffield Building, Oxford Road, Manchester Professor Revans Dr Rodney Harris, Reader in Averil Freeth, Assistant Director Reginald Medical Genetics; Professor The 'Age Concern' Wednesday 9 February Revd Canon G R Dunstan, Wednesday z6 January EMG symposium: RADIATION Professor of Moral and Social EMG symposium: VASECTOMY: RISKS I pm Western General Theology, King's College, London; WHY AND WHEN? i pm Western Hospital, Edinburgh Dr D W Warrell, consultant General Hospital, Edinburgh Thursday Io February obstetrician and gynaecologist BMG symposium: TH BATTERED Thursday 27 January FAMILY 7.30 pm Bristol Royal Tuesday I8 January LMG symposium: STIZATION Infirmary LMG symposium: SUICIDE: HAVE OF TH YOUNG AND OTHERS Mrs Jean Renvoize, author of THME SAMARITANS THE ANSWMI? INCAPABLE OF CONSENT 6.I5 pm Children in Danger; a of 5.45 pm St Mary's Hospital Westminster Medical School panel Medical School Mr D M Forrest, consultant local experts Professor W S Peart, Professor paediatric surgeon, Westminster Monday 14 February of Medicine, St Mary's Hospital; Children's Hospital; Ralph Gibson, MMG lecture: IRRECOVmABLE The Revd Prebendary Chad Varah, Esq, Recorder of the Crown Court; BRAIN DAMAGE 5.30 pm Stopford founder of the Sanaritans; Dr Dr Graeme Snodgrass, consultant Building, Oxford Road, Manchester Steven Greer, Department of paediatrician, The London Professor Bryan Jennett, Psychological Medicine, KCH Hospital; Dr Sheila Duncan, Professor of Neurosurgery, Glasgow 216 Lectures and symposia

Tuesday iS February W K Ankers, PhD, formerly of St Hon Lord Justice Lawton, Lord LMG symposium: PHYSICAL Augustine's Hospital, Canterbury Justice of Appeal; Dr Elizabeth DISABLEMENT IN THE COMMUNITY: Thursday 24 February Tylden, consultant psychiatrist, St DO DOCTORS CARE? 5.45 pm KCH GMG symposium: ExORCISM Mary's Hospital; Jonathon Glover, Medical School 5.30 pm Royal Infirmary, Glasgow PhD Mr E Maelor Thomas, ortho- Tuesday 15 March paedic surgeon, KCH; The Rt Monday 28 February Hon Baroness Masham of Ilton, MMG symposium: THE LMG lecture: THE END OF THE Countess of Swinton; Mr Peter THERAPEUTIC LIE: DECEPTION IN DOCTOR-PATIENT RELATIONSHIP London, accident surgeon, CLINICAL PRACTICE 5.30 pm Hope 5.45 pm UCH Medical School Hospital, Salford Professor Marshall Marinker, Birmingham Accident Hospital and Professor of Community Medicine, Rehabilitation Centre Tuesday I March University of Leicester Wednesday I6 February LMG symposium: ExORCISM: AN EMG symposium: CHLDRE AND UNQUALIFIED DISASTER? 5.45 pm Thursday 17 March DEATH I pm Western General St Bartholomew's Hospital LMG symposium: TH Hospital, Edinburgh Professor Ian McColl, Professor AVAILABILITY OF ABORTION: A of Surgery, Guy's Hospital; the GEOGRAPHY OF MORALS 6.I5 pm Thursday 17 February Revd Don Cupitt, Dean, Emmanuel Westminster Medical School LMG symposium: CONTACT College, Cambridge; Dr William Dr Richard Farmer, senior TRACING IN SEUALLY TRANSMITTE Sargant, hon consultant psychiatrist, lecturer in community medicine, DISEASES 5.45 pm The London St Thomas's Westminster Medical Hospital Medical College Hospital School; Thursday March Professor Francois Lafitte, Dr Eric Dunlop, Whitechapel 3 Professor of Social and Clinic, The London Hospital; LMG symposium: INCEST 6 pm Policy St George's Hospital, Tooting, Administration, University of Miss Isobel Hunter, Health Birmingham; Mrs Education Council London Juliet Dr Paul d'Orban, consultant Cheetham, lecturer in applied Tuesday 22 February social studies; University of Oxford LMG symposium: wHY Do psychiatrist, St George's Hospital; NURS HATE DOCTORS? 