Randall 223

to legalise euthanasia will risk undermining thefreedoms of the majority of society in an attemptto promote the autonomy of the small minority ofpatients who might retain an interest in endingtheir lives in this way. This risk to society arisesfrom the potential for abuse of legalised euthana-sia by, for example, increasing the pressure (real orimagined) that legalised euthanasia might placeon vulnerable people and by the denial of valueof elderly, chronically infirm, and dependentpeople.... The arguments advanced indicate that

respect for individual autonomy cannot be anabsolute value".

Dr Fiona Randall, FRCPJ is Consultant in PalliativeMedicine, Christchurch Hospital, Christchurch,Dorset.

References1 Farsides B. Palliative care - a euthanasia-free zone? 3tournal ofMedical Ethics 1998;24: 149-50.

News and notes

Psychology and Law International Conference

An international conference entitled Psychology andLaw is to be held from the 6th to the 9th ofJuly 1999 inDublin, Ireland. This will be the first joint annual con-ference of the American Psychology-Law Society andthe European Association of Psychology and Law.

Seven one-day "master" courses will precede themain conference.These will cover: Assessment and treatment of anger;

Interviewing children: techniques for improving theaccuracy and completeness of children's reports; Whatworks with crime? Cognitive-behavioural programmes

in criminal justice settings; Risk analysis, assessmentand management: implications of the latest research;Investigative psychology: informing criminal investiga-tions; Assessing credibility, and Advances in assessingcapacities for legal competencies.

Delegates may attend the one-day courses withoutregistering for the main conference.

For further information please contact: Jill Elliott,Conference Administrator, Faculty of Law, Universityof Southampton. Tel: +44 (0)1703 592376; FAX:+44 (0)1703 593885; email: jill.elliott@soton.ac.uk

News and notes

Ethics and Science - the Social, Juridical and PhilosophicalDebate

The University of Tubingen's Centre for Ethics in theSciences and Humanities is organising a conference,Ethics and Science - the Social, Juridical and Philo-sophical Debate, at the Eberhard-Karls University ofTubingenfromJune 1Oth- 11th 1999.The conference aims to explore and debate the philo-

sophical, cultural and legal aspects of the relationshipsbetween ethics, science and society in Europe. Special,but not exclusive, attention will be given to subjects

related to life sciences and technologies, as well as toinformation and communication technologies.For further information please contact: The Centre

for Ethics in the Science and Humanities, Keplerstr 17,D-72074 Tubingen, Germany. Tel: +49 (0)7071 - 2977516; fax: +49 (0)7071 - 29 5255; email: eu-congress@uni-tuebingen.deThe detailed programme can be found on the

internet: www.uni.tuebingen.de/zew/eu-congress

236 Genetically deternmined obesity in Prader-Willi Syndronme: the ethics and legality of treatmienit

Dr Anthony J Holland, BSc, MBBS, MRCPIMRCPsych, is a University Lecturer in the Departmentof Psychiatry, University of Cambridge and HonoraryConsultant Psychiatrist, Lifespan NHS Trust, Cam-bridge. Dr Josephine Wong, MBBS, MA, MRCPsych,was until recently a Clinical Research Associate at theDepartment of Psychiatry, University of Cambridge,funded by a grantfrom the Nuffield Foundation. She isnow Lecturer, Department of Psychiatry, University ofHong Kong. Correspondence: Dr A J Holland, Sectionof Developmental Psychiatry, Douglas House, 18bTrumpington Road, Canmbridge, CB2 2AH.

References1 Ledbetter DH, Riccardi VM, Airhart SD, Strobel RJ, KeenanSB, Crawford JD. Deletions of chromosome 15 as a cause of thePrader-Willi Syndrome. The Nezw Eniglanid Jornal of Medicinle1981 ;304:325-9.

2 Laurance BM. Prader-Willi Syndrome. Pediatric Reviews anidComnmuxnications 1993;7:77-91.

3 Swaab DF, Purba JS, Hoffman MA. Alterations in the hypotha-lamic paraventricular nucleus and its oxvtocin neurons (putativesatiety cells) in Prader-Willi Svndrome: a study of five cases.Journal of Clinical Endocrinology and Metabolisni 1995;80:573-9.

4 Holland AJ, Treasure, J, Coskeran P, Dallow J. Characteristicsof the eating disorder in the Prader-Willi Syndrome: implica-tions for treatment. 7ournal of Initellectutal Disability, Research1995;39,5,:373-81.

5 See reference 4: 380.6 Greenswag LR. Adults with Prader-Willi Syndrome: a survey

of 232 cases. Developniental Medicine a7id Child NVeturology 1987;29:145-52.

7 Dykens EM, Goff BJ, Hodapp RM, Davis L, Devanzo P, MossF, et al. Eating themselves to death: have "personal rights" gonetoo far in treating people with Prader-Willi Syndrome? MewitalRetardatio7i 1997;35:312- 14.

8 CNN transcript. Talkback live: thi obesits' tial. 1997 Dec 30.Web site address: http: svwww.size-acceptance.orgcnn_transcript.htm

9 Lord Chancellor's Division. Who dccides? Makinlg decisiolns ouubehalf of nientallv i'icapacitated aditlts. (Cm 3803) London: TheStationery Office Limited, 1998.

