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Ethics, Management and Mythology: Rational Decision Making for Health Service Professionals
  1. Richard Ashcroft
  1. Leverhulme Senior Lecturer in Medical Ethics, Imperial College of Science, Technology and Medicine, London W6 8RP, UK

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    Michael Loughlin. Oxford: Radcliffe Medical Press, 2001, £19.95 (paperback). ISBN 1 85775 574 X

    Michael Loughlin is famous (or notorious) in the world of health services management and management theory for his scathing attacks on such concepts as “quality” and “fair rationing”, and on the very idea of an ethics specific to healthcare management. This book brings together much of his thinking on these general themes in the form of a textbook of philosophy aimed at health service professionals, particularly managers.

    Loughlin's explicit aim is to challenge lazy thinking, the mindless use of jargon, and (even more) the deliberate use of “management science” as a sophistical technique. Sophistry, he reminds us, is the use of rational arguments to persuade one's audience of the rightness of one's beliefs or one's proposals for action, without critical scrutiny of one's own presuppositions or regard for the truth. Loughlin hopes to engage the reader in the activity of philosophy, which is concerned with the critical examination of assumptions and arguments in order to clear away nonsense, bad arguments, and misleading illusions. Underlying Loughlin's pedagogical aims is a specific theory of the relationship between the possibility of ethics and the prevailing social and political order.

    The health service professional into whose hands this book falls will certainly be greatly irritated by it. It is rude about the role of managers, arrogant about the correctness of its own analyses, and unduly scathing about the possibility of a genuine social science of organisations. While much of the language of quality management is absurd, he does no justice to its core intention—to seek to care better for one's patients. Nonetheless, the book achieves its primary aim of making the reader think for him or herself. Many of the targets Loughlin attacks more than merit his criticisms; I particularly enjoyed his skewering of what is wrong with Zen and the Art of Motorcycle Maintenance, and of what is wrong with the idea of “ethical guidelines” and the notion of a professional “ethicist”. There is a gnarly energy and intelligence and anger in the book which make it much the most entertaining and engaging book on ethics that I have read in a long time.