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BOOK REVIEWS TLĀ· Unmasking ofMedicine. By Ian Kennedy. Winchester, Mass.: Allen & Unwin, 1982. Pp. 189. $19.95. Philosophy in Medicine. By Charles M. Culver and Bernard Gert. New York: Oxford University Press, 1982. Pp. 240. $16.95 (cloth); $9.95 (paper). These books illustrate the spectrum of writing in the field called "medical ethics." It is useful to compare them, since each points out shortcomings in die other's perspective. Kennedy's book is intended for a popular audience in Great Britain. It covers a wide range of topics, including preventive medicine, care of defective newborns, the diagnosis of mental illness, and selection of patients for renal dialysis. It argues that these topics present political, social, and ethical issues to be decided by the public and its political representatives. They are not medical or technical issues; physicians have neither training, expertise, nor political accountability to make decisions about them. Since the book is polemical and provocative, some may consider it superficial or unbalanced. However, it reminds American readers that serious public discussion ofthese issues is lacking in the United States and that we do not acknowledge that difficult, tragic choices must be made. Culver and Gert represent the opposite end of the spectrum. Their philosophical work intends to clarify concepts, make distinctions, and analyze arguments . At times, however, their approach is so remote from clinical reality that it may obfuscate radier than clarify. For example, they argue that the term "malady" is more objective and general than "disease" or "illness." They suggest that using the term "malady" may reduce the cultural, political, and subjective influences that determine what phenomena are considered illnesses. Their special concern is the diagnosis of psychiatric illness; they want to ensure that socially deviant behaviors are not labeled as psychiatric disorders. However, their attempt to introduce new terminology may be misdirected. A more useful approach is die direct critique of Kennedy; pointing out the implicit assumptions and biases in diagnostic labels stimulates debate on the underlying ethical, cultural , and political issues. Culver and Gert imply diat these underlying issues, rather than being an inevitable part of medicine, result from imprecise thinking. Kennedy, however, would respond that conflict and choices occur, not because people lapse from perfect rationality, but because medicine exists only in a social, cultural, and political context. Other sections of Culver and Gert's book are excellent. A lucid analysis of paternalism is followed by a discussion ofinvoluntary commitment of psychiatric Permission to reprint a book review presented in this section may be obtained only from the author. 676 Book Reviews patients. This discussion is strengthened by the use of case examples and a consideration of the problems that occur in applying abstract principles to actual cases. For example, it is difficult to predict the benefits or harms of an involuntary hospitalization for an individual patient. Similarly, the section on the definition of death is useful, pointing out inconsistencies in die guidelines proposed by a recent presidential commission. . These excellent chapters are a model of how philosophy can be useful to clinicians and policymakers. Clarification and analysis can help us understand difficult practical problems. Bernard Lo Internal Medicine, University of California San Francisco, California 94143 The Biology of Race. By James C. King. Revised ed. Berkeley: University of California Press, 1981. Pp. 180. $15.95. This interesting and well-written book provides a good and fundamental introduction to the biological concept of race. King begins the first chapter with a discussion of the concepts of species and subspecies and the utility of such definitions for current research in evolutionary and population biology. A detailed but elementary discussion of the relationship between phenotype and genotype follows and is further supplemented with a basic description of molecular genetics and its relationship to developmental processes. Darwinian natural selection, and the processes influencing the maintenance of genetic variation at the population level, are also presented. In each of these background chapters, the biological points are made and supplemented with die cogent reporting of studies drawn from die empirical literature. This technique is helpful, not only because it illustrates more concretely the central arguments, but also because it gives the reader insight into the nature of biological research and the...


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