10 Department of Health. ldental Healtli Act, 1983. London:HMSO, 1983.

11 Re: F (Mental Patient: Sterilisation) [1990] 2 AC 1.12 Re: C (Refusal of Treatment) [1994] 1 Fanuuly Law Report, 3 1.13 Wong JG, Clare ICH, Gunn MJ, Holland AJ. Capacity to make

health care decisions: its importance in clinical practice.Psychological Medicinle (in press).

14 See reference 7: 312.1 5 Draper H. Treating anorexics without consent: some reserva-

tions. 7oiurial of Medical Ethics 1998;24:5-7.16 Department of Health and Welsh Office. Menztal Health Act

Code of Practice. London: HMSO, 1993:1, para 1.3.17 See reference 16:114, para 30.2c.18 Holland AJ. The nature of the eating disorder in PWS. Journlal

ofApplied Research iii Intellectual Disability 1998;1 1:192-206.19 Montague CT, Farooql IS, Whitehead JP, Soos MA, Rau H,

Wareharn NJ, et al. Congenital leptin deficiency is associatedwith severe early-onset obesity in humans. Nature 1997;387:902-8.

News and notes

The Annual Intensive Course on Medical Ethics

The Annual Intensive Course on Medical Ethics will It is organised in collaboration with the Institute oftake place at Imperial College, London from 13-17 Medical Ethics.September, 1999. For further information please contact: Sally Verkaik,The course provides a multidisciplinary introduction Imperial college Centre for Continuing Education,

to philosophical medical ethics for medical and nursing London SW7 2AZ. Tel: +44 (0)171 594 6882; fax: +44teachers, members of ethics committees, GPs, hospital (0)171 594 6883; e-mail: cpd(a ic.ac.ukconsultants and health administrators.

News and notes

Human Rights in Medicine

Human Rights in Medicine is the title of an inter- Mastilica, PhD, Andrija Stampar School of Publicnational summer course on health care ethics to be held Health, University of Zagreb, Rockefellerova 4, HR-from June 28 - July 3 in Dubrovnik, Croatia. 10000 Zagreb, Croatia. Tel: +385 1 468 4440; fax: +385

For further information please contact: Miroslav 1 468 4441; email: mmastil(@andrija.snz.hr

Denekens, Nys, Stuer 241

11 Rauh JL, Dine MS, Biro FM, Rauh TD. Sterilization for thementally retarded adolescent. Balancing the equities/theCincinnati experience. Jrournal of Adolescent Health Care1989;10:467-72.

12 Eser A. Contraception and abortion of mentally handicappedfemale adolescents under German law. Medicine and Law 1985;4:499-513.

13 Perrin JC, Sands CR, Tinker DE, Dominguez BC, Dingle JT,Thomas MJ. A considered approach to sterilization of mentallyretarded youth. American Journal of Diseases of Children1976;130:288-290.

14 Palmer FB, Capute AJ. Mental retardation. Pediatrics in Review1994;15:473-9.

15 Karp LE. Sterilization of the retarded. American J7ournal ofMedical Genetics 1981; 9:1-3.

16 Nash ES, Navias M. The therapeutic sterilization of the men-tally handicapped. Experience with the Abortion and Steriliza-tion Act of 1975. South Africa Medical Journal 1992;82:437-9.

17 McManus R. Sterilization and the mentally handicappedperson. North Carolina MedicalJournal 1983;44:92-3.

18 McLachlan R, Peppin P. Sexuality and contraception for devel-opmentally handicapped persons. Canadian Family Physician1986;32:1631-7.

19 Macklin R, Gaylin W, eds. Mental retardation and sterilization. Aproblem of competency and paternalism. New York and London:The Hastings Center Series in Ethics, Plenum Press, 1981.

20 Vining E, Freeman J. Sterilization and the retarded female: isadvocacy depriving individuals of their rights? Pediatrics 1978;62:850-3.

21 Hein K, Coupez SM, Cohen MI. Special considerations inpregnancy prevention for the mentally subnormal adolescentfemale. Journal ofAdolescent Health Care 1980;1:46-9.

22 Elkins TE, Gafford LS, Wilks CS, Muram D, Golden G. Amodel clinic approach to the reproductive health concerns ofthe mentally handicapped. Obstetrics and Gynecology 1986;68:185-8.

News and notes

European Commission: call for research proposalsThe European Commission is publishing calls forproposals for research in the area of biomedical ethicsand bioethics in 1999, 2000 and 2001 under the FifthFramework Programme for Research and the SpecificProgramme for "Quality of Life and Management ofLiving Resources".These calls are open to teams wishing to propose

either research projects or concerted actions, researchnetworks or conferences.The first call's closing date is June 1999. A second call

should be published with a closing date in October1999.This call will be covering areas such as: Ethical

aspects of scientific and technological developments;Ethical framework for the life sciences; Public policies,law and bioethics, and Bioethics infrastructures andmethodologies.For more details or an information pack please

contact Mr Maurizio Salvi at: fax: 32-2.299.58.88 or byemail: maurizio.salvi(dgl2.cec.be

