,nstitute of Medical Ethics

IO2tSII9F,Tk

pouglas Black

vpCE?RESIDFPmSlp,fesSor G R Dunstan

rgfessor Sir Raymond Hoffenberg

w I Sellsftofessor R B Welbourn

GoVF.RNING BODYprofessor M Brazier

erendan Callaghan SJlan Chappell

pw Colin Currie

pr I)onald Evans

professor Raanan Gillon(Editor, Journal ofMedical Ethics)

professor Roger Higgs

Dr Tony Hope

professor Bryan Jennett

Professor D Morton

professor Thomas Opp6(Chairnman)

professor Richard West

(General Secreta?y)professor Jenifer Wilson-Barnett

Director of Research and ScottishDirectorDr Kenneth BoydResearch FellowDr Hazel McHaffie

IME Amulree FellowThe Very Reverend Edward ShotterDean of Rochester

Honorary Research AssociatesDr Andrew FraserDr Jane SmithUrsula Gallagher

Ann Lloyd, Technical lEditor, J7ournal ofMedical EthicsMaureen Bannatyne, Editorial Assistant

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 of both professionaland public discussion of medico-moral questions; to promote thestudy of medical ethics; to promote high academic standards for thisever developing subject; to encourage a multidisciplinary approach to

discussion of the consequences of clinical practice; to stimulateresearch into specific problems, and to remain non-partisan andindependent of all interest groups and lobbies.

Institute reports include: The Ethics of Resource Allocation in HealthCare by Kenneth Boyd, and Dilemmas of Dying by Ian Thompson,Edinburgh University Press (both 1979); MWedical Research withChildren: Ethics, Law and Practice by Richard Nicholson, and Lives inthe Balance: the Ethics of Usinig Aizimals in Biomedical Medical Researchby Jane Smith and Kenneth Boyd, Oxford University Press (1986 and1991); Life Before Birth by Kenneth Boyd, Brendan Callaghan andEdward Shotter, SPCK (1986); Teachitng and Learning Nursing Ethicsby Ursula Gallagher and Kenneth Boyd, Scutari (1991) and SorbonaMilan (1993); The Pond Report on the Teaching ofMedical Ethics editedby Kenneth Boyd, and The Care of Patients with HIV and AIDS: ASurvey of Nurse Education in the UK, by Hazel McHaffie, publisheddirectly for the institute (1987 and 1994).

Shorter institute reports include: Assisted Death, Lancet, 1990; AIDS,ethics and clinical trials, British Medical Journal, 1992; AIDS and theethics of medical care and treatment, Quarterlv J7ournat of AMedicine,1992; Advance directives: partnership and practicalities, BritishJournal of Gezeral Practice, 1993; Implications of HIV infection andAIDS for medical education, Aledical Education, 1994; and Prolonginglife and allowing death: infants, Journal 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.

Professor Richard WestGeneral Secretary, LMEMedical Postgraduate DepartmentUniversity of BristolFrenchay Hospital, FrenchayPark Road, Bristol BS16 1LE

Dr Kenneth BoydDirector of Research andScottish Director, IMEDepartment ofMedicineRoyal Infirmary of EdinburghLauriston Place, Edinburgh EH3 9YW

Published by the BMJ Publishing Group on behalf of the Institute of Medical Ethics and the British Medical Association.Typesetting by Bedford Typesetters Ltd, Bedford. Printed in Great Britain by Derry & Son Ltd, Nottingham.the Institute of Medical Ethics is a registered charity, No 261876.

ndclass poustalge paid, Rahwav N J Postmnastcr: sent! address thanges to:I ofMedical Ethics c! M%ercurs Airfreight Internationial lInd , 2323 Randolph Avenue, Avenel, NJ (17001, USA.

The journal of the Institute of Medical EthicsThe Journal ofMedical Ethics was established in 1 975, with a multidisciplinary editorial board, to promote the study of contemporary medico..moral problems. The editorial board has as its aims the encouragement of a high academic standard for this ever-developing subject and the

enhancement of professional and public discussion. The journal is published six times a year and includes papers on all aspects of health care

ethics, analyses ethical concepts and theories and features case conferences and comment on clinical practice. Intermittent series focus 0n

the Teaching of medical ethics; on the medico-moral problems directly experienced by health care workers (At the coalface,) on thepursuit of arguments prompted by papers in the journal (Debate); on medical ethics in literature (Medical ethics and literature)' and on

briefly argued often unorthodox opinions related to medical ethics (Point of view). The journal also contains book reviews and letters.

