Mary Warnock
Duckworth £12.95, pp 128 
ISBN 0 71562841 0
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Rating: ★★★
Mary Warnock is a highly regarded moral philosopher. She has been headmistress of Oxford High School and mistress of Girton College, Cambridge, and she has chaired the Government Committee of Inquiry into Human Fertilisation and Embryology, whose conclusions formed the basis of subsequent legislation. She is no pure academic but has extensive experience in the practical application of moral philosophy, especially in medicine. This all shows in her latest book. Although written for the general reader, it has particular relevance for professionals working in the health service.
The first chapter presents two different moral dilemmas: a terminally ill woman suffering from progressive breathlessness and a young girl in a permanent vegetative state following a head injury. The underlying moral conflicts and commonly used arguments are discussed, including our concept of what is “natural” (she argues, “nothing could be less ‘natural’ than a plastic hip joint, although we have no moral objections to hip replacement surgery”), the philosophically suspect but widely accepted “double effect argument,” and the “slippery slope argument.”
Chapter two, “Birth,” concentrates on the moral permissibility of using live embryos for research and shows that the commonly asked question “When does human life begin?” should be reformulated as “When should a new human individual be thought to begin to exist?”
Having shown how complex medico-ethical problems can be, Warnock then digs deeper. She wonders where ethics comes from and assembles some strong arguments for not basing ethics on rights. She notes the tendency to claim what is merely desirable as a right, a term she would rather restrict to what is legally enforceable. She prefers to base ethics on altruism and “sympathy”—that is, the imaginative conception of the needs and wishes of others besides oneself. She confronts the notoriously perplexing problem of free will and determinism. After all, if everything is predetermined, we have no free will and thus cannot be held morally responsible for our actions. Her arguments against determinism are twofold: firstly, our emotional reactions commit us to the belief in personal responsibility; secondly, it is impossible, not only in practice but also in principle, to predict the future outcomes of physiological processes.
Her views are well argued and forcefully expressed. She does full justice to the complexity of the subject, exposes the sophistry of many widely held views, tackles the big issues, and is unafraid to draw controversial conclusions. Doctors and nurses confronted with ethical dilemmas can learn much from this book.