The second half of this eminently readable book begins with a summary of a survey of over 1000 cases of treatment without informed consent under the Mental Health Act 1983, which was undertaken by Fennell between 1992 and 1993. Studies suggest that the American healthcare system discriminates against African-American patients, and Fennell emphasises that black people in Britain are more likely to be diagnosed as schizophrenic, more likely to be admitted to psychiatric hospitals, more likely to be treated in secure conditions, and more likely to be given large doses of drugs. Even if one were to assume that, for one non-racist reason or another, black people are more likely to be diagnosed with a mental illness than white people, it should clearly raise suspicion that these patients receive on average larger doses of drugs than their white counterparts and that, as Fennell reports, they are more likely to receive doses in excess of those recommended by the British National Formulary. Several deaths have been reported as a consequence of sedative drugs being administered in excess of recommended doses.

Today, a court decision is required for all medical interventions that are not necessary for the health of a mentally disturbed patient. Fennell provides sufficient evidence to suggest that this has not altered the substantive outcome of medical decision making. He argues that patients capable of refusing consent are detained in order to allow for electroconvulsive therapy to be given without consent. This clearly violates the ethical principle of respect for autonomous people. I recommend Treatment Without Consent to anyone interested in the subject of ethical treatment of mentally disordered people.

Udo Schuklenk, lecturer in professional ethics, University of Central Lancashire

The main interest of this book is the way in which these holistic scientists interacted with the political culture of their times, although Harrington is emphatically not one of those sociological determinists who deny autonomy to the perpetual dialogue between scientists and nature.

Her story is that scientific holism sometimes became entwined with organicist and racist conceptions of the political order, and specifically with the strange idea that "mechanistic thought" was peculiarly Jewish. In 1935 a physician could write: "The Jew is always attempting to split all things, to break them down to their atoms and in this way to make them complicated and so incomprehensible that a healthy person can no longer find his way in the jumble of contradictory theories .... The healthy non-Jew, in contrast, born out of creation, thinks simply, organically, creatively."

Nevertheless, holism was gradually marginalised by the Nazi scientific technocrats such as Karl Astel, an adept at reducing entire populations to index cards detailing race or deviant behaviour patterns on behalf of the SS. Himmler may have been a crank, but he knew what sort of science he needed to operate a police state. Indeed,one of the implicit messages of this book is that the history of science is very interesting, but that in dictatorships it is dictators and not scientists who call the shots. This message was communicated very clearly: "The professors do not carry volkisch responsibility for the future; the movement does, whose Fuhrer is fully accountable and who therefore possesses as a result of this high responsibility the primal right of a political Fuhrer to sweep away anything that endangers the inner health of the Volk," including holism when it did not suit him.

After 1945, devotees of holism, notably Viktor von Weiszacker, were keen to promote the common view that a "mechanistic" objectifying perspective had resulted in the medical abuses committed under the Nazi dictatorship. As this book shows in the case of Weiszacker himself, who allegedly experimented on brains delivered from the Nazi "euthanasia" programme, matters were more complicated than his explanation suggests. Since the 1960s various "alternative" movements - largely innocent of holism's ambiguous German past, including the gigantic herbal plantation at Dachau - have once again embraced the search for wholeness, although they may have to soon drastically rethink the modern polarity of machine and nature since machines are now not only smart but potentially organic.

An interesting article extended to 300 dense pages, Harrington's book joins the lengthening list of books which describe the shifting relations between scientific factions and politics in modern Germany, mirroring their common defect of neglecting what the politicians thought of the scientists.

Michael Burleigh, distinguished research professor in modern European history, University of Wales, Cardiff

An alternative response to euthanasia stresses the importance of compassion. This point of view accords paramount importance not only to respect for life but also to good palliative care. Supporters of this view claim that sometimes illness and dying are associated with such suffering that life is reduced to pointless surviving. If all other palliative measures fail then euthanasia on request may be justified. Most proposals to regulate euthanasia follow this scheme.