Editorial BoardEDI) TOR:Professor Raanan Gillon, general practitioner and philosopher,Imperial College, London UniversityCO)NSLLTrNG EDITORS:Sir Douglas Black, physician, Manchester University, UKProfessor Robin Downie, moral philosopher, Glasgow University, UKCHAIRMAN, EDITORIAI. BOARD:Professor 7homas Oppe, paediatrician, St Mary's Hospital MledicalSchool, London UKEDiTORIAI. ASSOCIATrE:Dr Tony Hope, psychiatrist, leader, Oxford Practice Skills l'roject,Oxford University, UKDr Susan Bewley, Director of Obstretrics, St Thomas's Hospital,London, UKDr Kenneth Boyd, historian, chaplain, University of Edinburgh. UKProfessor Margaret Brazier, medical lawyer, Manchester University,UKProfessor Anthony Culyer, Professor of Economics, University ofYork, UKLouise de Raeve, nurse, philosiopher, University College, Swansea, UKDr Donna Dickenson, medical ethicist and philosopher, The OpenUniversity, Milton Keynes, 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, UKProfessor MargotJefferys, medical sociologist, University of London,UKRt Hon Sir Patrick Nairne, Chair of the Nuffield Council on BioethicsRabbiJulia Nieuberger, Chair, Camden Community Ilealth Coulcil,London, UKDr Allyson Pollock, public health phvsician, St George's Hospital,London. UKProfessor Alain Pompidou, pathologist, member of European parlia-ment, FranceDr Octavi Quintana, Chairman, Council of European SteeringCommittee for Bioethics, Madrid, SpainThe Very Reverend Edward Shotter, Dean of Rochester, Institute ofMedical Ethics Amulree Fellow, UKProfessor Robert Williamson, molecular biochemist, MurdochInstitute, Roval Children's Hospital, Melbournre, AustraliaEX-OFFICIO:Dr Richard Smith, editor, Bnntzsh Medical ournal, UKProfessor Richard West, postgraduate medical dean, BristolUniversity, UK, general secretary. Institute of Medical Ethics, UKAnn Lloyd, Technical Editor, JMFMaureen 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 Pecs,HungaryDr Mudr Martin Bojar, neurologist, Charles University. Prague,Czech RepublicJudge Christian Byk, medical lawyer and magistrate, Paris, FranceProfessor Alastair Campbell, theologian. Director, Centre for

Bioethics, University of Otago, New ZealandDr Roger Crisp, philosopher, St Anne's College, Oxford University, UKProfessor Fernando da Rocha, philosopher, Universidade Federal doRio Grande do Sul, BrazilDr Dolores Dooley, philosopher, University College, Cork, Ireland

Professor H E Emson, pathologist, Royal University HospitalSaskatoon, CanadaDr Calliope CS Farsides, philosopher, Universitv of Keele, UKMs Tina Garanis-Papadotos, medical lay-wer, Athens School of

Public Health, GreeceDr Shimon Glick, physician, Ben Gurion University of the Negev, Israel

Professor Zaki Hasan, physician, Vice Chancellor, Baqai UniversityKarachi, PakistanDr Neville Hicks, medical sociologist. University of Adelaide, Australia.MsJenniferJackson, philosopher, Director, Centre for Business and

Professional Ethics, University of Leeds, UKProfessor Albert Jonsen, ethicist and historian, Universitv of

Washington. USAProfessor lan Kennedy, President, Centre for Medical Law and

Ethics, King's College, London, UKProfessor Rihito Kimura, lawver, Waseda University, JapanDr Paula Kokkonen, lawyer, Director of the National Board of

Medicolegal Affairs, Helsinki, FinlandDr Simon Lundy, general practitioner, London, UKProfessor Ruth Macklin, philosopher and ethicist, Albert Einstein

