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Related Topics
Legal and Ethical Aspects of HealthcareReview - Legal and Ethical Aspects of Healthcare
by S. A. M. McLean and J. K. Mason
Cambridge University Press, 2003
Review by Kari Karsjens, JD
Jun 20th 2005 (Volume 9, Issue 25)

Legal and Ethical Aspects of Healthcare is authored by United Kingdom bioethicists, Sheila McLean and John Kenyon Mason. Overall, the casebook is well-written, thoughtful, and serves as a useful reference tool on general bioethics principles and concepts. The breadth of topics and issues in bioethics range from resource allocation, confidentiality, assisted reproduction, life/death, and even sex, gender, and the law.

Readers will immediately identify that the authors have chosen to pursue a dedicated perspective to the United Kingdom. Throughout the casebook, the authors primarily rely on U.K. cases, content, examples, citations, and U.K. governmental authorities and decisionmakers. This reviewer also noticed that the authors' perspective and analysis necessarily incorporates an assumption and common reference to universal health care and regulatory aspects, making the casebook less relevant for U.S. medical students and/or other individuals with vested interests in the U.S. health care delivery system. Additionally, the lack of supplement U.S. cases or legal decisions, and solitary reliance on U.K. cases severely limits the scope and outreach of this casebook.

In general, the case discussions and narratives are helpful but, as with any casebook, are far too brief and limited in analysis. Compared to other bioethics casebooks or textbooks, one lacking feature of this casebook is absence of a comprehensive appendix with more detailed case excerpts, analysis, and possible discussion topics. The authors' approach to a more abstract overview of life, death, and the associated bioethical aspects (Chapter 12, "Is Life Worth Living") was both novel and well-presented. However, for topics commonly associated with case-specific guidance and thus topics that require clearly-identified theories and foundations, the authors focused on generalities and minimal reference to accepted principles.

For example, with regard to chapter 3, "The Confidential Relationship," this reviewer generally observed that the content has limited relevance as the authors' scope of information is restricted to the U.K. authorities, cases, and laws. The lack of reference to, or mention of, U.S. health information privacy laws governing individuals' protected health information and security/integrity of electronic health information, is concerning. The casebook's reference point and analysis, especially a notion of deference to public health basis for disclosing and breaching patient confidentiality, may be misaligned with contemporary bioethics. Additionally, given the practical realities within the contemporary health care environment, recent trends indicate that health care systems and stakeholders are moving towards acceptance, implementation, and utilization of electronic records and protection of patient health information. Thus, the authors' omission of this aspect of confidentiality may create a gap in information for readers of the casebook, as bioethical inquiry necessarily will need to acknowledge and address issues such as limits to patient confidentiality, scope of responsibility for maintaining electronic records, and data and security of electronic health records.

Similarly, the authors pursued an intriguing yet divisive approach to discussion of patient consent and autonomy. The authors' choice of terms and chapter titles reference the competing aspects, related subjects, and implications of patient consent and autonomy, however, the casebook never directly addresses informed consent as a theory, model, or in a cohesive case analysis. Moreover, the authors in Chapter 4, pages 49-50, "The Therapeutic Partnership," the authors shy away from a glaring opportunity to present a full discussion between the U.S. trend of "prudent patient" for determining informed consent and the U.K. trend of "prudent professional standards."

As a general criticism, the casebook would certainly have been strengthened if additional supplementary materials, secondary sources, law review articles, and other journal articles were referenced, cited, or included in an appendix. The restrictive scope and intended audience is clearly evident and limits the practical usefulness and overall appeal to the general bioethics community.

 

2005 Kari Karsjens

 

Kari Karsjens is an Illinois-licensed attorney, specializing in health care law. She currently works as an investigator for the U.S. federal government in the San Francisco regional office, focusing on civil rights, health policy, and HIPAA compliance. She may be reached at: kari.karsjens@hhs.gov.


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