244 A problem for the idea of voluntary euthanasia

at the last possible moment, which will be when heis enduring tremendous pain and suffering, butthen we are right back where we started. Whethera living will was made thirty years ago or thirtyhours ago seems to make no difference, at leastnot a difference in kind. We therefore have no way

of ensuring that the patient's desire to end his lifeis freely chosen, and so, even with living wills itappears as though euthanasia (whether active or

passive) is not permissible where unbearable painand suffering are concerned.We have seen, then, that there are legitimate

reasons for questioning whether or not there can

be such a thing as voluntary euthanasia. In thosecases where the decision to end one's life is madewhen experiencing unbearable pain and sufferingwe cannot rule out the possibility that the choiceto end one's life was not made freely. In thosecases where a living will is in existence we have a

moral obligation to ensure that the patient still

wishes us to abide by the terms of the will, but todo this we need to determine the patient's wishesat the latest possible time, in which case we end upwith the same problem just mentioned. If theabove arguments are correct, then the currentdebates about active and passive euthanasia are

unnecessary, at least for certain types of cases, foreither form of euthanasia turns out to be involun-tary, and most ethicists agree that involuntaryeuthanasia is not permissible. To make some

progress on this issue ethicists should take a closerlook at the voluntary-involuntary distinction anddetermine, in greater detail, the conditions underwhich euthanasia can reasonably be characterisedas voluntary.

Neil Campbell, PhD, is a Sessional Instructor in theDepartment of Philosophy, University of Calgary,Alberta, Canada.

News and notes

Biomedicine, the Family and Human RightsThe International Society of Family Law is holding a on Human Rights and Biomedicine; family law and eth-regional conference, Biomedicine, the Family and ics; parenthood, duties and responsibility; internationalHuman Rights, from Friday 27th of August to Monday legal collaboration, and practical legal problems.30th August, 1999. Topics incude: Preimplantation For further information please contact: Ruth Deechgenetic diagnosis; genetic engineering; sex selection; (convenor) at St Anne's College, Oxford OX2 6HS,cloning; assisted reproductive technology; embryo UK. Tel: +44 865 274 820; fax: +44 865 274 895; emailresearch; surrogacy; the Council of Europe Convention sandra.madley(st-annes.ox.ac.uk

258 Abandonment of terminally ill patients in the Byzantine era. An ancient tradition?

20 See reference 9: 236-9.21 See reference 1: 261.22 See reference 13: 899.23 Prioreschi P. A history of nmedicine [vol 2]. Lewiston, New York,

USA: The Edwin Mellen Press, 1994: 361-93.24 Lee D. Plato, The Repuiblic. London: Penguin Books, 1987: 171.25 Deichgraber K. Die arztliche Standesethik des Hippokra-

tischen Eides. Quelleni isid Studieni zur Gcschichte der Naturzvwis-seuischafteni wnd der Medizimi 1933;3:79-99.

26 Adams F. The genuinle works of Hippocrates. Huntington, NewYork, USA: R E Krieger, 1972: 293.

27 Jones WHS. Hippocrates [vol II]. London: The Loeb ClassicalLibrary, 1981: 190-217.

28 See reference 27: 192-3.29 See reference 27: 212-3.30 See reference 27: 216-7.31 Schadewaldt H. Arzt und Patient in antiker und fruhchristli-

cher Sicht. Mediziniischle Klisnik 1964; 59:146-52.32 See reference 31: 151-2.33 Briau R. Chlisrugic dc Pass! d 'Egisi. Paris: V Masson, 1854:

356-7.34 See reference 27: 204-5.35 See reference 33: 357.36 Temkin 0. Hippocrates bi a zworld ofpagaiss asid Chiristiasis. Balti-

more and London: The Johns Hopkins University Press, 199 1:249-56.

News and notes

Ethics and Genetics

The International Programme in Bioethics Education For further information please contact: B Gordijn,and Research is organising the third Advanced Euro- PhD, Catholic University, Nijmegen, 232 Dept ofpean Bioethics Course, this time on Ethics and Genet- Ethics, Philosophy and History of Medicine, PO boxics. The course will be held in Nijmegen, Holland from 9101, 6500 HB Nijmegen, Netherlands. Tel: 0031-24-the 18th to the 20th of November 1999. 3615320; fax: 0031-24-3540254; email: b.gordijn(a

Topics will include: Ethics and the human genome; efg.kun.m; internet site: http://www.kun.nl./fmw/genetic counselling; genetic screening; human gene onderwys/ukgene.htmtherapy, and geneticisation.

286 Book reviews

specific introduction, rather than thereader being reliant on a brief preface.Secondly, the volume's title, Intersec-tions: Women on Law, Medicine and Tech-nology, does not direct the reader to thestated aim in the preface, that ofdissecting medical power. This titlealerts the reader to the fact that theauthors are women. However, whilemany of the essays in the collection doprovide a feminist slant to the discus-sion ofparticular health care issues (forexample, Anlue's discussion of Repro-ductive autonomy and reproductivetechnology: gender, deviance and infer-tility, and Darvell's essay, Gender andequity: emerging issues in Australiandrug trial regulatory policies,) andmany of the essays centre upon issuesparticularly pertinent to women, this isnot a collection of essays designed toprovide a feminist critique of medicalpower. For a more comprehensiveexamination of feminist issues in thehealth care context the reader wouldneed to look elsewhere, to collectionssuch as that edited by Sheldon andThomson, Feminist Perspectives ofHealthCare, which was published by Cavend-ish in 1997).

