Book Review – Ethical dimensions in the Health Professions

This review was written by George Prudden who is one of our fantastic volunteers. If you want to find out more about George then follow him on twitter and check out this blog post. 

Ethical dimensions in the Health Professions 6e by Doherty and Purtilois a large pocket book that may fit into your oversized tunic pocket but will it fit into your clinical practice? The book provides ethical theory as well as utilising examples from healthcare with the aim to allow you to identify situations that require some ethical thought and a framework of how to resolve issues. The content is aimed primarily at front line clinicians but scenarios that exclusively affect students and researchers are also covered.

Strengths

The textbook covers a range of common ethical scenarios such as consent and end-of-life care as well as the more contemporary complexity of multiple-disciplinary team working and healthcare in modern society. There is a good introduction to the basics of ethics that is made specific to healthcare professionals. The book is well organised and has an inoffensive style in colour tone and layout. The bulk of the content is text which is broken up by narratives, prompts for reflection, tables and images. The writing style is varied with some sections successful in explaining detailed concepts to those who are are new to ethics but on occasion concepts/ideas/topics seem overly explained and are long-winded which I fear could lead to busy clinicians putting the book down.

A defining feature of the book is the use of stories, these narratives take you right into the centre of an ethical issue and become a focus for the entire chapter. Sixteen different stories from across healthcare are told with a particular ethical dilemma made apparent such as finding a caring response following a professional’s mistake or determining how to allocate healthcare when there are not enough to go around. Following the narrative the authors thoroughly explain concepts inherent in ethical decision making, a subject often missing from other textbooks for healthcare professionals. The practicalities from within the narrative are drawn upon to make clinical sense to the theory that has been discussed. This is a great strength of the book and something that I think clinicians will appreciate.

Readers are guided through how a clinician could understand and ultimately solve the problem with the six-step process of ethical decision making tool. Here the stories are used to provide the meat on the bones of the theory by describing how the tool is implemented in a way which is engaging and a particular strength of the book. With every narrative the versatility of the tool is demonstrated as the individual nuances of the stories are explored.

The book has been well loved!

The reflection sections are an interesting addition, the authors provide questions which allow you to reflect on the narrative or your own practice. These sections reinforce the clear theme throughout the book that the locus of responsibility of ethical practice is on you, the clinician. Underneath the question is an area to jot down your thoughts, I am unsure whether many will be inclined to deface their copy of the book and whether readers will engage with these sections at all.

There are two different types of sections labelled ‘summary’. Surely the authors could have reached for a thesaurus but they are in fact distinct enough to not be confused. After each segment of theory a summary box with a take-home message is used. These come frequently enough and helped consolidate what could sometimes be detailed and lengthy topics. The second type summarises the whole chapter and a sneak preview for what’s coming in the next.

Weaknesses

Some readers will find the US focus distracting. It is manifested in differences in politics and approaches to healthcare, however, I did not consider this to be a deal breaker as it seems ethical challenges cross borders. On a number of occasions, religion is discussed as a source of moral direction and guidance, again this may be distracting to those who see religion as a private matter or those who have no strong religious views.

This book is difficult to dip in and out of, the content builds up and there are often references to topics discussed in previous chapters. This is potentially unhelpful for a clinician who is limited by time. However, I appreciate that ethical problems are complex and there are no easy answers, therefore, a measured and deeply thoughtful approach is required. The book achieves this somewhat by building your knowledge brick-by-brick. This book is therefore perhaps best suited to students taking modules in healthcare ethics.

Conclusion

Ethical dimensions in the Health Professions is a textbook unlike others. The difficult ethical challenges that clinicians encounter day-to-day are tackled as well as a pragmatic framework for their solution. It is impossible to flick to a single page and find your answer written in black and white. Perhaps this is not weakness, more an inevitability of solving ethical problems – they take time and require a comprehensive approach by the entire team. Ultimately this textbook is successful in empowering clinicians to make the right choices for their patients but may fail due to clinicians finding the text and tasks provided difficult to engage with.

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