College of Medicine, New York, USADr Maureen MacMillan, nurse, Edinburgh, UKProfessor AMalcolm Macnaughton, obstetrician/gynaecoilogist,Glasgow Universitv, UKProfessor Maunrizio Mori, philosopher, Consulta di Bioetica diMilano, ItalyProfessor Ben Osuntokun, physician, University of Ibadan, NigeriaDr Naomi Pfeffer, medical sociologist, University of North London, UKDr Sashka Popova, social scientist, Department of Social Medicine andPublic Health, Sofia, BulgariaProfessor Qui Ren-Zong, philosopher, Institute of Philosophy,Beijing, ChinaDrJanet Radcliffe-Richards, philosopher, Open University. MiltonKeynes, UKProfessor Pinit Ratanakul, physician, philosopher, MahidolUniversity, Bangkok, ThailandDr Stella Reiter-Theil, physician, Akademie fur Ethik in der Medizin,Georg-August-Universitat. Goettingen, GermanyProfessor Povl Riis, phvsician, Herlev University, Chair of NationalEthics Committee. DenmarkProfessor Daniel Serrao, physician, University of Porto MedicalSchool, PortugalMr Robert Sells, transplant surgeon, Director, Renal Transplant 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, IrelandProfessorAMark Siegler, physician and ethicist, University of ChicagoHospitals, lllinois, USAProfessorJack Stanley, philosopher, Lawrence University, Appleton,Wisconsin, USAMsfJulie Stone, medical lawyer, Hempsons, London, UKDr Per Sundstrom, freelance writer in medical ethics and philosophy,SwedenProfessorJuan Carlos Tealdi, physician and philosopher, FundacionMainetti. Buenos Aires, ArgentinaProfessor Henk Ten Have, physician and philosopher, CatholicUniversity of Nijmegen, the NetherlandsProfessor Dr Guido Van Steendam, philosopher, InternationalForum for Biophilosophy, BelgiumProfessor Francisco Vilardell, physician and president of CIOMS,Barcelona, SpainProfessor Jenifer Wilson-Barnett, nurse, Head of Department ofNursing Studies, King's College London, UK

Notice to subscribersThe7Jourmal of Medibcal Ethics is published six times a year. The annual subscription rate is £105 ($165) for institutions and £80.00 ($126)for personal subscribers for all countries. The rate in the USA for subscribers who order directly from the publishers is $158 for institutionsand $126 for personal subscribers, payable bv cheque or the charge/credit cards listed below. Payment for all other subscriptions may bemade by VISA, Mvlastercard, or American Express or by sterling cheque or draft drawn on a UK bank. All payments should be made to theBritish Medical Journal. Subscription orders may also be placed with any leading subscription agent or bookseller. For the convenienceof readers in the USA, orders may be sent to the British Medical Journal, PO Box 48, Franklin, MA 02038, USA. All other orders andenquiries for airmail rates, single copy sales and advertising should be sent to British Medical Journal, BMA House, Tavistock Square,London WC1H 9JR, United Kingdom. Website address: http://-www.bmj.com/bmj/ISSN 0306-6800

Goprnghtr 1996 J(ournal ofMedical Ethics. All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system,or transmitted, in any form or by any means. electronic, mechanical, photocopying, recording or otherwise, without the prior permission ofthe Jotrial of ledical Ethiics.

Dennis Cox 203

17-hydroxyprogesterone derivatives. American JournalofMedicine. 1991 90: 584-9.

14 Findings of a consensus meeting in 1987, sponsored bythe European Foundation for Osteoporosis and BoneDisease.

15 Marslew U, Overgaard K, Riis B, Christiansen C. Twonew combinations of estrogen and progestogen for pre-vention of postmenopausal bone loss: long-term effectson bone, calcium and lipid metabolism, climactericsymptoms and bleeding. Obstetnics and Gynaecology.1992; 79: 302-10.

16 Holland E, Leather A, Studd J, Gamett T. Theeffect of a new sequential oestradiol valerate andlevonorgestrel preparation on the bone mineral densityof postmenopausal women. British Journal of Obstetricsand Gynaecology 1993; 100: 966-7.

17 British National Formulary 1995; 30: 301. Joint publica-tion of the British Medical Association and the RoyalPharmaceutical Society of Great Britain.