Inevitably in a collection such asthis, there are issues which the re-viewer would have hoped would havebeen addressed. It is of course unfairto say to the authors that one wouldhave structured a volume in anotherway, etc and there is much of interestand of value in this particular collec-tion, not least in its comparativediscussions. I was, however, at least alittle disappointed that the impact onmedical power of professional self-regulation, statutory regulation andother measures such as clinical auditwere not afforded greater considera-tion. These are surely important issuesfor a volume dissecting medical powerand the role of technology today, avolume moreover which states that itaims to provide a "coherent frame-work for law and policy making". Thenature of the boundaries betweenmedical power itself and that wieldedby the scientist in the biotechnologicalcontext (as, for example, discussed byGannon in her essay, The science ofbiotechnology: present, past and fu-ture quagmires,) perhaps merited fur-ther consideration. Is the role of thescientist and of the doctor identical?Does this impact upon the appropriateregulatory mechanisms to be adopted?One final reflection. Overall this col-lection draws upon some interesting

cross-jurisdictional comparisons. Itraises some important themes andleaves the reader wanting to explorethe issue further.

J V MCHALESenior Lecturer in Law, Faculty ofLaw,

University ofManchester

Sharing the Journey:Spiritual Assessmentand Pastoral Responseto Persons withIncurable Illnesses

Cornelius J van der Poel, Minnesota,Liturgical Press, 1998, 94 pages,US$9.95.

The author of this book has taught eth-ics and pastoral theology as well as hav-ing served as a chaplain within a healthcare setting prior to retirement. Sharingthe J7ourney seeks to differentiate be-tween religious denomination and abroader spiritual perspective and fo-cuses on people who have AIDS,cancer or multiple sclerosis, recognis-ing that the assessment and evaluationof a patient's needs in respect ofspiritual care is far from easy. Theauthor offers an instrument for spiritualassessment which will allow the carer toevaluate the spiritual state of the personto whom care is being given.The first part of the book outlines

an understanding of the nature ofspirituality and the differentiation ofspiritual from psychological states,focusing in particular on key words offaith, hope and love.The key aspects of the assessment

document are five general questionsdealing with:

1. The place of God in the patient'slife;

2. The patient's attitude towards himor herself;

3. The patient's relationship withfamily and friends;

4. The patient's understanding of andinterest in prayer;

5. The patient's attitude toward his orher religious denomination orchurch.

Each question then has four state-ments and each assessment has a scoreof 1 to 5, ranging from strongdisagreement to strong agreement.The next chapter discusses the appli-

cability of this instrument in respect of

three situations/illnesses which impacton patients and families. This is thenfollowed by a chapter focusing on

pastoral responsibility and looking atways in which pastors or chaplainsmight plan suitable intervention. Read-ers may recoil from the description of"a pastoral treatment plan" (page 74)and one of the problems presented bythis book is the difficulty of using suchinstruments in the general care andmanagement of patients. There is somerecognition of this in that the authorenvisages chaplains might choose tomake the assessment retrospectively,following interaction with the patientand this would seem to be a less intru-sive way. This would then give thechaplain a way of reflecting on areas ofdevelopment or regression in the on-

going relationship with the patient.From an ethical perspective it feels

important that the development anduse of such instruments does notoverride the autonomy of the indi-vidual and his/her ability to say "No"to being so assessed. Issues might alsoarise regarding confidentiality: fearsabout information becoming accessi-ble to other team members and otherprofessionals involved in the care. Itwould also seem important that suchan instrument, if it were to be used,should not be included on the basis ofimplied consent but with the specificconsent of the patient being soughteach time.

REVEREND PREBENDARYPETER SPECK

Trust Chaplaincy Team Leader

Books: information andorders

If you wish to order or require furtherinformation regarding the titles re-viewed here, please write or telephonethe BMJ Bookshop, PO Box 295,London WC1H 9JR. Tel: 0171 3836244; fax: 0171 383 6455; Internet:www.bmjbookshop.com; email:orders@bmjbookshop.com. Europeancustomers should add 15 per cent forpostage and packing, other overseascustomers should add 30%. Paymentcan be made by cheque in sterlingdrawn on a UK bank or by credit card(Mastercard,Visa, or American Ex-press, stating card number, expiry dateand full name. (The price and availa-bality are occasionally subject torevision by the publishers.)

J7ournal ofMedical Ethics 1999;25:287

Notice for contributors to the Journal ofMedical Ethics

Submitting manuscripts forpublicationFour copies of papers submitted for publi-cation should be sent to: The Editor, JournialofMedical Ethics, 36 West Towers, Pinner,Middlesex HA5 lUA. The journal considerspapers only if they are not under considerationby any other journal at the same time.Rejected manuscripts are not returned.Papers, including references, should be indouble-spaced typewriting on one side of thepaper only. Pages should be numberedsequentially. On the title page brief details ofthe author's present post, an address for read-ers' correspondence and contact fax andphone numbers, and a total word countshould be supplied. Once a paper has beenscheduled it will be requested on disk. Thisshould be PC format, Wordperfect 6.1 ifpossible and there should be no hidden codes.