5.45 pm Mrs Pauline Crabbe, Brook Tuesday 22 March Middlesex Hospital Medical Advisory Centre; Miss D J BMG lecture: ABUSES OF CLINICAL School Tibbits, senior probation officer, INVESTIGATION 7.30 pm Bristol Mr Stuart Steele, Director, Dorset Probation and After-care Royal Infirmary Department of Obstetrics and Service; Professor John Mason, Dr M H Pappaworth, author of Gynaecology, Middlesex Hospital Professor of Forensic Medicine, Hunan Guinea Pigs Medical School; Miss Jennifer Edinburgh University Tuesday 22 March Wilson-Barnett, research nurse, Tuesday 8 March LMG symposium: THE MISUSE OF Guy's Hospital; Miss Janet LMG symposium: COT PSYCHIATRY: NOT ONLY IN THE Craig, Assistant Director, King's 5.45 pm St Mary's Hospital SOVIET UNION 6 pm Charing Cross Fund Centre; Dr Nelson Coghill, Medical School Hospital, Fulham Palace Road consultant physician, West Professor Thomas Opp6, Dr Malcolm Weller, lecturer in Middlesex Hospital Professor of Paediatrics, St Mary's psychiatry, Charing Cross Hospital; Wednesday 23 February Hospital; Lady Limerick, Vice- Professor John Wing, Professor of Chairman, Foundation for the Social Psychiatry, Institute of EMG lecture: TRMINAL CARE: of ITS NATURE AND MANAGEMET Study Infant Deaths; Professor Psychiatry; Larry Gostin, Esq, John Emery, consultant paediatric legal advisor, MIND 5.15 pm Edinburgh University pathologist, The Children's Medical School Hospital, Sheffield; Dr Robert Thursday 24 March Thursday 24 February Walker, family doctor and parent LMG symposium: sEx AND THE CMG symposium: WHAT IS Tuesday 8 March DISABLED 5.45 pm Guy's Hospital HEALTH? 5.30 pm Welsh National Medical School School of Medicine, Cardiff CMG symposium: TOO OLD TO Dr Donald Craig, hon CARE? 5.30 pm Welsh National Dr Stephen Gang, general School of Medicine, Cardiff lecturer in general practice, practitioner, Cardiff; Dr Julian Dr S L Willington, consultant Guy's Hospital Medical School Tudor Hart, general practitioner, physician in geriatrics; Dr John W F R Stewart, Esq, Glyn Corrwg; Dr Una Kroll, Agate, consultant Development Officer, general practitioner (and deaconess), geriatrician, Committee on Sexual Problems of South London Ipswich; Adrian Evans, Esq, Area the Disabled; Roy Billington, Esq, Thursday 24 February Adminirator, South Glam AHA; counsellor and advisor, Cheshire Professor Alan Williams, Depart- Foundation; Dr LMG symposium: CRUELTY IN ment of Economics, University Wendy HOSPITALS 5.45 pm Royal Free of Greengross, general practitioner, Hospital, Hampstead York broadcaster and author Dr Anthony Smith, Medical Thurday Io March Monday 28 Arch Correspondent, The Times; Dr LMG symposium: oF NMG symposium: STUDENTS Anthony Clare, senior lecturer, INFANTICIDE 5.45 pm St Thomas's UNDER STESS 5.I5 pm Royal Institute of Psychiatry; Hospital Victoria Infirmary, Newcastle- Dr Anthony Whitehead, consultant Dr W D Wylie, Dean, St upon-Tyne psychogeriatrician, Brighton; Thomas's Hospital; The Rt Dr Graham Grant, University Lectures and symposia 217