18 Re F (mental patient sterilisation) [1989]2 All ER 545(HL).

News and notes

Ethical review of Clinical ResearchA training conference for ethics committee members,entitled Ethical Review of Clinical Research, will beheld at Robinson College, Cambridge from the 29th ofSeptember to the 1st of October this year.The conference aims to provide practical training for

ethics committee members, to bring together those withmutual areas of interest and experience in ethicalreview, and to provide a forum for discussion of currentissues in ethical review.The conference, organised jointly by the Association

for Independent Clinical Research Contractors (AICRC)

and the Centre for Philosophy and Health Care,University of Wales, will be of interest to members andchairs of ethics committees, and to those involved in theplanning and ethical approval of clinical research. Amongthe plenary lecture topics will be an update from theDepartment of Health on arrangements for ethical reviewof multi-centre trials, and a presentation by Dr FrankWells of the Association of the British PharmaceuticalIndustry on future directions of ethical review.For further details contact: Mrs Jill Williams: phone/

fax: 01222 626651.

News and notes

BMA cali for evidence - ethics and human genetics

The British Medical Association has recently estab-lished a multi-professional steering group to examinethe ethical implications of new genetic technology andto provide practical guidance for health professionalswbo are not specialists in genetics but who areincreasingly asked to advise on the implications of thistechnology.The steering group is anxious to gather as much

information as possible on current practice and the

practical ethical problems which arise, from healthprofessionals, counsellors, social workers and lawyers.The group would welcome evidence of good practiceand unresolved issues from any of these sources or fromothers who have experience of these issues.Correspondence should be sent to the Medical

Ethics Department, British Medical Association,BMA House, Tavistock Square, London WClH9JP.

John McKie, Helga Kuhse, J7eff Richardson and Peter Singer 221

6 Harris J. Double jeopardy and the veil of ignorance - areply. tournal ofMedical Ethics 1995; 21: 153.

7 See reference 1: 213.8 Singer P, McKie J, Kuhse H and Richardson J. Double

jeopardy and the use of QALYs in health care alloca-tion. Journal ofMedical Ethics 1955; 21: 146.

9 See reference 6: 155.10 See reference 3: 204.

11 See reference 3: 205.12 See reference 8: 149-150.13 Harris J. QALYfying the value of life. Journal ofMedical

Ethics 1987; 13: 120-3.14 Harris J. The value of life. London: Routledge and

Kegan Paul, 1985: 97.15 See reference 13: 120-1.

News and notes

From Ethics to Law, from Law to Ethics

The Swiss Institute of Comparative Law, Lausanne, theInstitute of Health Law, Neuchatel, the InternationalAssociation of Law, Ethics and Science and the SwissSociety of Biomedical Ethics are organising anInternational colloquy, "From Ethics to Law, from Lawto Ethics", which will be held from 17-18 October,1996, in Lausanne.

The languages of the conference will be English,French and German.For information please contact the Swiss Institute

of Comparative Law, CH-1015 Lausanne-Dorigny.Tel: +41 21/692 49 11; e-mail: secretariat@isdc-dfjp.unil.ch.

News and notes

The Seventh Annual Medical Device TechnologyConference

The Seventh Annual Medical Device TechnologyConference and Table-Top Exhibition will take placefrom 18-19 November, 1996, at the Swiss6tel inDusseldorf/Neuss.

This conference will provide delegates with a com-prehensive update on the implementation of the

medical devices directives, focusing on currentconcerns such as technical standards, product liabilityand environmental considerations.For further information please contact: Sonja Lloyd,

Associate Conference Manager on Fax: +44 (0)1244370 011.

News and notes

III World Congress of Bioethics

The III World Congress of Bioethics will be held in SanFrancisco, California, USA from 20-25 Novemberthis year. It is being organised by the InternationalAssociation of Bioethics in conjunction with theAmerican Association of Bioethics.

Topics include: Feminist approaches to bioethics;Studying human genetic diversity: can we doit right?, and The globalisation of bioethics:

international human rights and health professionals.For further information please contact, as soon as

possible: Congress Secretariat, III World Congress ofBioethics, Pacific Center for Health Policy andEthics, University of Southern California, Los Angeles,CA 90089-0071, USA. Tel: (213) 740-2541; fax:(213) 740-5502. World Wide Website http://www.usc.edu/dept/law*llb/bioethics/world/congress.html.

254 Book reviews

debate - within the new interdiscipli-nary journal devoted to philosophyand psychiatry which enjoys almostthe same title as this volume -

Philosophy, Psychiatry and Psychology-and within the pages of this volumeitself (see chapters by Hope, Wilkes,Boden, Binns and Shotter).

