Ethics in Health Services Management, 4th ed, by Kurt Darr, JD, ScD, FACHE, Baltimore, Md: Health Professions Press Inc, 2005. 408 pages, paperback, 6 x 9, $ 39.95, ISBN 1-878812-99-8.

There is no shortage of ethical issues in health care management. The author has been addressing the ethical issues of health services for about 2 decades. Dr Darr is a Professor of Hospital Administration in the Department of Health Services Management and Leadership at The George Washington University. He received a Doctor of Science degree from The Johns Hopkins University, and his Master of Hospital Administration and Doctor of Jurisprudence degrees from the University of Minnesota.

This book is intended for managers of health services, or graduate students studying ethics of health services management. Issues relate to legal matters, politics, heath care finance, medical technology, and health care quality. The book evolves from definitions of ethics and law, to moral philosophies and principles, to thinking about ethics in the context of health care, to specific situations in health care. The topic of virtue ethics is touched on in several areas of the book.

The book is divided into 5 sections, and 2 appendices. Section 1, "Identifying and Solving Ethical Problems," gives an overview of moral philosophies and the derivative principles (respect, beneficence, nonmaleficence, and justice) as well as solving problems involving ethics. Section 2, "Guiding Ethical Decision Making," discusses the organizational decision-making guidelines that are provided by the organizational values, vision, mission, and codes of ethics. Section 3, "Administrative Ethical Issues," covers conflicts of interest, and ethical issues related to staff, patients, and community. Section 4, "Biomedical Ethical Issues," covers such issues as consent, death and dying, patient autonomy, and physician-assisted suicide. The last section, "Emerging Ethical Issues," covers marketing, managed care, resource allocation, and social responsibility. Eighty case studies and vignettes provide real-life examples to various ethical issues.

The 2 appendices provide examples of 6 different mission, vision, and values statements and the ethical codes from the American College of Healthcare Executives, American College of Health Care Administrators, American Medical Association, and the American Nurses Association.

One part of the book, about one and a half pages in Section 2, that I found a bit confusing was related to a case study in which the treatment of a patient was being considered as experimental. While variation in treatment processes is often undesirable, improving outcomes by enhancing the patient's intrinsic disease fighting ability is an evolving field that usually does not compromise patient safety.

The area that I thought was given the best discussion was the section on consent, death and dying, patient autonomy, and physician-assisted suicide. These topics often contain terrain with slippery slopes.

Overall, this book covers health services ethical issues very well. The author did an outstanding job providing guidelines and methodology for solving ethical problems in health services. I recommend this book to professors and practitioners of health services management, including nurse and physician executives.

Mark Best, MD, MBA, MPH

Associate Professor Lake Erie College of Osteopathic Medicine - Bradenton Bradenton, Fla