A book on ethical dilemmas and challenges in the context of health and social care is both timely and pertinent. Health and social care professionals must operate in a world in which ethical conduct is far from obvious (Bauman, Reference Bauman1993). As Honig (Reference Honig1996) argues, the ethical subject must function within what she termed ‘dilemmatic spaces’ in which choices are ambiguous, indeterminate and contested. Moreover, professionals bring to such choices their own ambivalence, internal conflicts and contradictions, as well as their own values and commitments (Miller, Hoggett and Mayo, Reference Miller, Hoggett and Mayo2006), and which in turn place complex emotional demands upon them (Hoggett, Reference Hoggett2005). At the same time as ethical issues become ever more complex so the desire by government and management to exert greater control over such matters has grown both through the increased regulation of practice and the management of research. In other words, there is a great deal of rich material to be explored as practitioners and researchers attempt to negotiate a way through systems that are, at best, reluctant to acknowledge the need for professional autonomy and judgement.

Unfortunately, this edited collection produced by Leathard and McLaren will disappoint the reader hoping for a text that engages with such dilemmas. In what proves to be a helpful conclusion, the editors identify five ethics-related themes explored in the book: ethical decision-making in collaborative working, user–professional relationships in decision-making, vulnerable people, service users, and governance and accountability. Yet oddly the book is not organised around these potentially interesting themes. Instead the 19 chapters are organised into three sections: research and provision; law, management and ethics; and ethics – from the start of life to the end. Not all chapters appear to sit comfortably in their allocated section so that Irvine and McPhee's chapter [10] on ‘Multidisciplinary team practice in law and ethics’ includes a substantial section on dialogical ethics, thereby getting much closer to the reality of addressing contemporary ethical issues, and would perhaps sit better alongside Terry's chapter [2] on ethical theories and principles. Somehow the chapters rarely convey a sense of people struggling to negotiate complex situations but rather remain somewhat abstract and removed from practice. However, the chapter [5] by Campion-Smith, a General Practitioner, explores ethics in primary health care and conveys much more effectively the contested nature of ethical choices. Too often there is a sense in which the writers, experts in their respective fields, have been asked to identify some ethical challenges in relation to what the editors describe as ‘front-runner issues’– such as management or the imposition of service fees – some quite specific professional concerns – such as reproductive technology or euthanasia – or more general policy areas – such as mental health, child care, and disabilities. The consequence is that a number of chapters fall between providing an overview of the topic area and highlighting what appear to be a self-selected number of ethical concerns – hence the need perhaps for the editors to provide a summary of the emergent themes – and usually without the space to explore these in depth.

The book is written for an essentially UK market – 20 of the 24 authors are located in the UK and there is little attempt to explain terms or legislation for the international reader. Yet without explanation, the reader is presented with two chapters, interesting in themselves, one from America and other Australian. The relationship between the UK situation and Dombeck and Olsan's chapter on the ethical implications of the American insurance-based model of health care and the position facing the 43 million uninsured is never made clear, while Irvine and McPhee's chapter on ethics and multidisciplinary teams is easily related to the book's theme, the fact that it is written by two Australians seems irrelevant. The suggestion on the book notes that this is anything more than a UK-focused book is at best misleading.

If the book tries to cover too much ground and therefore struggles to retain a focus, it also appears reluctant to engage critically in areas that are in practice problematic. For example, those writing about research governance (Stanley and McLaren [Chapter. 3], and Pierce [Chapter 4]) accept with only few minor reservations the well-intentioned rationale for the introduction of ethical scrutiny as being solely concerned with ‘protecting the rights, health and well-being of research participants’ (Stanley and McLaren, p.35). Indeed Pierce, as Head of Research and Development in a London specialist hospital, is writing as ‘insider’ and ‘gatekeeper’ to such governance arrangements. In neither case is there much that relates to the inconsistent practices of such arrangements, their use as risk management mechanisms, the extent to which qualitative research has suffered under the dominant positivist medical research model and often lack of competence to judge other research methodologies, or their function in managing the research agenda – all of which have ethical implications. More importantly, neither chapter asks whether the introduction of this ethical regulatory framework has enabled researchers to be any more ethical in their practice or equipped them to better deal with the ethical challenges they encounter during the research. The reader would not come away with a sense that these are contested developments or gain any insight into other ways in which ethical dilemmas might be considered.

In a publication of this length and with some eminent contributors one would expect to find some useful material and indeed this is so. In addition to those already mentioned, I found Terry's second chapter on ethical and legal perspectives to be both informative and engaging and much better written than her first rather stilted contribution on ethical theories and principles. Similarly, Colin and Margaret Whittington's chapter, exploring the relationship between values and ethical codes and the political and organisational context of practice, and in particular the implications of interagency work, poses a number of questions for professional bodies and practitioners. Overall, this collection struggles to sufficiently develop a focus and remains a collection of individual chapters.