The JME uses a simplified 'Vancouver style'for references. The full text of the 'VancouverAgreement' was published in the British Medi-cal Journal in 1991;302:338-41. As the "Van-couver style" is incompatible with the longestablished style of references for legal articles,lawyers should use their own standard style,but avoid abbreviations so as to facilitate refer-ence by others. The journal ismultidisciplinary and papers should be inclear jargon-free English, accessible toany intelligent reader.

Authors are asked to avoid footnotes. Thepreferred maximum length of papers is 3,500words -absolute maximum 5,500 (includingreferences). Book reviews should be between600 and 1,000 words. Abbreviations should beavoided. The names of journals, organisationsetc should be given in full in the text.

Two copies of the journal will be sentto authors free of charge after theirpapers are published. Offprints of indi-vidual papers may be bought from ThePublisher, journal ofMedical Ethics, BMJPublishing Dept, BMA House, TavistockSquare, London WCIH 9JR. If your paperinvolves research on human subjects pleaseconfirm that the study has received approvalfrom a research ethics committee (or if not,please explain why not).

Simplified 'Vancouver style'All papers submitted for publication shouldcontain the following:1 On page one of the manuscript:

a) the title of the article which should beconcise but informative and designed toattract the reader. The Editor reserves theright to change titles to achieve these ends.

b) names, initials or forenames and aca-demic degrees (if any) of author or authorsc) names of department(s) and institu-tion(s) to which the work should be attrib-uted, if anyd) disclaimers, if anye) source(s) of support, if any

2 On page two:a) an interesting abstract or summary of notmore than 150 words. Emphasise impor-tant and or new aspects of the article toattract the potential reader. Ensure theabstract contains a statement of the aim,key points and conclusion of the paper.Papers reporting the author's empiricalresearch should contain a structuredabstract summarising the research underthe headings: objectives; design; setting;patients or participants; interventions;main measurements; results; conclusions.Structured abstracts should not be longerthan 250 words.b) key (indexing) terms -below theabstract. Provide and identify as such, threeto six key words or short phrases that willassist indexers in cross-indexing your articleand that may be published with the abstract.Where appropriate, use terms from theMedical Subject Headings List fromIN\DEX Medicus.

3 Acknowledgements:Acknowledge only persons who have madesubstantive contributions to the study.Authors are responsible for obtaining writ-ten permission from everyone acknowl-edged by name because readers may inferthe latter's endorsement of data and con-clusions.

4 References:Number these consecutively in theorder in which they are first men-tioned in the text, tables, and captions,by arabic numerals, in square brack-ets, for example, according to Jones.[31The list of references at the end of thepaper should be numbered in the order inwhich each reference appears in the text.Try to avoid using abstracts as references.'Unpublished observations' and 'personalcommunications' may not be used as refer-ences, although references to written, notverbal, communications may be inserted(in parenthesis) in the text. Manuscriptsaccepted but not yet published may beused as references -designate the journalfollowed by 'in press' (in parenthesis).Information from manuscripts submittedbut not accepted should be cited in thetext as 'unpublished observations' (inparenthesis).

Where a further reference is made to a previ-ous reference, but to a different page number

or numbers, this should have a new referencenumber of its own and it should then referback to the original reference, thus:1 May T The nurse under physician

authority. Journal ofMedical Ethics1993;19:223-7.

2 See reference 1:225.

Please note also that the names of journalsshould be in italics. The volume numbershould be in bold.

References must be verified by theauthor(s) against the originaldocuments.The following scheme, a simplification of the'Vancouver style' for biomedical journals,should be followed for each reference: in thetext number in square brackets, followingpunctuation; in the list author (list all authorsif six or less; if seven or more, list only the firstsix and add 'et ar), title, name of publication ifdifferent from title -in italic; place of publi-cation and publisher (where appropriate); yearof publication; and, where appropriate, vol-ume number in bold and page references ofarticle or chapter referred to. Examples of cor-rect forms of reference are given below:

a) Standard journal article:1 Teasdale K, Kent G. The use ofdeception in nursing. Journal ofMedicalEthics 1995;21:77-81.

b) Corporate author:2 General Medical Council.Toniorrozv's doctors -recomninendationIs onundergraduate niedical education.London: General Medical Council,1993.

c) No author given:3 Anonymous [editorial]. AnonymousHIV testing. Lancet 1990;335:575-6.

d) Personal author(s):4 Singer P, Kuhse J. Should the baby live?Oxford: Oxford University Press, 1985.

e) Editor, compiler, chairman as author:5 Phillips CE, Wolfe JN, eds. Clinicalpractice and economics. Tunbridge Wells:Pitman Medical, 1977.

f) Chapter in book:6 Hope T. Ethics and psychiatry. In:Rose N, ed. Essential psychiatry, [2nded]. Oxford: Basil Blackwell ScientificPublications, 1994:45-51.

g) Agency publication:7 The Linacre Centre for the Study ofEthics and Health Care. Paper 1: Theprinciple of respect for human life. In:Prolongation of life. London: TheLinacre Centre for the Study of Ethicsand Health Care, 1978.

