There are many challenges of an ageing society but the particular focus of this book is on the consequences of increasing life expectancy and decreasing fertility in the United States (US) for inter-generational relations, particularly autonomy, responsibility and distributive justice across the generations. The book has 17 papers or essays that originated in presentations at two inter-disciplinary conferences about science and ethics for ageing well. These are organised into four sections: ‘Autonomy and end-of-life decisions’ (four chapters), ‘The future of family responsibility’ (three chapters), ‘Policies and politics of generational responsibility’ (five chapters) and ‘Contemporary public policy for health and wealth’ (five chapters). Books developed from conference papers generally result in heterogeneous collections, but in this case the editors have made a credible attempt to join and integrate the material, although the ethical framework of autonomy, responsibility and distributive justice does not work throughout. The chapters vary considerably in length, from 15 to 50 pages, in style (reflective essay, critical overview of policy and detailed analysis of specific public policies) and quality (excellent to mediocre). While there is something for everyone, many of the contributions have displayed their arguments elsewhere and in more accessible publications. This is probably not a book for the general reader. For students and academics interested in the history and politics of US public policy, there are some illuminating contributions. For gerontologists, policy makers, and health and social care professionals from outside the US, this is probably not a book to buy.

Part 1 sets the ethical landscape. Dubler considers the role of US law and how it has helped or hindered the medical profession in promoting patient wellbeing. She provides an historical account of the legal milestones concerning ‘incompetent’ patients and issues of resuscitation. Marson reviews his own research on competency and the abilities of older patients to understand complex scenarios and future decisions about their care. His chapter highlights the limitations of current knowledge in this area which remains highly subjective and contested. Fahey considers ethical issues around long-term care and Feild provides a useful overview of religiosity and spirituality at the end of life that highlights cultural and religious diversity.

In contrast to Part 1, which has a rather dry apolitical ethical perspective, Part 2 is more critical in that it challenges contemporary thought and knowledge about ‘the family’ in America. Putney, Bengtson and Wakeman provide an overview of the key demographic, cultural and social changes that have affected ‘family structures’. They challenge the pessimistic forecasts of the New Right and many policy makers of the consequences of population ageing. From a feminist perspective, Holstein reminds us of the gendered nature of US society through an analysis of care-giving. She proposes a collectivist ethic based on interdependency and intergenerational solidarity and reviews the appropriateness of the German long-term care insurance model for US policy. Moody reflects on the ‘inter-generational debate’, and highlights conflict, ambiguity and competition in the context of different ways of thinking about ‘generation’ and distributive justice.

Part 3 widens the debate. Absent in the discourse in much public policy is a discussion of diversity and inequality in general and the ageing of members of minority populations in particular. Markides and Wallace redress this deficiency through a careful analysis of the implications for health care and public policy more broadly in a society where the majority of minority elders have little or no social protection. Manheimer's chapter revisits the inter-generational debate through an analysis of life-long learning and post-retirement education. An historical perspective is provided by Achenbaum and Cole, who conclude that public policies in education, disability support and social security have developed incrementally and that the ageing of the population does not require a rapid change in policy direction. They see no need for the increased average age to drive public policy. In contrast, Hudson argues that age-based public policies are politically more acceptable and realistic than need-based policies. Finally, in this section, Binstock asks whether responsibility across generations is politically feasible, and concludes that politicians are unwilling to take the necessary long-term action to address the challenges of population ageing but focus on ideologically mediated short-term issues.

The final part comprises several papers on the short-term preoccupations of politicians and policy makers. Williamson provides a helpful review of the contested nature of the inter-generational debate in US politics through an analysis of ‘generational equity’ and ‘generational interdependence’ in relation to social security reform. Kingson (Chapter 14) and Diamond and Orszag (Chapter 15) provide technical accounts of developing a European style social insurance scheme for social security. In the final two chapters, Stuart and Bishop review the costs and benefits of the new Medicare Drug Benefit from economic and clinical perspectives. As said, there is something for everyone in this collection but rather little that is not available elsewhere. This would have been a more interesting book if the editors had attempted to draw all the contributions together rather than leaving it as a series of loosely-connected papers.