Moreover, the clinician's stock intrade is, and has always been, matterswith profound moral and philosophi-cal resonance and importance: notonly irrationality, personal autonomy,and responsibility, but the mind, sub-jectivity, happiness and visions of thegood life, character and the charac-terological traits known as vices andvirtues, self-deception, authenticity,dangerousness, criminal insanity andthe nature of meaning and communi-cation, as well as the set of concemsover what makes good science. Thephilosopher-psychiatrist Jaspers some-

where remarks that any attempt toexclude philosophy from psychiatrywould be disastrous. As this listreveals, it would also be impossible:psychiatry is by its nature philosophi-cal.The philosophers and clinicians

writing in this collection recognise andcelebrate these links and are forgingthe new interdisciplinary conversationbetween their respective disciplineswhich these disciplines' shared subjectmatter so urgently invites.So much for philosophy and psychi-

atry, how about psychology? Asthis new rapproachement betweenphilosophers and clinicians has beentaking shape, the world has not stayedstill. Two revolutions in the science ofmind have followed upon what Harrecalls the experimentalist-statisticalmethodology with which psychologybegan the century. First came thecognitive revolution insisting on "theineliminability of the phenomena ofcognition from the subject matter ofthe science of psychology" (page 26),and, second, the "discursive turn,"recognising cognitive psychology to bethe study of meanings, of "the activeuse of symbolic systems of variouskinds by active and skilled humanbeings in public and private contexts,for the accomplishment of varioustasks and projects jointly with others"(pages 27-28). This discursive turn,as Harre and several other contribu-tors to this volume show, is a versionof what continental philosophers havelong recognised, and honoured, as

hermeneutics, and we need it for a fullunderstanding of psychology andpsychiatry.Another development in the science

of psychology shifts the frame withinwhich we analyse mental concepts: wehave come to think of minds on anal-ogy with computers. Computationalmodels are introduced by MargaretBoden to help us understand multiplepersonality disorder, and DavidPapineau attempts to illuminate someof the puzzles associated with mentaldisorder, mental dysfunction, mindand brain by appeal to functionalismin computers. Just as we find in com-puters, he proposes, there may bepeople whose brains are unimpairedwhile yet there are glitches in thestructural system which affect theirpsychological functioning.)

This is a wonderful book, scholarlyand well-researched, yet full of sur-prises and odd turns- as one mightexpect when a number of creativethinkers from various backgrounds are

given carte blanche at an inchoateinterdisciplinary boundary. Richesabound here; I can but list some

of my favourites. There is Fulford'sstylish overview of the field, whichserves as a broad introduction to thebook. As I have indicated, this essaysurveys some of the areas where cur-

rent philosophical work has been mostconcentrated and productive, aroundthe phenomena of thought insertion,delusion and personal identity.Kathleen Wilkes offers a subtle dis-cussion of the "politics" of self-decep-tion in which she tries to understandthe kind of madness involved whenotherwise normal people can give or

obey orders to commit atrocities:what occurs within the person, shetheorises, is a very extreme form ofpropaganda-induced, but culpable,duality. Tony Hope's artful use ofcases (the changeable manic Mr M,and dissolving Mr D with Alzheimer'sdisease) challenges and presses on

Parfitian theories of personal identity,and advances our understanding ofthe intriguing but elusive notion of an"authentic self". Daniel Robinson'ssweeping and erudite review of legalresponses to mental disorder throughthe ages (including our own), andNigel Walker's crisp and policy-oriented discussion of the vexed issueof dangerousness, and the justificationfor detaining a mentally unimpairedperson who is innocent, yet danger-ous, are both fine pieces. Finally,Gabriele Taylor's penetrating analysisof the vices of avarice, envy and prideillustrates her thesis that some vicesare so fundamentally harmful to us

that "it must be in (our) own interestto cultivate such virtues which wouldprevent their occurrence or mitigate

their impact" (page 145). Self-knowl-edge is an example of such a virtue.The relevance of a collection like

this for medical, and particularly psy-chiatric, ethics cannot be disregarded.Few authors in this book concernthemselves directly, and as such, withthe ethical dos and don'ts which arisein clinical settings. Yet few pieces herefail to introduce the kind of under-lying assumptions about mental dis-order and its treatment which mustinform and influence how we castthose dos and don'ts. Questions of thepersonal identity of the patientrendered unrecognizably different byhis disorder, such as Hope raises in hisdiscussion, for example, may seem atfirst to rest on and imply metaphysicalrather than ethical matters. But, as

Hope makes clear, how we assess MrM's personal identity is not onlyinfluenced by, but also will pro-

foundly influence, how we see theethics surrounding his treatment. Inthe same way, other topics raised bythe authors in this volume will serve toilluminate, ground and support themore specific ethical decisions whicharise in practice.This is not a tidy book. It covers an

immense range of subject matter andone does not come away with a veryclear picture of how it all hangstogether. But perhaps the expectationthat it should is, too, a "disciplinary"illusion - or a kind of systematic delu-sion imposed by intellectuals on whatis actually a disorderly world?

