Book Review

Bioethics: A Clinical Guide for Medical Students

N Engl J Med 1994; 330:1912June 30, 1994

Article

Bioethics: A Clinical Guide for Medical Students
By Dan C. English. 224 pp. New York, W.W. Norton, 1994. $19.95. ISBN: 0-393-71021-1

I might as well admit that my first thought when I started to examine Dr. English's book was that it might represent a rather entrepreneurial approach to bioethics. Then I noticed that in addition to his M.D. degree and to his having served as a professor and chair of surgery in the College of Human Medicine at Michigan State University, he also has a master's degree in philosophy. Moreover, he is currently a clinical scholar at the Center for Clinical Bioethics at Georgetown University. This background, and reading the book, helped to establish his credibility with me.

The “intent of this book,” English states, “is to serve as a guide to the beginning development of ethical awareness and case analysis.” The unique quality of the book arises from the fact that it is written for medical students by a physician who can serve as a role model. Each of the 11 chapters addresses the student's situation. Indeed, chapter 10, “Student-Specific Issues,” was written with a medical student in her clinical years and includes sections on stress, conflicts of interest, abuse of students, honesty, health, and debt.

The book opens with the statement that “the Physician-Patient Relationship . . . is the central focus of ethics in medicine.” In this chapter, English defines differing concepts of medicine, and reviews eight models for the physician-patient relationship from the literature. He favors the “managerial model,” in which the physician guides the healing process, coordinates access to other personnel, and encourages a broad view of the patient's needs.

The 13-page summary of ethical theories and principles in chapter 2 will need to be supplemented by the teacher in the classroom. Of the four principles of medical ethics -- beneficence, autonomy, fidelity, and justice -- the red thread of fidelity is seen most often throughout the book. Chapter 3 discusses the rules of bioethics that emerge from the four principles. It has cogent sections on informed consent, truth telling, and confidentiality and a good outline for ethical case analysis. Dr. English deals with most of the current problems in medical ethics and gives due consideration to legal issues (chapter 10). He sometimes mentions religious issues as well. “Reflection Questions” are inserted at 13 strategic points. Well-selected recommended readings are listed at the end of each of the 11 chapters.

Dr. English demonstrates a thorough familiarity with the literature of bioethics and the problems of medical students. His straightforward writing style is clear and interesting. He is especially adept at summarizing issues. I recommend his work as a textbook for medical students studying bioethics.

Richard Dayringer, Th.D.
Southern Illinois University School of Medicine, Springfield, IL 62794-9230