Health Service; Mrs Janet Clark, journalist on Woman; Professor Thursday 5 May social worker; Dr Humphrey Eric Wilkes, Professor of Com- BMG symposium: TH NURSE AS A Richardson, consultant psychiatrist munity Care and General Practice, LEARNER AND AS A TEACHE 7.30 pm University of Sheffield Bristol Royal Infirmary Tuesday 5 April Professor Reginald Revans, BMG lecture: TH VALUE op ThurSdy 28 April author of Action Learning in HUMAN LIFE 7.30 pm Bristol Royal LMG symposium: THE MEDIcAL Hospitals; Dr Alison Tierney, Infirmary AND SOCIAL CONSEQUENCES OF lecturer in nursing studies, Metropolitan Anthony of SUDDEN DISASTERS 5.45 pm Royal Edinburgh Sourozh Free Hospital, Hampstead Mr Colin Madgwick, orthopaedic Monday 9 May Wednesday 13 April surgeon,-Royal Free Hospital; MMG lecture: REASSURANCE BMG symposium: DRUG Surgeon Rear-Admiral Stanley 5.30 pm Stopford Building, PROMOTION - IN WHOSE INTEEST ? Miles, Medical Director, Health Oxford Road, Manchester 7.30 pm Bristol Royal Infirmary Assessment Centre, Cardiff; Miss Professor W I N Kessel, Dr Clifford Hawkins, consultant Audrey Davey, family case worker, Professor of Psychiatry, University physician, Birmingham; Dr Wales Council for the Disabled, of Manchester Miriam Stoppard, Medical formerly of Aberfan Director, Syntex Pharmaceuticals Tuesday Io May Tuesday 3 May LMG symposium: WHO'S HAVING Tuesday I9 April LMG symposium: NEUROLOGICAL TBE BABY: THE MOTHER OR TH LMG lecture: MARITAL AND SOCIAL CONSEQUENCES OF OBSTETRICIAN ? 5.45 pm St Mary's BREAKDOWN 5.45 pm KCH HUNTINGTON'S CHOREA 5.45 pm St Hospital Medical School Medical School Bartholomew's Hospital Professor Richard Beard, Dr Jack Dominian, consultant Dr Patrick Cox, Department of Professor of Obstetrics and Gynae- psychiatrist, Central Middlesex Child Health, St Bartholomew's; cology, St Mary's Hospital; Mr Hospital Professor Charles Marsden, B Victor Lewis, consultant Professor of Neurology, Institute obstetrician and gynaecologist, Thursday 2I April of Psychiatry; Dr Adrian Caro, Watford General Hospital; Mrs LMG symposium: CLINICAL Director, Huntington's Chorea Shiela Kitzinger, childbirth AND ETHICAL ASPECTS OF GENDER Research Project educationist and social IDENTITY 5.45 pm The London Tuesday 3 May anthropologist Hospital Medical College CMG symposium: WHO'S HAVING Thursday I2 May Dr Stuart Mason, consultant THE BABY: THE MOTHR OR TH endocrinologist, The London LMG symposium: HAVE WE MADE OBSTETRICIAN? 5.30 pm Welsh ADOLESCENCE A DISEASE? 5.45 pm Hospital; Dr John Randell, National School of Medicine, St Thomas's Hospital consultant psychiatrist, Charing Cardiff Professor W I Cranston, Cross Hospital; Peter Byrne, Esq, Miss Christine Chapman, Professor of Medicine, St Thomas's moral philosopher, King's College, Director, Advanced Nursing Hospital; Dr Stephen Wolkind, London Studies, University Hospital of senior lecturer in psychiatry, the Wales; Professor Peter Huntingford, London Hospital; Dr Moses Monday 25 April Department ofObstetrics and NMG lecture: WHAT SHOULD WE Laufer, Director, Brent Consulta- Gynaecology, The London tion Centre DO ABOUT BAD DOCTORS? 5.15 pm Hospital and St Bartholomew's Royal Victoria Infirmary, Hospital; Professor B Hibbard, Tuesday 17 May Newcastle-upon-Tyne Department of Obstetrics and LMG symposium: TRANQUILLZERS: Professor John N. Walton, Gynaecology TREATMENT OF PATIT OR DOCTOR? Dean of Medicine; Dr Donald 5.45 pm UCH Medical School Irvine, family doctor, Hon. Sec, Thursday 5 May Professor A Brant, Professor of Royal College of General LMG symposium: FRINGE Clinical Obstetrics and Gynaecology, Practitioners, member of the MEDICINE: CAN IT EVER BE PART OF UCH Medical School; Dr John Merrison Committee TH NHS? 6 pm St George's Stevens, general practitioner, Hospital, Tooting Aldeburgh; Dr J D Pollitt, Tuesday 26 April Professor A E Bennett, Professor Department of Psychological LMG symposium: TREATMENT BY of Clinical Epidemiology and Medicine, St Thomas's Hospital PHONE-IN: THE NEXT STEP BEFORE Social Medicine, St George's COMPUT1RS? 5.45 pm Middlesex Hospital Medical School; Dr Wednesday I5 June Hospital Medical School Ralph Twentyman, consultant BMG lecture: THE LARGE TEACHNG Dr R D Catterall, Director, physician, Royal London HOSPITAL - A DISASTER IN THE THIRD James Pringle House, Middlesex Homeopathic Hospital; Albert WORLD ? 