Medical Ethics Today: ItsPractice and Philosophy

BMA Ethics, Science and InformationDivisionBMJ, £12.95, pp 374ISBN 0-7279-0817-0

Alisdair Macyntyre in After Virtue: AL4 Study ofMoral Theory has argued froms a historical perspective that moral

theory is in a degenerate state. The kind ofsynthesis achieved by Aristotle and Aquinascould not survive the Enlightenment. We arenow left with a ragbag of principles andassumptions that have lost their originalframework. The order of the day isemotivism, which is based on the conclusionthat all attempts to produce an objectivemorality founded on reason have failed. Thismay not be universally accepted, butMacyntyre's argument is convincing. The

words bad and good are, or should be,replaced by disapproval and approval. Theresult is potential moral chaos.

It follows that we have no certain path tofollow in solving the ethical problems raisedin health care. A twentieth century Christianmay use reason, scripture, and tradition toanalyse the problems, but the lack of con-sensus in the outcome of such deliberationsshows that religious belief does not carry anyparticularly moral authority.The BMA's publication Medical Ethics

Today makes no claim to be a textbook ofmoral philosophy. The varied principles andlack of any coherent framework are acknow-ledged in chapter 13. It is intended as apractical guide for doctors seeking help in thedifficult decisions that face them. The usualtopics are covered with reasonable clarity andthe association's position is stated. Certainlyit is much more authoritative than previouspublications. Even so, is it really possible forthe BMA, given the wide disparity in ethical

judgments, to produce a book giving a"party" line? The Church ofEngland has notbeen able to speak or write with conviction onbehalf of all its members, and the BMA is notlikely to do better. At the end of the bookthere is a brief history of the BMA's involve-ment in ethics over the years; an honourabletradition, but should it now end? It is usefulto have practical information for doctorsabout their professional obligations, but thiswork is more ambitious.The authors acknowledge that Medical

Ethics Today is intended for doctors but hopethat other professions will find it useful.Many of the topics covered are of equalimportance to doctors and nurses. It wouldhave been a much more interesting exerciseto produce a joint publication with the RoyalCollege of Nursing. Health care ethicsrequires the abandonment of narrow profes-sionalism, and the dialogue required toproduce a joint publication would have beencreative.

Despite these reservations the bookprovides a great deal of useful information. Itis well presented, and many doctors will findit worth consulting.-MICHAEL SAUNDERS,medical director, Northalerton Health Services TrustandAnglican priest, Ripon Diocese

Charity Appeals: The CompleteGuide to Success

Marion AllfordDent, £15.99, pp 438ISBN 0-460-86191-3

r arion Allford "invented the wheel"of the hugely successful appealwith her work on the Hospital for

Sick Children's "Wishing Well" campaign.Her guide to success makes me feel ratherdepressed, perhaps because it is written from

Olympus endoscope incorporating echoprobe and needle for pancreatic biopsy in Surgery of the Pancreas(Churchill Livingstone, £ 135, ISBN 0-443-04427-9). In spite of technological advances such as this and insurgical technique, the broader aspects of causation and optimal treatment are still not fully understood and arediscussed at length in this book.

a pinnacle of excellence and assured achieve-ment that mere mortals find gloom inducing.All of us at some time or another have triedto shoehorn money out of friends and col-leagues for causes that we believe in (whichmakes it easier) or that we don't believe in(which makes it almost impossible). Passionis a great selling tool, and Marion Allfordtells us how to organise ourselves and ourpassions. She adopts a summary style, andher checklists at the end of each chapter makethis long book accessible.

Charity in Britain has a bigger turnoverthan agriculture, and the best appeals are runvery professionally. Just as there are manyways to run a business or a farm there aremany ways to run a charity. The basic rulesand structure, however, are the same. Thebook sets out a superb framework for guid-ance and is a welcome guide at a time whenthe Charity Commission is asking charities toadopt sound accounting processes.To those ofus working in 1994 in a difficult

recessionary period, however, Marion All-ford's experience at Great Ormond Streetmay not be totally relevant. The rapidlychanging nature of charitable giving meansthat fundraisers have to become increasinglyagile and chameleon-like, devising new ideasand promotions that align themselves withparallel corporate marketing and publicrelations budgets rather than trying tosqueeze donations from chronically over-subscribed charity budgets. People arepoorer and busier if they have jobs at all,and, as Mrs Allford rightly admits, "charityfatigue" of the '90s has reached epidemicproportions.Companies and individual people alike are

less able to react generously at a whim; £2000is quite a large donation to receive from. alarge company. Getting £30 000 out of anational high street retailer, still makingexcellent profits, may take six months ofnegotiation. Money was easier in the '80s,and the "Wishing Well" appeal was verymuch an '80s phenomenon. Companies,individual people, and trusts today arenaturally much more careful about donationsto "bricks and mortar" projects.