J7ournal ofMedical Ethics 1999;25:288

The Institute of Medical Ethics: research andmedical groups

Research

Since 1975, the institute has conductedresearch in many areas of health care ethicsand education, including issues related toresource allocation in health care, deathand dying, abortion and the treatment ofinfertility, research with human subjects,and medical involvement in torture. Recentstudies have been concerned with the use of

Medical groupsABERDEEN MEDICAL GROUPDr M D McArthur, Department ofMedicine for the Elderly, Wood EndHospital, Aberdeen AB9 2YS

BIRMINGHAM MEDICAL GROUPMr R Sawers,Birmingham Maternity Hospital,Queen Elizabeth Medical Centre,Edgbaston, Birmingham B 15 2TG

BRISTOL MEDICAL GROUPDr Oliver Russell, Reader in MentalHealth, Bristol University,Department of Mental Health,41 St Michael's Hill,Bristol BS2 8DZ

DUNDEE MEDICAL GROUPMr Paul Preece,Department of Surgery,Ninewells Hospital,Dundee DD1 9SY

EDINBURGH MEDICAL GROUPDr Sarah Cunningham-Burley,Department of Public Health Sciences,Edinburgh University Medical School,Teviot Place, Edinburgh EH8 9AG

GLASGOW MEDICAL GROUPDr E Hillan,Department of Nursing Studies,Glasgow University,Glasgow G12 8QQ

LEEDS MEDICAL GROUPMr Brian Bentley, Principal of the School ofRadiography,General Infirmary, Belmont Grove,Leeds LS2 9NS

animals in biomedical research, ethicalaspects ofHIV infection and AIDS, andmedical and nursing education. The insti-tute's current research programme includesstudies of decision-making in neonatal careand in the care of the elderly. Its researchunit, based in Edinburgh, works in collabo-ration with multidisciplinary working par-

LEICESTER MEDICAL GROUPDr R K McKinley,Department of General Practice,University of Leicester,Leicester General Hospital,Gwendolen Road,Leicester LE5 4PW

LIVERPOOL MEDICAL GROUPDepartment of General Practice,Liverpool University, PO Box 147,Liverpool L69 3BX

LONDONTHE UNITED MEDICAL ETHICS GROUP (GUY'SAND ST THOMAS S HOSPITALS)Dr Graham Clayden,Reader in Paediatrics,St Thomas's Hospital,Lambeth Palace Road,London SKI 7EH

THE ROYAL FREE AND UNIVERSITY COLLEGEETHICS GROUPLesley Armstrong,Sheila Sherlock Education Centre,Royal Free Hospital,Pond Street,London NW3 2PG

ST GEORGE'S MEDICAL GROUPDr N Eastman,St George's Hospital Medical School,London SW17 ORE

ST MARY S HOSPITAL ETHICS FORUMJane Tessier-Denham,St Mary's Hospital Ethics Forum,St Mary's Hospital Medical School,Praed Street,London W2

ties whose membership is drawn from allparts of the United Kingdom. The researchunit provides information and advice oncurrent issues in medical ethics to a varietyof academic and health care bodies.Reports on the institute's research are regu-larly published in medical and nursing jour-nals and by the institute.

MANCHESTER MEDICAL GROUPHillary Murray,4 Limefield Cotts,Manchester Old Rd,Middleton, Manchester M24 4EA

NEWCASTLE MEDICAL GROUPThe Revd Bryan Vernon,Lecturer in theEthics of Health Care, NewcastleUniversity, Department of Primary HealthCare, School of Health Care Sciences,The Medical School, FramlingtonPlace, Newcastle upon Tyne NE2 4HH

NOTTINGHAM MEDICAL ETHICS GROUPDr T C O'Dowd,Department of General Practice,University Hospital and MedicalSchool, Clifton Boulevard, NottinghamNG7 2UH

SOUTHAMPTON MEDICAL GROUPThe Revd T Pinner,8 Bassett Close, Southampton S02 3FP

Medical groups associated with the Insti-tute of Medical Ethics have been estab-lished in British university teachinghospitals. Each academic year they arrangeprogrammes of lectures and symposia onissues raised by the practice of medicinewhich concern other disciplines. Althoughthese programmes are addressed primarilyto medical, nursing and other hospital stu-dents they are open to all members of themedical, nursing and allied professions.There is no fee for attendance. Lecture listsare available by direct application to theappropriate co-ordinating secretary namedabove. A stamped addressed A4 envelopewould be appreciated.

Institute ofMedical Ethics

PRESIDFN'T

Sir Douglas Black\'ICh PRESIDELNTS

Professor G R DunstanProfessor Sir Raymond Hoffenberg

Mr R Sells

Professor R B Welbourn

GOV'ERNING( BOD)Y

Professor M BrazierAllan Chappell

Dr Colin Currie

Dr Donald Evans

Professor Raanan Gillon(Editor. Joutralolf AIcdical Ethics)

Professor Roger HiggsDr Tony Hope

Professor Bryan jennett

Professor D Morton

Professor Thomas Oppe(Chairmian,)Brendan Callaghan SJ(General Serrtarx).

Director of Research and ScottishDirectorDr Kenneth Boyd

Research FellowDr Hazel McHaffie

IME Amulree FellowThe V'ery Reverend Edward ShotterDean of Rochester

Honorary Research AssociatesDr Andrew FraserDr Jane SmithUrsula Gallagher

Ann Lloyd, lichniical Editor, Jouriial ofMedical EthicsMlaureen Bannatvne, Edhiorial Assistalt

The Institute of Medical Ethics is an independent, non-partisanorganisation for the multidisciplinary study of medico-moral issuesraised by the practice of medicine, and concerned with research, edu-cation and information. It is financed by grants and donations frompublic and private sources.

