AM I MY BROTHER'S KEEPER?

Careful consideration of some of the knottier bioethical problems of our times, by the director of the Center for Bioethics at the University of Pennsylvania, who fears that cynicism and mistrust have eroded our ability to see ourselves as our brothers' keepers. Caplan, who recently compiled essays largely from his newspaper columns (Due Consideration, p. 1564), draws here on weightier sources—his articles in law reviews and medical journals as well as some book chapters. The topics he discusses thoughtfully are often the same ones he tackled somewhat pugnaciously in the earlier collection—the ethics of fetal tissue research, reproductive technologies, gene therapy, assisted suicide, organ transplant, etc. Occasionally, whole paragraphs are virtually identical, but overall, Caplan is writing to a more sophisticated readership this time, and he spends more time presenting the issues and developing his arguments. The theme of trust recurs often in these essays. Caplan points out that when the free-market approach drives behavior, as in for-profit managed health care systems, trust, a crucial element in any therapeutic relationship, is hard-pressed to survive. Trust becomes an issue, also, in the question of redefining death: As Caplan points out, mistrust of medicine makes us leery of leaving that task to doctors whose motives we cannot be sure of. To the title question he responds with a firm ``yes,'' reminding us that in an age when personal autonomy is much valued, we must not overlook the need to trust, rely on, and help one another. Of the two collections, this is more satisfying, though less lively; more thoughtful, though less provocative; and while timely, less likely to become dated.