JENNIFER RADDENPhilosophy Department,

University ofMassachusetts,Boston, MA 02125, USA

Books: information and orders

If you wish to order or require furtherinformation regarding the titlesreviewed here, please write to ortelephone the BMJ Bookshop, POBox 295, London WC1H 9JR. Tel:0171 383 6244. Fax: 0171 383 6662.Books are supplied post free in theUK and for BFPO addresses.Overseas customers should add 15per cent for postage and packing.Payment can be made by cheque insterling drawn on a UK bank or bycredit card (Mastercard, Visa, orAmerican Express, stating card num-ber, expiry date, and full name (Theprice and availability are occasionallysubject to revision by the publishers).

Journal ofMedical Ethics 1996; 22: 255

Notice for contributors to the Journal ofMedical Ethics

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Four copies of papers submitted forpublication should be sent to: The Editor,Journal ofMedical Ethics, Analytic EthicsUnit, Imperial College of Science,Technology and Medicine, LondonSW7 2AZ. The journal considers papersonly if they are not under consideration byany other journal at the same time.Rejected manuscripts are not returned.Papers, including references, should be indouble-spaced typewriting on one side ofthe paper only. An approximate totalword-count is required, and pages shouldbe numbered sequentially. On a separatesheet brief details of the author's presentpost, an address for readers'correspondence and any other relevantinformation should be supplied.

The JME uses a simplified 'Vancouverstyle' for references. The full text of the'Vancouver Agreement was published inthe British Medical Journtal in 1991; 302;338-41. As the "Vancouver style" isincompatible with the long establishedstyle of references for legal articles, lawyersshould use their own standard style, butavoid abbreviations so as to facilitatereference by others. The journal is multi-disciplinary and papers should be inclear jargon-free English, accessible toany intelligent reader.Authors are asked to avoid footnotes

wherever possible. The preferred maximumlength of papers is 3,500 words - absolutemaximum 5,500 (including references).Book reviews should be between 600 and1,000 words. Abbreviations should beavoided. The names of journals,organisations etc should be given in full.Two copies ofthe journal will be sent

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The Publisher, Journal of MedicalEthics, BMJ Publishing Dept, BMAHouse, Tavistock Square, LondonWClH 9JR.

Simplified 'Vancouver style'

All papers submitted for publicationshould contain the following:On page one of the manuscript:a) the title of the article which shouldbe concise but informative and designedto attract the reader. The Editor reserves

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2 On page two:a) an interesting abstract or summary ofnot more than 150 words. (Structuredabstracts, where required should be 250words maximum). Emphasise importantand/or new aspects of the article toattract the potential reader.b) key (indexing) terms - below theabstract. Provide and identify as such,three to six key words or short phrasesthat will assist indexers in cross-indexingyour article and that may be publishedwith the abstract.Where appropriate, use terms from theMledical Subject Headings List fromINDEX Medicus.

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4 References:Number these consecutively in the orderin which they are first mentioned in thetext, tables, and captions, by arabicnumerals, superscript, no brackets, forexample, according to Jones.3 The list ofreferences at the end of the paper shouldbe numbered in the order in which eachreference appears in the text. Try toavoid using abstracts as references.'Unpublished observations and 'personalcommunications' may not be used asreferences, although references to written,not verbal, communications may beinserted (in parenthesis) in the text.Manuscripts accepted but not yetpublished may be used as references -designate the journal followed by 'inpress' (in parenthesis). Information frommanuscripts submitted but not acceptedshould be cited in the text as 'unpublishedobservations' (in parenthesis).

