Am I My Brother's Keeper? The Ethical Frontiers of Biomedicine By Arthur L. Caplan (review)

to her doctor hadn't. If anything, in the final stages of illness, her need for his human empathy , his care, his interest in her, if not for his encouragement, was stronger than ever at the very point when he had disappeared. In her last days in the hospital, and even after she had moved into the hospice, over and over Beth would ask for Dr. P. She'd continue saying that Dr. P. didn't like her anymore, that he didn't want to see her, that she had obviously let him down. In Beth's mind pleasing her oncologist and getting well had become one and die same thing. Whether it is in these vignettes or rigorously controlled scientific studies like the SUPPORT study that looked at patient/physician relationships in intensive care units, the message is clear. Many physicians fail in maintaining the humane interaction that must continue past the "chronic combination of high-tech treatments and hyperspecialized language" and fail badly at the deathbed. Americans, having demythologized the "deity", now want knowledgeable partners as health care providers and physicians who will responsibly see them through to the end of life. This is a small book, but it talks of many important things. Of life and its joys, untimely death, the nature of family relationships, the burdens of caring, and the meaning of love. It is well worth your attention. Audrey K. Gordon University ofIllinois, Chicago Am I My Brother's Keeper? The Ethical Frontiers of Biomedicine. By Arthur L. Caplan. Indiana University Press, 1977, 232 pages, $24.95. Arthur Caplan is always willing to take a stand. He usuallyjustifies his positions as reflecting "simple moral rules." About the use of new reproductive technology, for example, he writes, ' 'Those who use reproductive technology must be permitted to do so in an informed and uncoerced manner. They should know all of their options and choices. No one should become a parent without the person's express consent. Nothing should be done with reproductive materials without the express consent of the parties who created them. Money and commercialism should be kept to a minimum where the creation of life is concerned. Those who use technology to make babies ought to be infertile or face serious risks to their health if they try to have their own children by means of sex and pregnancy" (p. 19). Like the Ten Commandments, such rules have both an appealing simplicity and a curious ambiguity. They seem to respect individual choice, until we ask where the requirement that candidates for IVF "be infertile" comes from. And what does it mean to keep "money" to a minimum? Whose money? What minimum? Caplan's latest book, entitled Am IMy Brother's Keeper, and vaguely subtitled "The Ethical Frontiers of Biomedicine" is divided into five parts: "Research, Experimentation , and Innovation," "Starting and Stopping Treatment for the VeryYoung and the Very Old," "Transplantation," "Health Policy," and "What Is Your Doctor Trying To Do To You?" The title suggests Biblical timelessness, the subtitle suggests that this is up-to-the-minute stuff (and it includes a last chapter on Dolly and cloning ) , and section headings promise to cover the waterfront of bioethical dilemmas. It is a heady agenda. 608 Book Reviews A number of themes run through the essays in the book. First, a deep distrusts of "markets" or "commercialism." In criticizing the new reproductive technology business, he writes, "It is ludicrous to think that true informed consent can be obtained from people whose financial well-being depends upon attracting customers in an increasingly competitive marketplace" (p. 20). This sounds good, although it would seem to apply notjust to IVF but to all other aspects of medicine today. On paying for organs, he writes, "I believe that any form of compensation for cadaver organs and tissues is immoral" (p. 96) . Again, the firm stand is comforting , but would he also prohibit people who sell their blood products, or who "donate " sperm or ova for a fee? If not, why not? Instead of arguments, we get certainties , "Virtues do not thrive in bottom-line, profit-oriented markets. . . . Many of the features that providers and patients want form their medical providers...