These two responses seem to differ foremost in their answer to the question: "Does intractable excruciating suffering exist? "Even palliative care specialists will admit that, unfortunately, it does (see James Gilbert's excellent chapter on the topic). The real question, therefore, is whether you should allow the principle of respect for life to be overridden by other considerations in special circumstances. The current Dutch euthanasia policy fits completely into this second approach. The small number of hospices in the Netherlands is misinterpreted as proof of the neglect of palliative care, whereas such care is provided within the existing health care system.

In practice, however, the Dutch attitude to euthanasia seems to be developing in another direction, with increasing emphasis on the respect for autonomy. This signals the possibility of a third approach - which regards euthanasia as a choice. This approach assumes that patients want to decide autonomously how and when they should die and value "being in control." Until recently, this approach was found only among members of "right to die" societies, but it might soon become part of an official policy. In January 1997 the Supreme Court of the United States will confront the question of whether it is unconstitutional for states to have laws forbidding physician assisted suicide. Two circuit courts had decided earlier this year that it was, and in doing so accepted the existence of a right to die. Trudo Lemmens provides a good introduction to the American debate.

One of the circuit courts' decisions was that, since people have the right to forgo medical treatment, they should have the right to assisted suicide as well. In its reasoning the court claimed that the difference between killing and letting die is of no moral importance.If a right to be killed is indeed accepted in a society with over 40 million underinsured inhabitants, a disaster may result. I hope that the Supreme Court will read the careful and illuminating article by Will Cartwright, who, in my opinion, successfully defends the distinction between killing and letting die.

The 18 chapters vary in quality and usefulness. Some contributors (such as R P A Rivers) deal only with decisions about withholding treatment and not with euthanasia at all, and some (such as Martin Roth) apparently need to exaggerate the situation in the Netherlands (relying on secondary reports) to make their point. On the whole, however, this is a very informative book and will certainly help to promote the inevitable debate on euthanasia and other end-of-life decisions.

Johannes J M van Delden, nursing home physician and senior bioethics researcher, Centre for Bioethics and Health Law, Utrecht University

We may be incapable of taking on board the sheer weight of human misery - soon, for example, a new generation of orphans will lack not only parents but also grandparents. But in an increasingly interdependent world, the destabilising effects of AIDS on the economies and societies of developing countries, like the renewed threat of tuberculosis, are deeply worrying.

Anne Bayley is a surgeon who knows about AIDS in Africa. She was there when cases began to appear, but the accumulating consequences have exceeded her worst expectations. Her book is a reasoned argument against the "dishonest mood of denial" in which communities and governments all too often shelter against the facts. But Bayley is not a prophet of doom and knows that people need something to hope for if they are to respond effectively to a crisis of these proportions. In the challenge of AIDS she glimpses possibilities beyond scientific optimism's failure to deliver a meaningful existence to most people .Because she believes in it, the language she uses to talk about this is theological. (Bayley is also an Anglican priest and her book is written as a study guide for theological students and church groups.) But the possibilities she perceives are (unlike resurgent fundamentalism) inclusive, generous, and practical.

Much of the book is a series of accounts of how Africans have responded to the pressures of the pandemic, for example by rethinking the role of women and by small scale socioeconomic projects to recreate devastated communities. Whether this will achieve the larger goal of changing social norms and sexual behaviour sufficiently to limit the spread of HIV remains to be seen. Bailey's chaos theory hope is that "small events start chain reactions which have unpredictable and large consequences," although these need to be helped by enlightened Western self interest, particularly in terms of debt reduction. AIDS in turn, she adds, "is helping to restore a human face to Western medical care.... Doctors who reach the end of their stock of useful drugs must either walk out of the clinic in despair, or else stay and talk to their patients."

Kenneth M Boyd, research director, Institute of Medical Ethics, Royal Infirmary, Edinburgh