Book Review

Ethics Consultation: A Practical Guide

N Engl J Med 1994; 331:1532-1533December 1, 1994

Article

Ethics Consultation: A Practical Guide
By John La Puma and David Schiedermayer. 234 pp., illustrated. Boston, Jones and Bartlett, 1994. $29.95. ISBN: 0-86720-797-3

In the July 2, 1970, issue of the Journal, Philip Tumulty asked, “What is a clinician and what does he do?” The same question could be asked today about ethics consultants: What is an ethics consultant and what does he or she do? La Puma and Schiedermayer answer this question in their new book on ethics consultation.

The past 20 years have seen the emergence of ethics committees and clinical ethicists who perform consultations, yet there is little published information on the actual process. Ethics Consultation is a short but in-depth introduction to the practice of clinical ethics, written by two physician-ethicists who have substantial experience in the field. Though the book is targeted to readers who are interested in ethics consultation as a professional career, much of it would interest clinicians who desire a practical approach to the ethical issues arising in their own cases.

This well-written book is divided into four chapters, each of which centers on a case example. The first chapter is the most valuable, since it outlines and illustrates the process of ethics consultation. The second gives details of the skills required for effective ethics consultation. The third chapter addresses practical issues in setting up a clinical ethics-consulting practice and thus will be of little interest to the more general reader. The fourth explores the relation between ethics consultants and ethics committees. This chapter should prove useful not only to consultants and committee members, but also to clinicians who consult them.

Particularly valuable is the book's lengthy appendix of cases. These short narratives give a real flavor of the ethics consultant's work. The annotated bibliography is also well done. If there is a weakness in the book, it is the lack of at least one highly detailed case to contrast with the wealth of shorter narratives. The authors, sensitive to this issue, have chosen to sacrifice detail in order to emphasize the scope of problems encountered by ethicists.

As a field, clinical ethics consultation is still in its infancy. A key issue has been whether ethicists should work to “specialize” their field or whether they should “democratize” it by disseminating their skills to clinicians who lack formal training. This is a false dilemma, since both approaches are needed. There will always be a need for specialists in clinical ethics consultation -- those whose training and experience have equipped them to help others with tough ethics cases. But there is also a need for clinicians to incorporate the tools of clinical ethics into their everyday practice. The publication of Ethics Consultation is an important practical step toward addressing both needs.

Robert M. Walker, M.D.
University of South Florida College of Medicine, Tampa, FL 33647