The institute aims to help improve the quality ofboth professional andpublic discussion of medico-moral questions; to promote the study ofmedical ethics; to promote high academic standards for this ever

developing subject; to encourage a multidisciplinary approach to dis-cussion of the consequences of clinical practice; to stimulate researchinto specific problems, and to remain non-partisan and independentof all interest groups and lobbies.

Institute reports include: The Ethics of Resouirce Allocationi in HealthCare by Kenneth Boyd, and Dilenmmas of Dying by Ian Thompson,Edinburgh University Press (both 1979); Afedical Research wVithChildren: Ethics, LawtX and Practice by Richard Nicholson, and Lives in

the Balance: the Ethics oJ Using Anlimals inl Bionmedical Medical Researchby Jane Smith and Kenneth Boyd, Oxford University Prcss (1986 and1991); Life Before Birth by Kenneth Boyd, Brendan Callaghan andEdward Shotter, SPCK (1986); Teachinlg and Learning Nursing Ethicsby Ursula Gallagher and Kenneth Boyd, Scutari (1991) and SorbonaMilan (1993); The Pond Report ot the Teachintg of.Medlcal Ethics editedby Kenneth Boyd, and The Cae oJ 'Patients with HITVand AIDS:A Suir-vey oflNuri-se Education in the UK, by Hazel McHaffie, publisheddirectly for the institute (1987 and 1994); Life, Death an-id Deciaionls:Doctors and Nuirses Reflect on NVeonatal Practice, by Hazel .MIcHaffie andPeter Fowlie, published by Hochland and Hochland (1996).

Shorter institute reports include: Assisted Death, Lanicet, 1990; AIDS,ethics and clinical trials, Br itish .M\1edical _ournial, 1992; AIDS and theethics of medical care and treatment, Quiarterly Joutrnal of Aledicie,1992; Advance directives: partnership and practicalitics, British Jour-

nial of Genieral Practice, 1993; Implications of HIV infection and AIDSfor medical education, Aledical Edtucationi, 1994; and Prolonging lifeand allowing death: infants! _ourinal ofMedical Ethics, 1995.

The institute derives from the London Medical Group, a studentgroup for the study of ethical issues raised by the practice of medicinewhich, beginning in 1963, arranged a comprehensive programme oflectures and symposia on such issues. Similar groups associated withthe institute are now established in university teaching hospitalsthroughout the UK.

Brendan Callaghan SJHeythrop CollegeKensington SquareLondon W8 SHQ

Dr Kenneth BoydDirector of Research andScottish Director, IMEDepartment of MedicineRoyal Infirmary of EdinburghLauriston Place, Edinburgh EH3 9Y-W

Published by the BMJ Publishing Group on behalf of the Institute of Medical Ethics and the British Medical Association.Printed on acid free paper by Latimer Trend and Co Ltd. The Institute of Medical Ethics is a registered charity, No 261876.

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Journal of Medical Ethics ii Miercury Airtrcighe Inr onai lid, Th itlait Road, Avenel,IJ (o1,I SA

The journal of the Institute of Medical EthicsThe Journial of Afedical Ethics was established in 1975, with a multidisciplinary editorial board, to promote the study of contemporarymedico-moral problems. The editorial board has as its aims the encouragement of a high academic standard for this ever-developing sub-ject and the enhancement of professional and public discussion. The journal is published six times a year and includes papers on all aspectsof health care ethics, analyses ethical concepts and theories and features case conferences and comment on clinical practice. Intermittentseries focus on the Teaching ofmedical ethics; on the medico-moral problems directly experienced by health care workers (At the coal-face); on the pursuit of arguments prompted by papers in the journal (Debate); on medical ethics in literature (Medical ethics and lit-erature), and on briefly argued often unorthodox opinions related to medical ethics (Point ofview). The journal also contains book reviewsand letters. For submissions, see Notice to contributors.

Editorial BoardEDITOisR:

Professor Raanan Gillon, general practitioner and philosopher, Impe-rial College, London UniversityCONSUiTING EDITORS:Sir Douglas Black, physician, Manchester University, UKProfessor Robin Downie, moral philosopher, Glasgow University, UKCHAIRNLAN, EDITORAI. BOARD:

Professor Thomas Oppe, paediatrician, St Marv's Hospital MedicalSchool, LIondon UKEDii)ORiAL ASSOCIA(E:Dr Tony Hope, psvchiatrist, Reader in Medicine and leader, OxfordPractice Skills Project, Oxford University, UKCASE CONFEREN(E ASSOCI.ATE:

