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book reviews Ethical Decision Making in Therapy Practice

more narrowly defined ‘medical ethics’, both illuminating and accounting for their characteristic nature.

The introduction is followed by a chapter headed ‘Ethical decision making’ which seeks to provide the broad theoretical base for the more applied discussion of particular concepts and issues which follows. While the account of the main theo- ries is clear and concise, there is a tendency to simplify and to deal in a somewhat truncated fashion with the complexities and contradictions of the material. There are, however, some apt and telling links to prac- tice and effective illustrations through case studies and examples.

The chapters following this examine particular areas of ethical concern under the headings: ‘Tmth- fulness’, ‘Informed consent’, ‘Confidentiality’, ‘Death and dying‘, ‘Resource allocation’ and ‘Codes of ethics’. The discussion throughout is clear and focuses effectively on the dilemmas which occur in practice

by Julius Sim. Butterworth Heinemann, Oxford, 1997 (ISBN 0 7506 21 73 7). 204 pages. f 16.99.

This book provides an introduction to the main ethical concepts and dilemmas to be found in the practice of the various therapies associated with health care. Though it is not specifically addressed to physio- therapy, since it encompasses occupational therapy and speech and language therapy as well, it would prove of interest and use t o students of physiotherapy, particu- larly as many of the examples and illustrations are drawn from that field.

In the clear and convincing preface and introduction Professor Sim makes a persuasive case for the essential nature of the ethical base underlying the therapeutic profes- sions, and distinguishes the concerns and dilemmas characteristic of ther- apeutic practice both from the kinds of ‘dramatic’ issues often covered by the media and those typically canvassed in texts dealing with

and the role and responsibilities of the therapist in dealing with them. The main points of argument are discussed and, as throughout the text, are aptly and usefully illus- trated by relevant and convincing case-studies and examples. A number of crucial points are made about the difficulties and pitfalls of practice in the context of ethical decision making in a modern health care setting.

The final chapter deals with a somewhat disparate range of topics - advocacy, suicide, care of older people, and HIV infection - which are discussed accessibly and clearly, with reference to the material covered in earlier sections.

The book is clearly relevant t o physiotherapy and to physiothera- pists and would serve as an approachable and useful introduc- tion, particularly for students, to the main ethical issues and arguments currently occurring in practice.

A C Tuxill BA MA

Legal and Ethical Issues in Physical Therapy by Laura L Swisher and Carol Krueger- Brophy. Butterworth Heinemann, Oxford, 1998 (ISBN 0 7506 9788 1). 231 pages. f 30.

This book sets out to introduce physical therapists to the legal and ethical issues they may meet in a variety of practice settings. It does not pretend to address each potential issue, rather it hopes t o introduce readers to the tools required for a problem-solving approach to the many and varied situations which may arise.

The book is aimed at physical therapists, both clinical practi- tioners and managers, as well as students who are beginning their clinical experience.

Unfortunately chapter 1, which lays the groundwork for the rest of the book, is based on American

sources of law and is therefore largely irrelevant t o those of us who practise within the United Kingdom. However, the section which explores the area of ethics is well developed and challenging.

Subsequent chapters use care examples t o generate discussion about the legal and ethical problems related to professional issues; busi- ness issues; administrative and organisational issues; institutional and personal aspects of patient rights and research and educational issues. Each of these chapters has something of interest, but I found the American context difficult to follow.

The last chapter deals with emerging and future legal and ethical issues in physical therapy. While interesting, this chapter is

again too deeply rooted in the American healthcare system to be truly helpful in a United Kmgdom context.

In summary, this is an interesting and thought-provoking text which would benefit from being re-written to take account of the United Kingdom legal and regulatory system.

I found the ethical discussions stimulating but had some difficulty with the legal ones. However, it would be a useful text for those clin- icians who are hoping to work in the United States as it would success- fully introduce them to the legal and ethical debates pertinent to the healthcare system there. It may be more suitable as a library text rather than a personal purchase.

Jean Johns BSc MCSP

Physiotherapy, July 1998, vol84, no 7