Where a further reference is made to aprevious reference, but to a different pagenumber or numbers, this should have anew reference number of its own and itshould then refer back to the originalreference, thus:1 May T. The nurse under physician

authority. Journal ofMedical Ethics 1993;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 ofthe 'Vancouver style' for biomedicaljournals, should be followed for eachreference: in the text- number insuperscript, following punctuation; in thelist - author (list all authors if six or less; ifseven or more, list only the first six andadd 'et al'), title, name of publication ifdifferent from title - in italic; place ofpublication and publisher (whereappropriate); year of publication; and,where appropriate, volume number in boldand page references of article or chapterreferred to. Examples of corTect forms ofreference are given below:

a) Standard journal article:Teasdale K, Kent G. The use of

deception in nursing. Journal ofilMedical Ethics 1995; 21: 77-81.

b) Corporate author:2 General Medical Council.Tomorrovw's doctors - recommeno-idatienson undergraduiate medical educaulml.London: General Medical Council,1993.

c) No author given:3 Anonymous [editorial].Anonymous HIV testing. Lancet1990; 335: 575-6.

d) Personal author(s):4 Singer P, Kuhse J. Should the babylive? Oxford: Oxford UniversityPress, 1985.

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

0 Chapter in book:6 Hope T. Ethics and psychiatry. In:Rose N, ed. Essential psychiatry [2nded]. Oxford: Basil BlackwellScientific Publications, 1994: 45-5 1.

g) Agency publication:7 The Linacre Centre for the Studyof Ethics and Health Care. Paper 1:The principle of respect for humanlife. In: Prolongation of life. London:The Linacre Centre for the Study ofEthics and Health Care, 1978.

h) Newspaper article:8 Dinwoodie R. Volunteers die asheart drug results baffle doctors.The Scotsman 1980 Sept 5: 1 1 (cols1-6).

ourzncal of Aledical Ethics 1996; 22: 256

The Institute of Medical Ethics: research andmedical groups

Research

Since 1975, the institutc has conductcdresearch in manv areas of health carc ethicsand education, including issues related toresource allocation in health care. deathand dving, abortion and the trcatmcnt ofinfertility, rescarch with human subjcets,and medical involvement in torturc.Recent studics have been concerned wwith

Medical groups

Aiii'.Ri).F.N' .51.1'i)( Si. (;Rut 1

Dr M 1 McArthur, L)epartment ofMedicine for the Elderly, Wood EndHospital, Aberdeen AB9 2YS

BiiRM\iiN(iiAMMIDIi1tGt(ROtIPMr R Sawers,Birmingham Mvatcrnitv Hospital,Queen ' lizabeth Miedical Centre,Edgbaston, Birmingham B 15 2'1G

BRI.Sl ( *1. M11'.1) I(It 1,\1 GiRo ) 13'D)r Oliver Russell, Reader in McntalHcalth, Bristol University.Departmcnt of Mcntal Health,41 St Michael's Hill,Bristol BS2 8DZ

DUNl'EE .\MiiICAL t(GRtOPIMr Paul IPreece,Department of Surgerv,Ninewells Hospital.Dundee 1)1)1 9SY

FI)INBTR(I,H .XI)I(:IAi (GROtP'

D)r Sarah Cunningham-BurIev,Dcpartment of lPublic Health Sciences,Fdinburgh Univcrsity Mcdical School,'reviot Place, Edinburgh EH8 9AG

GiASG,OWNAMELDitAL GROtP'Dr E I lillan,Department of Nursing Srudies,Glasgow University,Glasgow G 1 2 8QQ

iLE'i)S I.'iItCAL GROL'P.Mr Brian Bentles, Principal of the Schoolof Radiography,Gcncral Infirmary, Belmont Grove,Leeds LiS2 9NS

the use of animals in bioimledical research,ethical aspects of HIV infection and AID)S,and medical and nursing cducation. Theinstitute's current research programmeincludcs studies of decision-making innconatal carc and in the care of the elderly.Its rescarch unit. based in Edinburgh, worksin collahoration with multidisciplinary

i it Si :R \iiI)I( Ai. ()GROUi'Dr R K MvcKinlcv,I)cparmtucnt of ,Gcncral Praicticc,University of ILeicester,ILciccstcr General Hospital.(wuwondolen Road.I.ciccster I 1.i 11'%

1 .1i'+R1'()( )I .11- iD1CA ( "ROUP'

1)epartment of ('General I'racticc,Liverpool Lniversity, P0 Box 147,Liverpool L69 3BX