Dr Brian Hurwitz, Professor of Primary Health Care and GeneralPractice, Imperial College School of .M4edicine at St Mary's London, UKDr Kenneth Boyd, historian, chaplain, University of Edinburgh, UKProfessor Margaret Brazier, medical lawyer, Manchester University,UKBrendan Callaghan 5J, Hevthrop College, London, UKProfessorAnthony Culyer, Professor ofEconomics, University of York,UTKDr Donna Dickenson, medical ethicist and philosopher, Imperial Ciol-lege, London University, UKProfessorJohn Haldane, philosopher, University of St Andrews, UKProfessorJohn Harris, philosopher, Manchester University, UKProfessor Roger Higgs, general practitioner, and Head of Departmentof General Practice, King's College. London, UKRt Hon Sir Patrick Nairne, Chair of the Nuffield Council on BioethicsAllyson Pollock, Professor of Health Policy Research, School of PubLicPolicy, ucL, London, UKProfessor Alain Pompidou, pathologist, member of Europeanparliament, FranceDr Octavi Quintana, Vice President, European (Commission) Groupon Ethics in Science and New TechnologiesThe Very Reverend Edward Shotter, Dean of Rochester, Institute ofMedical Ethics Amulree Fellow, UKProfessor Bob Williamson, molecular biochemist, Murdoch Institute,Royal Children s Hospital, Melbourne, AustraliaEX-OFFICIO:Dr Richard Smith, editor, British Medical Journal UKProfessor Richard West, postgraduate medical dean, Bristol Univer-sity, UKAnn Lloyd, Technical Editor, JME,Maureen Bannatyne, Editorial Assistant, JME

Editorial Advisory BoardProfessor Kare Berg, physician, Chairman, Institute of MedicalGenetics, University of Oslo, NorwayDr Bela Blasszauer, medical lawyer, Medical University of Pccs, Hun-garyDrMudrMartin Bojar, neurologist, Charles University, Prague, CzechRepublicJudge Christian Byk, medical lawyer and magistrate, Paris, FranceProfessor Alastair Campbell, theologian, Professor of Ethics in Medi-cine, University of Bristol, UKProfessor Fernando da Rocha, philosopher, Universidade Federal doRio Grande do Sul, BrazilDr Dolores Dooley, philosopher, University College, Cork, IrelandProfessor H E Emson, pathologist, Royal University Hospital,Saskatoon. CanadaDr Calliope CS Farsides, philosopher, University of Keele, UK

.Ms Tina Garanis-Papadotos, medical lawyer, Athens School of Pub-lic Health, GreeceDrShimon Glick, phvsician, Ben Gurion Universitv of the Negev, IsraelProfessor Zaki Hasan, physician, Vice Chancellor, Baqai University,Karachi, PakistanDr Neville Hicks, medical sociologist, University of Adelaide. AustraliaMs Jennifer Jackson, philosopher, Director, Centre for Business andProfessional Ethics, University of Leeds, UKProfessor AlbertJonsen, ethicist and historian, University of Washing-ton. USAProfessor Ian Kennedy, President, Centre for Medical Law and Ethics,King's College, London, UKProfessor Rihito Kimura, lawyer, Waseda University, JapanDr Paula Kokkonen, lawyer, Director of the National Board ofMedicolegal Affairs, Helsinki, FinlandDr Simon Lundy, general practitioner, London, UKProfessor Ruth Macklin, philosopher and ethicist, Albert EinsteinCollege of Medicine, New York. USADr Maureen MacMillan, nurse, Edinburgh, UKProfessor Malcolm Macnaughton. obstetrician,'gynaecologist, Glas-gow Univcrsitv, UKProfessorAMaurizio Mori, philosopher, Consulta di Bioetica di Milano,ItalyDr Naomi Pfeffer, medical sociologist, Universitv of North London,UKDrSashka Popova, social scientist, Department of Social Medicine andPublic Health, Sofia, BulgariaProfessor Qui Ren-Zong, philosopher, Institute of Philosophy, Beijing,ChinaDr Janet Radcliffe-Richards, philosopher, Open University, MiltonKevnes, UKProfessor Pinit Ratanakul, physician, philosopher, Mahidol Univer-sity, Bangkok, ThailandDr Stella Reiter-Theil, physician, Akademie fur Ethik in der MedizinGeorg-August-Univ,crsitat, Goettingen, GermanyProfessor Povl Riis, physician, Herlev University, Chair of NationalEthics Committee, DenmarkProfessor Daniel Serrao, physician, Universitv of Porto McdicalSchool, PortugalMlr Robert Sells, transplant surgeon, Director, Renal Iransplant Unit,Royal Liverpool University Hospital, UKProfessor Gamal Serour, obstetrician/gynaecologist, InternationalIslamic Center for Population Studies and Research, Cairo, EgyptProfessor WShannon, general practitioner, Royal College of Surgeonsof Ireland Medical School, Dublin, IrelandProfessor Mark Siegler, phvsician and ethicist, University of ChicagoHospitals, Illinois. USAProfessor Jack Stanley, philosopher, Lawrence University, Appleton,Wisconsin, USAMrs Julie Stone, Senior Lecturer in Health Care ILaw and Ethics,University of Greenwich, UKDr Per Sundstrom, freclancc svritcr in mcdical ethics and philosophy,SwedenProfessorjuan Carlos Tealdi, phvsician and philosopher, FundacionMainetti, Buenos Aires, ArgentinaProfessor Henk Ten Have, physician and philosopher, CatholicUniversity of Nijmegen, the NetherlandsProfessor Dr Guido Van Steendam, philosopher, International Forumfor Biophilosophy, BelgiumProfessor Francisco Vilardell, physician and past president ofCIOMS, Barcelona, SpainProfessor Jenifer Wilson-Barnett, nurse, Head of Department ofNursing Studies, King's College London, UK

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