Strategy, market research, business plans,etc may be alien to the small fundraiser butare essential tools and skills for the profes-sional appeal. The business-like approachwithout apology is one lesson that should betaken from this guide. Charity is big businessin Britain, so why should we apologise forbeing anything other than professional aslong as "management and marketing tech-niques remain subordinate to the spirit ofcharity"? I would also assert that strongbelief in a cause is more important than all themarketing techniques in the world and that ateam of passionate, well coordinated fund-raisers working on an agreed strategy is apretty unbeatable formula.Don't get depressed: read the book, create

the structure, and start the charity. It's worthit. Love thy neighbour.-LucY NELSON,managing director, Tommy's Campaign, London

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Best books on infectious diseases: a personal choice

Books for the generalist*** The Oxford Textbook of Medicine. 2nd edn. EdD J Weatherall, J G G Ledingham, D A Warrell.(,C130, two volumes.) Oxford University Press, 1987.ISBN 0-19-261551-3.** Forfir and Arneil's Textbook of Paediatrics. 4thedn. Ed A G M Campbell, N McIntosh. (£130.)Churchill Livingstone, 1992. ISBN 0-443-04193-8.** Immunisation Against Infectious Disease.1992 edn. Joint Committee on Vaccination andImmunisation. (p5.50.) (An individual copy is sentfree to general practitioners.) HMSO, 1992. ISBN0-11-321515-0.* Diagnostic Picture Texts in Infectious Diseases.R T D Edmond, H A K Rowland. (,8.50.) Wolfe,1987. ISBN 0-7234-0927-7.* Manual on Infections and Immunisations inChildren. 2nd edn. British Paediatric Association.(p12.50.) Blackwell, 1991. ISBN 0-19-262118-1.** Control ofCommunicable Diseases in Man. 15thedn. Ed A S Benenson. (,C16.95.) American PublicHealth Association, 1990. ISBN 0-87553-170-9.** Health Advice for Travellers. Department ofHealth and Central Office of Information. Free onrequest. Form T4, March 1993. Obtainable byphoning the health literature line-0800 555 777.

M r ost large textbooks of generalmedicine have a chapter on in-fectious diseases. The Oxford

Textbook ofMedicine remains one of the mostcomprehensive reference textbooks of in-ternal medicine. The infection section (640pages) is by far the largest in the textbook.Reflecting the interest of David Warrell, thesection on tropical infections is as good assome specialist books, and the detailed andauthoritative nature of the articles on eachtopic meets the needs of most generalists(including general practitioners) seekinginformation on a specific topic. The currentedition of this book is becoming out of date,but a new edition is due for 1994. The textalso cannot cover all aspects of paediatrics,and those specialising in children may preferthe new edition of Forfar and Arneil, whichalso has a well structured and substantivesection on infection (290 pages), with paedi-atric HIV infection particularly well des-cribed. Both general texts are unable to giveless experienced practitioners a pictorialguide to rashes, and the Wolfe DiagnosticPicture Text is an economic addition.

Immunisation, the public health manage-ment of individuals or outbreaks, and adviceto those travelling abroad are importanttopics which general texts cannot coverin sufficient detail. Immunisation AgainstInfectious Disease is the UK's immunisation"bible." The British Paediatric Association'sManual on Infections and Immunisationsin Children concerns a limited age groupbut also includes aspects of public healthmanagement as well as infections when noimmunisation is available. Neither volume inits current edition gives comprehensivepublic health advice. Indeed, no single textcan do this (which is why each district andhealth board should have a consultant incommunicable disease control), but the best

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X~~~~~~~~~~~~~~~~. ... .........Electron micrograph of Corynebacterium diphtheriaebacterium in the human throat

is Benenson's compact text for the AmericanPublic Health Association. Finally, theDepartment of Health's booklet HealthAdvice for Travellers gives good general andspecific guidance on how to advise thosetravelling abroad. Although it providesdetailed information and is updated annually,this cannot cover all eventualities, and prac-titioners will still need occasionally to consultone of the national advice centres such as theCommunicable Disease Surveillance Centreor the Communicable Diseases (Scotland)Unit.