7.30 pm Bristol Royal Hospital; Dr Hugh Jolly, Rumfitt, Esq, Dean Emeritus, Infirmary consultant paediatrician, Charing British College of Naturopathy and Dr David Morley, reader in Cross Hospital; Mrs Anna Raeburn, Homeopathy tropical child health Volume two The Journal of the Numbers I-4 Society for the Study of Medical Ethics

Editor A V Campbell

Consulting Editors A S Duncan C M Fletcher

Editorial Board R B Welbourn (Chairman) Patrick Byrne R Y Calne R D CatteraU J Dominian G R Dunstan Roger Higgs Lord Kilbrandon Gordon Horobin W S Peart Raymond Plant Dame Muriel Powell Anthony Thorley Sir Martin Roth Cicely Saunders Tony Smith Edward Shotter

Technical Editor Gunilla Liddle

Society for the Study of Medical Ethics, Tavistock Square, London WCi journal of Medical Ethics, 2, I976

Index to volume 2

A Jewish Medical Ethics: A Compara- Correspondence (alphabetical list Abnormalities, congenital, and selec- tive and Historical Study of the of tides) tive abortion, 2, I38-14I Jewish Religious Attitudes to Medi- Language, turgid and obscure, 2, Abortion, selective, and congenital cine and its Practice, by Inumanuel '5I abnormalities, 2, I38-I4I Jakobovits, 2, 44 Reproduce, a woman's right to, 2, 45 Abuse, barbiturate, 2, 63-67 Law and ethics of AID and Sterilization, child, 2, 99 Animals, benefits for man and, 2, io6 Embryo Transfer, 2, IOO-I03 Unconscious patients, ethics and America, report from, 2, 97-98 Moral Dilemmas in Medicine-A legalities relating to, 2, i51 Amniocentesis, issues of public Coursebook in Ethics for Doctors Don: Comment on Exorcism: policy in the USA raised by, 2, 8-I I and Nurses (2nd ed), Alastair V Cupitt, Animal experimentation, the ethics Campbell, 2,44 A psychiatric viewpoint, 2, I34-135 of, 2, I I8-I26 Some Mothers' Experiences of D Animal experimentation, the ethics Induced Labour, document sub- Dependence, barbiturate, what is of: Commentary, 2, I22-I26 mitted by Sheila Kitzinger from the and who is at risk, 2, 58-62 National Childbirth Trust, 2, IOI Dunn, Ian, and Schrock, Ruth: Analysis (alphabetical list of titles) Value for Money in Health Services, Commentary on 'Homosexuality and Equality, 2, 206-207 by Brian Abel-Smith, 2, 210-211 the medical profession: A behaviour- Liberty, 2, 147-I48 ist's view' by John Bancroft, 2,24-27 Morality and , 2, 93-94 Bowden, Paul: Medical practice. Natural law, 2, 34-36 Dependants and prisoners, 2, I03- E 172 Editorial (alphabetical list of tides) Arnold, A, and Moseley, R: Ethical Blackie, James, C, 2, I55 issues arising from human genetics, C Doctors, industrial action by 2, I-2 2, I2-I7 Campbell, A V : Equality, 2, 206- Ethics and priorities, 2, I05-o6 207 Ethics, medical, and philosophy, 2, Penitentiary Service, dil- I-2 B Canadian Incurable patient, death and the, 2, 2 Bancroft, John: Dr Bancroft replies, emmas of medical ethics in, 2, Interdisciplines, 2,51 2,26-27 I80-I84 both ways at once, Barber, Barry, Cohen, R D, Kenny, Janus, or looking D J, Rowson, J, and Scholes, Case conference (alphabetical list 2, I55-I56 Maureen: Some problems of con- of tides) Etzioni, Amitai: Issues of public fidentiality in medical computing, 2, , limits of, 2, 28-33 policy in the USA raised by amnio- 7I-73 Death, retreat from ? 