Book reviews 107 J Med Ethics: first published as 10.1136/jme.16.2.107-a on 1 June 1990. Downloaded from The text is well-referenced, and should nurses be aware of their own indications of the hazards encountered suggestions for further reading are values, they should also understand and on the way. His second chapter outlines given at the end of each chapter. respect their patients' values in order the scope ofvariations, encouragements In conclusion, this book would be a for effective care to be undertaken. An and diversions made possible by human welcome addition to medical and overview of some professional Codes is intervention, with timely corrections of nursing libraries, and, although aimed included in the book, but it is noted that popular misunderstandings of 'genetic specifically at nurses, medical staffwho these Codes are limited in their scope to engineering', gene therapy, cloning, maintain a holistic approach to care protect nurses in specific stated hybrids, chimaeras and the like. Two should also find this book both situations. chapters follow on the reasons for interesting and informative. Detailed discussion ofcertain areas of infertility and on ways ofovercoming it. ethics are put forward in the following A fifth chapter, on ethics and law, JANE WARNER chapters ofthis book, including nurses' examines some of the ethical and formerly Nurse Teacher, rights and responsibilities, patient pseudo-ethical objections brought Queen Elizabeth II Hospital, advocacy, accountability and loyalty to against infertility treatment and pre- Weluyn Garden City, Hertfordshire. peers and patients. Conflicts that may embryo research, and reflects on what arise pertaining to these areas are the law might reasonably be expected to expanded upon. contribute to the assurance of good Ethics in Nursing: Ethical decision-making, and the practice. the steps that the nurse must take in order The facts are not presented without Caring for this process to happen are described comment and interpretation, and the Relationship in depth in the final chapters of this book is the better for it. Other book. The nature ofethical dilenunas is commentators' theories on 'when life Verena Tschudin, 151 pages, London, put forward. begins' (a biological question too often £7.95, Heinemann Nursing, 1986. Overall, this book should serve to dressed up as an ethical question) are raise nurses' consciousness of the fairly stated; and this makes Austin's This book was published at a time when ethical issues that are constantly being own speculation the more interesting. the nursing process (a system of met within a framework ofthe giving of His words are so compact, and individualised care comprising individualised care. Nurses, especially exactitude so necessary, that they assessment, planning, implementation those at the 'sharp end', ie, the bedside, should be quoted: and evaluation of will care) had been be able strongly to identify with copyright. established throughout most hospitals these ethical issues. 'Almost the whole of the embryo and in the community. The concept of Ethics in Nursing may be strongly manifestly develops into the placenta nurses being in partnership with their recommended, certainly for nurses, and etc, and no one can deny that, with only patients, together with the increasing also for those interested in all aspects of a small fraction becoming (eventually) utilisation of medical technology, has medical and nursing ethics. the fetus. So the sequence can be stated therefore led nurses to focus upon rationally as follows: a very small part of ethical aspects of their work. JANE WARNER the ovary (an oocyte, in fact) becomes By writing this book, the author formerly Nurse Teacher, an embryo, and a very small part of the http://jme.bmj.com/ assists the nurse to gain insight into Queen Elizabeth II Hospital, embryo (the disc or plate) becomes the matters pertaining to nursing ethics. Weluyn Garden City, Hertfordshire. fetus. The inference is clear: the The first chapter sets the scene in terms embryo should be regarded as an organ, of the role of the nurse today. In the Human Embryos: like the ovary, and as such is not entitled second chapter, the author delves into to the respect due to something destined the specific nature of the caring The Debate on to become a person. The embryonic and relationship as it affects nursing. Her fetal parts are easily distinguished, a arguments are well supported with Assisted notable fact being that the fetal valuable references. Reproduction component grows much faster than the on September 29, 2021 by guest. Protected Chapter three is devoted to the embryo-placental component' (p18). exposition of ethical theories. The C R Austin, 183 + vii pages, author contrasts morality with ethics, Oxford, £6.95, Oxford University After rehearsing the scientific and and proceeds by describing the Press, 1989. logical difficulty in insisting on the term normative (prescriptive) and