Book reviews 207

they are unacquainted with the work of
games theorists and welfare economists.
Hare, however, shows himself well
aware of the difficulties; and there is
great force in his contention that they
face all moralists who attach any impor-
tance to doing social good or preventing
social harm, and not just utilitarians.

Part III seeks to show why we should
go in for critical thinking, conceding
that there is no logically compelling
argument against the amoralist, but
endorsing a probable argument in pru-
dence against bringing up children to be
such. It is further argued that it is logi-
cally impossible for there to be a consist-
ent, non-utilitarian fanatic. Here, as
throughout, it is maintained that critical
moral reasoning is both philosophically
justified in terms of the concept of
moral judgments as universalizable
prescriptions and capable of directing
ideally acute, sensitive, fully-informed
people to rational solutions to practical
questions. Actual human beings, of
course, fall short; but rational solutions
remain possible in principle.
Hare is unquestionably the most

influential British moral philosopher of
the last 30 years. His book will inevit-
ably be of immense interest to fellow
philosophical practitioners, who will
want to see how he has qualified and
developed his views. Hare, however,
clearly hopes to reach a wider public,
feeling that 'unless some way is found of
talking about [urgent practical issues]
rationally and with hope of agreement,
violence will finally engulf the world'. I
am sure that an understanding of the
present book would greatly improve
public discussion; but I fear that it may
not exert the wide direct influence that
it should. Hare is an exceptionally care-
ful thinker and a clear-headed writer; but
his book is not wholly accessible to the
lay reader. It comes across as a report on
work in progress, shaped as often as not
by the objections of critics, and com-
pressed by a notable reluctance to bore
the reader by repetition of other writ-
ings or extended discussion of matters
not central to the main argument. These
intuitions have merit; but critical
thought should convince the author that
he could do good by expressing himself
at greater length and in a more relaxed
and less argumentative manner. He
acknowledges debts to Kant and Mill. I
think he could surpass the rigour of the
former in a work as widely readable as
the Utilitarianism or Liberty of the
latter.

PROFESSOR R F ATKINSON
Department ofPhilosophy
The University ofExeter

Justice and Health
Care

Ed Earl E Shelp
Holland, D Reidel Publishing Co
(Volume 8 of Philosophy and Medicine
series)
Dfl 6o US $3I.50 (paperback Dfl 30
US $14-95)

The dominant emphasis in medical
ethics during the last decade has been on
specific moral problems ofindividual or
small group decision-making. Analysis
has concentrated on issues such as abor-
tion, fetal research, care of the termi-
nally ill, drug abuse and organ trans-
plantation etc. The objective has been
to articulate and assess the parameters
for moral decision-making in these
specific contexts of medical care.
Insofar as bioethicists have stressed
analysis of these 'micro' issues, there
has been a corresponding lack of sus-
tained analysis of the institutional
character of medicine and health care
provision - the 'macro' structure within
which the micro issues arise. The Shelp
volume attempts to correct the imbal-
ance of focus by i) examining the health
care institutions within which micro
problems arise; 2) investigating the
larger array of institutions of which the
health care sector is only one part. Key
concepts examined throughout the vol-
ume are those of 'justice', 'right', and
their relevant application to the domain
of 'health care'. But justice and rights
considerations can only be clarified by
examining various theories in terms of
which certain claims about justice and
rights are made and by means of which
these claims can be defended. Without
at least an implicit ethical theory or a
theory of justice, certain questions can-
not be coherently asked much less
answered.

Such questions include: Is there a
right to health care? What does such a
right mean and imply with respect to an
array of other basic rights we try to
defend? What is the content ofa right to
health care? Are we claiming a right
to free provision of medical care in crisis
situations of disease and this for all
members of society in an equal way or
do we also include under the umbrella
ofthis 'right' free access to the full range
of technological provisions in medicine
including such items as human in vitro
fertilisation, heart transplants and
cosmetic surgery (to name only a few of
the procedures available which many
would consider non-essential under a
right to health care)? The parameters of

rights claims are not self-evident and
the essays in this volume show no pre-
sumption that their analyses offer final
resolutions of these complex questions.
They do, however, highlight some of
the essential questions that would need
to be asked in order to come to some
plausible view as to the resolution.

Another question concerns the
socio-economic and ethical issue of
priorities. The priority question arises
at two levels: the priority of health care
relative to other goods and needs, and
the order of priority of various forms of
health care. While the issue of priorities
is complex in terms of theoretical con-
siderations it is no less so at the level of
practical decision-making in any society
faced with limited economic resources.
Thus a third question, which asks about
the justice or injustice of current health
care systems, is a question which pre-
supposes that we opt for a theory of
justice that can argue for or against a
universal right to health care and like-
wise provide a basis for defending priority
decisions. It is not surprising, then, that
the present volume on justice and health
care will be considered as weak or as
strong as are the theories of justice pro-
posed to defend the various claims both
at the micro and macro level of health
care allocations.

DOLORES DOOLEY-CLARKE
Department ofPhilosophy

University College
Cork, Ireland

The Rights of Doctors
and Nurses and Allied
Health Professionals
G J Annas, L H Glantz and B F Katz
New York, Avon Books
$3.95

Doctors and nurses might be forgiven
for believing that they have obligations
and other people have rights so it was
with some surprise that I received this
book for review. My surprise was heigh-
tened when I saw that the cover
described it as an 'American Civil
Liberties Union Handbook'.
The book was suggested following

one on the rights of hospital patients by
one ofthe authors and from time to time
the impression is given that the authors
are more at home speaking of a doctor's

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