2, I99-205 centesis, 2, 8-II Barbiturate abuse, 2,63-67 'Soft embalmer of the still midnight' Exorcism: A psychiatric viewpoint, Barbiturate dependence, what is, and Volunteers at risk, 2, 87-92 2, 127-I37 who is at risk, 2, 58-62 Barbiturates, the moral choice in Christie, David J: Volunteers at risk F prescribing, 2,68-7o (Case conference), 2, 90-I Focus: Current issues in medical Clark, Stephen R L: Licensed ethics (alphabetical list of tides) Book reviews (alphabetical list of torture ? in Commentary on the Dangerousness, the concept of, 2, titles) ethics of animal experimentation, 2, I6I Case of Leonid Plyushch, ed. by I25-126 Mentally abnormal offender, the Tatyana Khodorovich, 2, 2IO Cohen, R D et al.: Some problems case of, and the protection of the Health Care: The Growing Dilem- of confidentiality in medical com- public, 2, 157 ma, by Robert Maxwell, 2, 2IO-2II puting, 2, 71-73 Protection of the public, and the case Health is for People, by Michael Computing, medical, some problems of the mentally abnormal offender, Wilson, 2, I02 ofconfidentiality in, 2, 71-73 2, 157 Houseman's Tale, by Colin Douglas, Confidentiality, some problems in Quinlan, Karen, the case of: Prob- 2, 103 medical computing, 2, 7I-73 lems and proposals, 2, 3 Human Medicine: Ethical perspec- Connell, Philip H: What is barbitur- tives on New Medical Issues, by ate dependence and who is at risk? G James B Nelson, 2,152 2, 58-62 Genetics, human, ethical issues Human Rights in Health, edited by Cooper, F B K: The literature of arising from, 2, I2-17 Katherine Elliot and Julie Knight, 2, medical ethics: A review of the Geriatrics, the answer to the prob- 100-103 writings of Hans Jonas, 2, 39-43 lems of old age?, 2, 192-198 Index to Voluwe 2

H Medical ethics, the literature of: A Rowan, A N, and Hegarty, T W: Health care, the just provision of: A review of the writings of Hans Commentary on the ethics of animal reply to Elizabeth Telfer, 2, I85- Jonas, 2, 39-43 experimentation, 2, 122-124 I89 Medical ethics, the teaching of: In Rowson, J et al: Some problems of Health care, the just provision of: the Nottingham Medical School, 2, confidentiality in medical comput- Three points at issue, 2, I88-I89 83-86 ing, 2,7I-73 Hegarty, T W, and Rowan, A N: Medical practice: Defendants and Roy, C: Dilemmas of medical ethics Commentary on the ethics of animal prisoners, 2, I63-I72 in the Canadian Penitentiary Ser- experimentation, 2,122-I24 vice, 2, I80-I84 Hepburn, R W: Morality and Medical groups (alphabetical list Ryder, Richard D: Commentary on religion, 2, 93-94 of titles) the ethics ofanimal experimentation, Herxheimer, Andrew, and Higgs, Calendar for the summer term, 2, 49 2, I24-125 Roger: Commentary on 'Side' Lectures and symposia, 2, I53-I54; effects: A misnomer, 2, I 5-I I7 2I4-2I6 S Higgs, Roger, and Herxheimer, Scholes, Maureen et al: Some Andrew: Commentary on 'Side' Metcalfe, D H H, and Jones, J S P: problems of confidentiality in effects: A misnomer, 2, II 5-1 I7 The teaching ofmedical ethics in the medical computing, 2,7I-73 Hobman, David: Is generiatrics the Nottingham Medical School, 2, Schr6ck, Ruth, and Dunn, Ian: answer to the problems of old age ? 2, 83-86 Commentary on 'Homosexuality and I92-I98 Millard, P H: Is geriatrics the answer the medical profession: A behaviour- 'Homosexuality and the medical to the problems of old age? 2, I92- ist's view' by John Bancroft, 2, 24- profession: A behaviourist's view' I98 27 by John Bancroft, 2, 24-27 Mitchell, Basil: Is a moral consensus Seller, Mary J: Congenital abnorm- Hughes, Gerard J: Natural law, 2, in medical ethics possible? 