Physicians in their role as healers have a unique relationship with respect to their patients; trust in the patient’s physician is the basis of the physician–patient relationship. No one chooses to be a patient. Each physician must make the appropriate decisions that balance the needs of the patient with the societal laws and professional codes of conduct, and the sometimes conflicting self self-interests of the physician. Sometimes the physician’s interests supersede the interests of the patient. A particularly egregious example, but also one that gives us deep insights on the failure of institutional ethical review boards to adequately prevent aberrations of normative behavior of physicians and also to hold the perpetrators accountable, is the book Waking Up Blind,Lawsuits over Eye Surgery by Tom Harbin, MD.

Physicians and scientists in the course of their extensive education and training may have been exposed to a short course or a series of lectures on the general topic of biomedical ethics. Typically, there was a required course on the medical–legal aspects of the practice of medicine. For example, in German medical schools the book Medizin & Recht für Ärzte (Springer-Verlag,2001) by Dettmeyer may have been the textbook of such a course. While the legal structure that is operational in the State (Land in Germany) and the country where the physician is licensed to practice medicine serves as a guide, there is a much more complex and disparate field, which is the domain of biomedical ethics. While the former legal field sets the boundaries that if transgressed may cause the physician to be open to criminal prosecution, the latter field of biomedical ethics is typically governed by international, national, state, hospital and professional medical society codes of ethics and behavior. Transgression of these codes of ethics may result in profession censure; however, in egregious cases the physician can be criminally prosecuted and subjected to civil law procedures.

There are general ethical principles which were formulated many centuries ago, including the ethical principles of the world’s major religions. More recently, the writings of philosophers such as Kant, Mill and others have prepared the basis for different theories of ethical behavior. While fundamental principles such as “do no harm” as stated in the Hippocratic Oath are as valid today as when they were first formulated, the science and art of medicine in recent times is growing at an accelerating rate and with increasing complexity. For example, three topics that the book’s editors discuss in the later part of their book—embryonic stem-cell research, genetics and human reproduction, and social justice and access to health care—were not dominant issues only a few decades ago. The modern advances in medicine and biology in many cases precede the development of clear and deliberative discussion and the eventual legislative processes that produce new laws to regulate the research, testing and the use of the new technologies and therapies on animals and humans. It is imperative that physicians, patient advocates, scientists, philosophers, feminists, lay people, animal rights people, medical students, attorneys, and government officials engage in civil discourse in order to formulate the foundations of a set of biomedical ethics that are based on science and evidence based medicine. To insure this process, which is an ongoing process since the science and the art of medicine is itself constantly changing, it is necessary to look at the studies and the discussions that are occurring in a variety of countries and for a variety of populations. When the data is obtained or derived from a specific group of people or from one cultural group, then the result may not be appropriate for the culturally diverse world in which we live.

David DeGrazia, Thomas A. Mappes and Jeffrey Brand-Ballard edited the 7th edition of their book Biomedical Ethics, which is widely used in the United States. I propose that this book, which is an anthology of readings and case studies concerned with the ethical issues of biomedicine, is a useful reference and textbook for undergraduate, graduate, and medical school courses. The general introduction of the volume begins with the editor’s clear introduction to the historical and the modern nature of biomedical ethics. The reader is introduced to a variety of competing ethical theories, with critical assessments and comparative analysis, from the classical formulation of utilitarianism by Jeremy Bentham and John Stuart Mill, to Immanuel Kant’s deontology, to W. D. Ross’s theory of prima facie duties, to feminist ethics. These critical essays are followed by notes, an annotated bibliography, and an appendix containing selected reference sources in biomedical ethics as print resources, and then a list of web resources. Subsequent chapters are of a similar format, except that following the introduction there are a series of reproduced journal articles. Each article contains its own bibliography and or notes. The book ends with 42 case studies that are intended to provoke and stimulate thoughtful analysis and discussion.

For those primarily concerned with clinical research ethics I strongly recommend The Oxford Textbook of Biomedical Clinical Research, Ezekiel J. Emanuel et al.; see my book review DOI:10.1007/s00417-009-1180-9, Graefe's Archive for Clinical and experimental Experimental Ophthalmology, and the link to the editorial website:http://www.di-ep.com/ethics-in-medicine.html.

While Biomedical Ethics is intended to be used as a textbook, I think that eye-care professionals will find this book a useful reference. Some of the reasons why I recommend this book are: the inclusion of papers with diverse and often opposing themes and arguments, the clarity and the logic of the writing and the arguments, the scope of the subjects included in the book, the pedagogical excellence, the multicultural framework, and my experience that the readings are truly thought-provoking.