Nuffield Council on Bioethics, London, Nuffield Council on Bioethics, 1998, 116 pages, £20.

The moral climate of our society has changed. Management has replaced consensus. Acquisition of riches has replaced personal achievement. Orders have replaced encouragement. Blame has replaced empathy. The effect of this on psychiatrists is that, through the requirements of the Mental Health Commission and the sanctions of inquiries at all levels, what they do and how they do it is prescribed and monitored and threats of sanction in event of failure are no longer remote instruments of last resort. The creation of such a climate requires individuals and bodies who are prepared to adopt and promote these values and lay down the rules. Individuals and bodies who predated the changes are adept at modifying their values and approaches for large numbers of reasons, some no doubt good but others probably bad. It is hard not to find these changes reflected in this book.

The Nuffield Council on Bioethics is a worthy organisation, funded jointly by the Medical Research Council, …