2, I8-23 alities and selective abortion, 2, I38- 34-36 Moseley, R, and Arnold, A: Ethical '4' issues arising from human genetics, 'Side' effects: A misnomer, 2, I12- 2, I2-I7 117 Jonas, Hans, a review of the writings Sissons, Peter L: The place of of: 2, 39-43 N medicine in the American prison: Jones, J S P, and Metcalfe, D H H: Natural law, 2, 34-36 Ethical issues in the treatment of The teaching ofmedical ethics in the News and notes, 2,46-48; 104; I54; offenders, 2, 173-I79 Nottngham Medical School, 2, 2I3-2I4 Skegg, P D G: The case for a 83-86 Norton, Alan: The concept of statutory 'definition of death', 2, Joyce, C R B: 'Side' effects: A dangerousness, 2, i6i I90-I9I misnomer, 2, II2-II7 Smith, Tony: The parliamentary Justice, welfare and health care, 2, 0 scene, 2,37-38; 2, 95-96; 2, 149-I50; 107-III Offenders, ethical issues in the 2,208-209 treatment of, 2, 173-179 Speciesism, 2, I24-I25 Statutory 'definition the K d'Orban, P T: Barbiturate abuse, 2, of death', 63-67 case for, 2, I90-I9I Kennedy, Ian McColl: The Karen Steiner, Hillel: Liberty, 2, I47-I48 Quinlan case: Problems and pro- Steiner, Hillel: The just provision of posals, 2,3-7 p Parliamentary scene, the (alpha- health care: A reply to Elizabeth Kenny, D J et al: Some problems of Telfer, 2, 185-I89 confidentiality in medical comput- betical list of titles) ing, 2, 71-73 Congenital Disabilities (Civil Lia- bility) Bill debate in the House of T Commons, 2,,95-96 Teamwork, interdisciplinary, 2, 52- L Lords, House of, medical ethics in, 57 Lane-Petter, W: The ethics of 2, 37-38 Telfer, Elizabeth: Justice, welfare animal experimentation, 2, II8-I26 Prisoners, dependants and: Medical and health care, 2, 107-IIl Lectures and symposia: See Medical practice, 2, I63-172 Telfer, Elizabeth: The justprovision groups Private beds and clinical judgment, of health care: Three points at 2, I49-150 issue, 2, I88-I89 M Treatment, consent to, 2, 208-209 Thompson, Ian E: The implications McKay, Angus S: Comment on of medical ethics, 2, 74-82 Congenital abnormalities and selec- Pitt, Brice: Is geriatrics the answer Torture, licensed ? 2, 125-126 tive abortion, 2, I40-I4I to the problems of old age? 2, 192- Towers, Bernard: Report from Marteau, Louis: Comment on Exor- I98 America, 2, 97-98 cism: A psychiatric viewpoint, 2, Prison, the American, the place of Trethowan, W H: Exorcism: A 135-I37 medicine in: Ethical issues in the psychiatric viewpoint, 2, I27-137 May, William, W: Volunteers at treatment of offenders, 2, 173-179 risk (Case conference), 2, 9I-92 w Medical ethics, the implications of, R Wachter, M De: Interdisciplinary 2,74-82 Rollin, Henry R: The care of the teamwork, 2, 52-57 Medical ethics, is a moral consensus mentally abnormal offender and the Wells, Frank: The moral choice in possible in, 2, I8-23 protection ofthe public, 2, 157 prescribing barbiturates, 2, 68-70 President Lord Amulree Director of Studies Edward Shotter Society for the Scottish Director Kenneth Boyd Honorary Assistant Director Anthony Thorley Study of Medical Ethics Treasurer Kenneth Darke Chairman, Editorial Board R B Welbourn The Society for the Study of Medical Ethics is an independent, Editor, Yournal of medical ethics non-partisan organization fbr the multidisciplinary study of issues A V Campbell Consulting Editors raised by the practic6 of megieine. A S Duncan C M Fletcher The