1 .0Nil)tN'1N111- ii i.DMI-DI)ii 'At 1.I i i,Rii'L'(GLi'S S-Ni)1S'iii0MIAS'S IOSPi'iTAiSiS)D)r Graham Clavcdcn,Reader in Paediatrics,St Thomas's Hospital.Lambeth P3alacc Road,London S1 71/ 11

itHI ROYAt RI1R ETHICS G(ROti'sD)r Nargaret I loyd,Department of lublic eIealth andPrimary Carc, Thc Royal FreeI lospital School ol Mcdicine,IPond Street,London NW3 21PF

S'i ( ,IoR( i 'S Mi.1' :A1.(;ii .ODr N Eastmiatn.St George's Hospital Mcdical School,London SW17 ORE

1i MAtRY'S HIOSi'ITAFITHiiCutS F'ORtUMJane Tessier-Denham,St M1ary's Hospital Ethics Forum,St NMary's Hospital Medical School,P'racd Street,London W2

wvorking partics whose membership id l- 'swnfrom all parts of the United Kingdonm. ilkcresearch unit provides information andadvice on current issues in medical ethic& toa variety of acadcmic and health carebodies. Reports on the institute's rcisarAicare regularly published in medical andnursing journals and by the institute.

SNl.AN'(:1115'I i-R .'iiOi.At. 1(1RlA

Dr Gcoffrey Jessup,27 Oakwood Lane.Bovwden. Altrincham.Cheshire WA l4 31)1.

N'5W(.SAS FiD.1 ii AI ROt 1'The Revd Bryan Vernon, ILecturer in thcEthics of Health Care, NewcastleUniversity. )epartment of lrimars I IcalihCare, School of HIcalth Care Sciences,Ilhe Mcdical School, FramlingtonP'lace, Newcastle upon TIyne NE2 41111

NOYFIiN(GH.-ASI 5M1CA1 iTiCiiii(S GROUtPID)r T C O'D)owd,D)epartment ot General P'ractice,Univcrsity Hospital and MedicalSchool, (Cliftin Boulevard, NottinghamNG7 2UEI

sOUt H.AMPF'1ON .5SA1C)11 (LitROUL''Ihe Rcvd I Pinner,8 Bassctt Close, Southampton SO2 311'

Medical groups associated with LheInstitute of Medical Ethics have bccnestablished in British universitv teachimighospitals. Each academic vear thcv arrangeprogrammes of Iccturcs and ssmposia onissues raised by the practice 1fmedicinewhich concern other disciplines. Althoughthese prograrTmcs arc addressed primarilsto medical. nursing and other hospital stu-dents they are open to all members of themedical, nursing and allicd professions.'Ihere is no fee for attendance. ILecturelists arc available bv direct application tothe appropriate co-ordinating secretarynamed above. A stamped addrcsscd A4envelope would bc appreciated.

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DIPLOMA IN THE PHILOSOPHY OF MEDICINE

The next course will start on Saturday 5 October 1996. Thereafter sessionswill be held on alternate Saturday mornings until 28 June 1997. The fee forthe course is £350.

Details of the course are available from The Society of Apothecaries,Apothecaries' Hall, Black Friars Lane, London EC4V 6EJ. Tel: 0171-236-1180.

Keynes Press

Keynes Press

A VARIED LIFE:MEMOIRS OF A

ISWANSEA GPThe diaries of Urban Marks,whose career as a GP spannedthe introduction of Lloyd George'snational insurance scheme andthe start of the National HealthService as well as two world wars.

Illustrated and signed by Paul Cox,with an introduction by AndrewSmith, general practitioner.

UK £35.00; Overseas £37.50

Available fromBMJ Publishing GroupPO Box 295, London WC1H 9TE(Telephone 0171 383 6185/6245)

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MIDDLESEXUNIVERSITY

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.P..ti.r.d.u...D.p. a h

OWho do you treat when resources arenot adequate for the treatment of all?

OWhen do you switch off life support?O How do you handle confidentialinformation about infectious life-threatening illnesses?

As a health care professional you increasingly facethese and other perplexing moral problems. Thispart-time programme (Wednesdays, 2pm -

4.30pm for one and a half years) helps you toreach reasoned decisions. Open to graduates,suitably experienced non-graduates or thoseworking or qualified in other related disciplines.

Telephone 0181 362 5370or write: School of Philosophy, (ref C741F),Middlesex University, London N17 8HR

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