248 Book reviews

have either a living will or a durable
power of attorney) and are frequently
mistrusted as gimmicks to reduce the
cost of health care.
The essays are clearly written, free

from philosophical jargon, and the
author frankly admits that they are not
based upon a rockbed moral theory or
meta-ethical foundation. There are
obvious merits in this non-founda-
tional and pragmatic approach: the
author is free from the dogmatic belief
that what can solve a problem in one
area must also be capable of solving
problems in other areas. For Caplan
there is no Holy Grail for medical
ethics. Nevertheless, he is not without
a method: the aim of the ethicist, he
says, is to identify and determine the
nature of the problem, to pinpoint its
source, and to see whether it is
possible and desirable to do some-
thing about it.

Aside from the many practical
issues addressed here Caplan makes
an important contribution to the
debate about whether -applied ethics
can play an effective role in health
care. There is a growing backlash
against philosophical experts in
medical ethics and Caplan is con-
cerned to pinpoint the source of
resentment among health care profes-
sionals. In many respects, he observes,
the moral theorist plays a diversionary
role in ethical decision-making; it is,
for example, far easier to employ
moral philosophers to theorize on the
ethics of allocating scarce resources
than to ask health-workers and
patients to accept the fact that society
is unwilling to fund resources for
those who are in need. One of the
main problems with applied ethics,
says Caplan, is the commitment to
'the engineering model', which pre-
sumes that a body of knowledge about
ethics can be employed in medical set-
tings by the deduction of conclusions
from theories, analysing the process of
deduction, and then applying ethical
theories to medicine in an impartial,
disinterested, and value-free manner.
This methodology once dominated
the philosophy of the natural and
social sciences and it is puzzling why it
has taken hold in applied ethics when
it has been so forcibly discredited in
the philosophy of science. Why
applied ethics has become the final
rest home for the nomological-deduc-
tive model of explanation is a project
worthy of serious study.
This book is strongly recommended

as a useful and pragmatic contribution
to the philosophy of health care,
which calls for a reassessment of the

relationship between philosophy and
medical practice and addresses
numerous ethical problems which
have recently come to the forefront of
public concern.

DAVID LAMB
Department ofBioethics,

University ofBirmingham

New horizons in the
philosophy of science
Edited by David Lamb, London,
Avebury, 1992, 191 pages, £30.00

This is a collection of articles commit-
ted to challenging current orthodoxies
in the philosophy of science. In the
first, Richard F Kitchener maintains
that mainstream philosophy of science
is intrinsically 'positivist', a dirty word
in anyone's mouth these days. He
makes a number of fairly astute criti-
cisms of the narrow focus of much of
the work in this field, and urges that
philosophers should draw on meta-
physics, on ethics, on sociology, and a
greater knowledge of science to make
a more radical and significant contri-
bution. As David Lamb's introduc-
tion stresses, the articles in this book
are intended to be examples of just
such a radical and ambitious
approach.
Given this build-up, Lamb's own

contribution is unexpectedly tradi-
tional in approach. In 'Death: the final
frontier', he argues cogently that we
ought to regard irreversible damage to
the brainstem as the sole criterion of
death. This has ethical consequences,
such as how we regard certain termi-
nations of treatment. If a patient's
brainstem is dead, and the ventilator
is subsequently switched off, then it is
wrong to say that 'life support has
been disconnected'. Doctors have just
chosen not to continue treating a dead
body. This is a good example of how
philosophy can contribute to the way
we think about medical practice.
E K Ledermann uses case studies to

argue that a 'mechanistic-scientific'
approach to treatment is inadequate.
A 'holistic' approach, which acknowl-
edges and influences the personal feel-
ings and circumstances of the patient,
is to be preferred to treatment that
views the patient as one would a dam-
aged machine. It is difficult to dis-
agree with this claim; it is surely right
to suggest that there are psychological
factors involved in both the causes
and the best treatments of many ail-
ments. What is hard to believe is that

many doctors disagree. We are told
that 'Patients seek treatment from
doctors who follow either mechan-
istic-scientific or holistic principles'.
Do doctors really fall so neatly into
one camp or the other?
Lucy Frith's article, 'Sociobiology,

ethics and human nature', might give
us some reason to think that a mech-
anistic view, not just of illness, but of
human affairs in general requires
examination. Her excellent article
reviews the arguments for socio-
biology, the view that all human
behaviour is genetically encoded. She
shows just how far some philosophers
are willing to take this view, and
provides a sustained critique both of
this strong view and of a weaker
version which allows some environ-
mental influences.

In 'A sociological perspective on
disease', Kevin White attacks 'empiri-
cist' and 'normative' analyses of
disease. He points out that what we
classify as a disease is greatly affected
by our social attitudes. Someone can
cease to be 'diseased' simply through
a change in attitudes; for example,
certain sexual predilections were once
thought of as diseases. This is a good
point to make, even if we are not
entirely convinced that there is a con-
flict between 'empiricist' and 'socio-
logical' analyses. If a person has
cancer then there is a fact of the
matter as to what is happening in his
or her body (empirical), and we
choose to call this a disease (socio-
logical). Nonetheless, White provides
a good discussion of the sociological
issues.
The rest of the book is devoted to

general issues in the philosophy of
science, such as the 'evolutionary par-
adigm' and the nature of scientific
knowledge. This is a useful reference
text; most of the ten articles provide
general reviews of available literature
on the different questions they tackle.

MICHAEL GAYLARD
Darwin College, Cambridge

Morality, mortality
vol 1: death and whom
to save from it

F M Kamm, Oxford, Oxford
University Press, 1993, viii+ 344
pages, £35 (cloth)

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