Society aims to influence the quality of both professional and Technical Editor Gunilla Liddle public discussion of niedico-moral questions; to promote the study of Secretaries Penny Stewart developing Helen Horton medical ethics; to enslure a high academic standard for this subject; to encourage a multidisciplinary approach to discussion of Governing Body the conse4uences of clinical practice; to stimulate research in specific Lord Amulree remain of all interest Chairman problems.j to non-partisan and independent P S de Q Cabot groups aid lobbies." Management consultant Since I963 the London .Medical Group, a student group for the R D Catterall study of tisues raisedbty ;the practice of medicine, has arranged a Consultant venereologist, Middlesex Hospital series of lectures and symposia, now twice weekly throughout the A S Duncan academic year, in the, I2 London teaching hospitals and medical Executive Dean, Faculty of Medicine, schools. University of Edinburgh the Edinburgh Medical Group was established with similar G R Dunstan In I967 Professor ofMoral & Social Theology, aims, and subsequently medical groups have been formed in a majority King's College, London ofthe British medicdl.schools-.-currently Newcastle, Sheffield, Glasgow, C D Falconer Bristol, Birmingham, Minchester, Liverpool and Cardiff. Scottish Secretary, British Medical been associated Association In 1972 junior doctoGrs, nvho had themselves with C M Fletcher the London Medical, Gr&f¢, founded the Society for the Study of Professor of Clinical Epidemiology, Medical Ethics to deve1op these aims at a postgraduate level. Royal Postgraduate Medical School DOCUMENTATION iii, Medical Ethics, superseded as the organ T W A Glenister is now as Dean andProfessor ofAnatomy, Char- of the Society by the Journal of medical ethics, produced ing Cross Hospital Medical School the proceedings of the annual conference held in conjunction with Sir Cyril Kleinwort the London Medical Group. Chairman, Finance and General In research fellows were appointed by the Edinburgh Medical Purposes Committee I975 0 M Lidwell Group which has established, in conjunction with the University of Medical Research Council Edinburgh, a research project in medical ethics and education. This Dame Muriel Powell is funded by the Leverhulme Trust Fund and the Nuffield Provincial Chief Nursing Officer, Scottish Home Hospitals Trust. & Health Department R B Welbourn The Society for the Study of Medical Ethics is a registered edu- Professor of Surgery, Royal Post- cational charity and a Company Limited by Guarantee. It relies on graduate Medical School voluntary grants and donations and is not supported from government Sir Brian Windeyer Formerly Vice-Chancellor, University sources. of London There is no individual membership of the Society. Those- interested Dorian Haskard in this work are invited to subscribe to the journal of medi`cal ethics. Middlesex Hospital Medical School The lectures of the London Medical Group and the other associated Paul Nunn addressed to medical, nnrs;ng tUniversity College Hospital Medical medical groups, although primarily School and other students, are open to all those professionally interested. Colin Ball There is no charge. St Thomas's Hospital Medical School Tim Helme Middlesex Hospital Medical School ADDRESS: Society for the Study of Medical Ethics Edward Shotter Tavistock House East, Tavistock Square, London, WCrH 9LG. Director of Studies ex officio Tel: 01-387 8I32

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