Book reviews Genetics, the Fetus and our Future Carmel Bagness, Hale, Cheshire, Hochland Hochland Ltd, 1998, 105 pages, £10.95 (sc). Overall, I think this book is worth reading. It includes plenty of relevant facts, interesting quotations and con- flicting arguments - the latter being an essential component. The more fac- tual aspects of the remit are well organised and chapter one and the second half of chapters four and five are clearly laid out. I recognise that philosophical and speculative issues are by their very nature less amenable to “organis- ation” within the confines of a short text. Nevertheless, I think the author only deals with these issues in a superficial manner. Philosophies are described but no philosophising is oVered. The author is clearly in favour of according greater respect to the “pre- embryo”. In a book such as this I had hoped to be oVered a deeper explora- tion of his/her own arguments together with some personal conclusions. I have to question the author’s understanding of in vitro fertilisation (IVF) and other assisted reproduction techniques. On Page 68 it is men- tioned that genetic manipulation of the pre-embryo may prove unaccept- able to many couples because of a low success rate of 10 -15%. No mention is made of the variables that determine these harsh figures - and the fact that they depend inherently on numbers of attempted treatment cycles, maternal age and previous obstetric history. Nor is it mentioned that these quoted figures may be very diVerent for couples who present for treatment because of a genetic disorder but have “normal” fertility. I was surprised that the editor of this text had not corrected the poor use of English, which includes grammatical errors and on occasions the incorrect use of language. This is a pity since it detracts from the overall impression and the potential importance of the take-home message for the reader, for example on page 71 the use of permeations instead of permutations and on page 84, elude instead of allude. In parts the prose is diYcult to follow because the sentences are too long and unwieldy. In summary, as a digest of the current state of opinion and the law and because it oVers a practical understanding of the potential value of the study of the pre-embryo, the book has some merit. Readers will need to look elsewhere for in-depth discus- sion, analysis and the speculation that the title promises but does not ad- dress. PROFESSOR L REGAN Imperial College School of Medicine, St Mary’s Hospital, London Ethics: The heart of Health Care (2nd ed) David Seedhouse, Chichester, Wiley, 1998, 232 pages, £15.99. The second edition of Seedhouse’s well-known book comes ten years after the first. Like the first, the second edi- tion will undoubtedly be well received by many, including teachers, students and practitioners of health care. In- deed one is tempted to suggest that, if a medical or nursing student read only one ethics text in the course of his or her training, then this would be a good choice. If students and practitioners of health care management, policy- makers and civil servants could also be persuaded to read it then this would be a bonus. Seedhouse’s style is highly personal and individual. He takes pleasure in being irreverent, provocative and con- troversial. This is most certainly not a textbook in the academic tradition of neutrality and impartialism. Seed- house has a clear agenda of his own and strongly held views about the nature of health care and the place of ethics within that domain. He is self- assured and self-confident almost to the point of arrogance, writing un- selfconsciously of the “secret of the book’s success”, describing the work as “genuinely philosophy applied” and “long overdue”. “Here at last,” he says, “is the beginning of a philosophy of health” and one wonders what to make of his observation that his Ethi- cal Grid “has not yet been universally adopted”: perhaps he thinks this is only a matter of time. The book is likely to appeal more to health care students and young practitioners than would some of the more traditional texts in the area. Some readers, perhaps particularly those from a gen- eration (or even two) before Seed- house (we are told that he was at grammar school from 1967-74) may find some of his idiosyncrasies irritat- ing rather than appealing. Others will welcome the humorous and un-stuVy approach (while many of us will share his fond memories of the Grafton Arms). Certainly few authors in the field will have given so personal an account of their own experiences of health care as Seedhouse gives of his recent diagnosis of and treatment for a benign tumour. Statistically one should note that the new edition is some 66 pages longer than the first and although the number of chapters is the same the structure of the book is slightly diVerent. The selection of case studies in part one has been increased from 10 to 15 and in part three the main decision making device of the Ethical Grid has been joined by a preliminary device called the Rings of Uncertainty. In other respects the text is very similar, although a certain amount of re- writing has taken place, some addi- tional material has been added and the typeface and presentation has gener- ally been improved. The index to the Journal of Medical Ethics 2000;26:143–150 group.bmj.com on March 21, 2013 - Published by jme.bmj.com Downloaded from