Inasmuch as any meaningful discussion 'embryo' for the early conceptus during descriptive approaches to ethics as of medical ethics must be grounded in cleavage, Austin adds: allied to health care. The ethical the science and practice of the matter theories of consequentialism and non- discussed, the first merit of C R 'By an alternative system, an embryo consequentialism are explored together Austin's book is that it provides that originates as a very small part of a pre- with their implications for decision- knowledge. (His competence in the embryo, and co-exists with the pre- making in nursing. The case of field is amply evidenced by, inter alia, embryo as the latter differentiates into prescribing oral contraceptives without the eight volumes on Reproduction in placenta, etc, prior to becoming a fetus' parental consent for girls under the age Mammals which he edited with RV (p20). of 16 is highlighted. The author Short for Cambridge University Press). completes the chapter by discussing the His first chapter gives a concise and On this basis of biological fact the five principles of ethics which are illustrated description of the chapter on ethics can discuss the applicable in many nursing situations. transmission of life from the formation attribution of 'personhood' and of The book continues by raising the of the gametes, egg and sperm, through human rights to the pre-implantation topics of values, attitudes and beliefs. fertilisation and cleavage to embryo. The understandable wish to do The author emphasises that not only embryogenesis and fetal growth, with so can rest only on an imagined and 108 Book reviews J Med Ethics: first published as 10.1136/jme.16.2.107-a on 1 June 1990. Downloaded from unreal picture of a tiny baby claiming which theology and ethics cannot be were made aware at an early stage in our protection - which the pre-embryo is separated. He writes of there being a existence of the need for a not; and the only authoritative support Christian world view and a Christian comprehensive account of nursing for such a view comes from the Church ethical system 'based on the character of ethics which would be both faithful to (he means the Roman Catholic God as revealed in Jesus Christ his Son Catholic moral tradition and accessible Church), in which the position is and on his creation of the world and of to a wider audience'. demonstrably a novelty. At this point St man' (p x). However, the discussion of The book stands on its own terms, Thomas Aquinas and the animation particular issues frequently admits a that is as a guide to Catholic nurses in tradition is properly invoked. degree of pluralism in Christianity. clinical practice. I am not so sure of its Unfortunately on p30 Austin appears to Whilst a helpful and clear methodology appeal to a 'wider audience'. The have followed Glanville Williams in his is given in the first section of the book chapter dealing with Issues in sexual interpretation ofSt Thomas's language, too much of the discussion is ethics is perhaps the most obvious to assert that he took quickening as the frustrating. No one could deal justly example of the book's specific outlook. first indication of life. Animatus in with natural morality in six pages or There are four practices which Aquinas, as in the writing of biblical ethics in twelve pages. It would Fitzpatrick points out are philosophers, moralists and canonists have been useful to have indicated more 'objectionable' from the Catholic for centuries, refers specifically to clearly the authority of the Bible. Its viewpoint. These are contraception, 'animation' in the Aristotelian sense - absolute authority seems to become sterilisation, artificial insemination and the point when the morphology of the relative as the particular is discussed in vitro fertilisation. In this chapter the organism revealed or displayed that its and the various sources of Christian Catholic beliefs are well articulated but animating or organising principle was a ethics come into conflict. little time is given to the idea that those 'rational soul', that of a man and not of A more positive appreciation of the who do not hold these views might have an animal. Inevitably animatus came in descriptive and analytical strands of their rights compromised if they are time to be identified with the subjective ethics might have helped the third nursed by someone who is primarily experience of quickening (vivificatus) section of the book. In one part of the concerned with keeping faith and and as such the concept passed into the discussion of the beginning of life the conscience intact. English common law. This minor phrase 'the termination ofpregnancy' is The position taken leads to some blemish detracts little from a very good abandoned in favour of 'abortion' and rather bizarre lines of argument. For and useful book. 'the unborn contents of the mother's instance, in an attempt to maintain the uterus' in favour of 'child'.