Books for undergraduates** Davidson's Principle and Practice of Medicine.16th edn. C Edwards, I Bouchier. (C22.95.) ChurchillLivingstone, 1992. ISBN 0-443-04092.Lecture Notes on Infectious Disease. B K Mandal,R T Mayon-White. (,k12.95.) Blackwell Scientific,1984. ISBN 0-632-01168-8.* Student Notes on Medical Bacteriology. 3rd edn.J D Sleigh, M C Timbury. (,C13.95.) ChurchillIivingstone, 1990. ISBN 0443-04147-4.* Student Notes on Medical Virology. 9th edn. M CTimbury. (,C9.50.) Churchill Livingstone, 1991.ISBN 0-443-04148-2.

Tnhere is a dearth of infectious diseasetexts for undergraduates, and medicalstudents may also be best served

getting an up to date general text whichincludes a substantive section on infection.With over 100 well written pages the currentDavidson meets this need. The infection textin the Lecture Notes series is now seriously outof date, but a new edition is due in 1994.Undergraduates need to appreciate micro-biology, and the two volumes in the StudentNotes series are useful resources. A newedition of Medical Bacteriology will appear in1994.

Books for the specialist** Principles and Practice of Infectious Diseases.3rd edn. Ed G L Mandell, R G Douglas, J E Bennett.(,C199.) Churchill Livingstone, 1990. ISBN 0-443-08686-9 (single volume); 0-443-08710-5 (two volumeset).*** Infectious Diseases: Medicine and Surgery. EdS L Gorbach, I G Bartlett, N R Blacklow. (L132.)Saunders, 1992. ISBN 0-7216-4168-7.** Medical Microbiology. D Greenwood, R Slack, JPeutherer. 14th edn. (p26.50.) Churchill livingstone,1992. ISBN 0-443-04256-X.

O ver the past decade "Mandell" hasbecome the standard specialist text-book of infectious diseases. The third

edition has an extra 535 pages accommodatingnew sections, including AIDS and retro-viruses, Lyme disease, and slow virus infec-tions of the central nervous system. All thepre-existing chapters have also been updated.The book is mainly for those with an interestin clinical infectious disease, although themicrobiology sections, with emphasis onpathogenesis rather than descriptions oforganisms, should benefit clinical micro-biologists. The copious and up to date refer-encing of each chapter is of great help forthose seeking further information. This text-book remains the gold standard by whichthe competitors should be judged. It has,however, a decidedly North American per-spective, is expensive, and shows little aware-ness of the problems of some infectiousdiseases (for example, diphtheria) in coun-tries with few resources.Gorbach et alrs comprehensive text is

probably the main rival. About 300 pagesshorter, it is well written, and all "newinfections" and modem diagnostic methodsare adequately covered. The illustrations,figures, and referencing are excellent. Par-ticularly appealing is the chapter on clinicalinfection as it deals with each disease systemby system and outlines a general clinicalapproach to infection within a given system.This textbook is useful when one needs areference book with a clear approach inmanaging infection in everyday clinicalpractice, and it is particularly useful whenone is seeking definitive answers for difficultinquiries over the phone. A major advantageis the excellent coverage of prevention andcontrol of hospital and surgical infection.Those who enjoy a more system based clinicalapproach and who have a particular interest inhospital or surgical infection would be hardpressed to purchase a better reference textof infection. Medical Microbiolog-y (the four-teenth edition of "Mackie and McCartney")is the most useful book for infectious diseasespecialists needing a microbiology text. At£26.50 it is also exceptionally good value.-ANGUS NICOLL, consultant epidemiologist, PublicHealth Laboratory Service, Communicable DiseaseSurveillance Centre, London, DILIP NATHWANI,consultant in infectious diseases, King's CrossHospital, Dundee

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