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Deciding for Others: The Ethics of Surrogate Decision Making , Allen E. Buchanan and Dan W. Brock Cambridge: Cambridge University Press, 1989, 422 pp.

This book concerns itself with one central question—how should medical treatment decisions be made for those who are not competent to make such decisions for themselves? Its authors are philosophers who began their work in this area when both were staff philosophers (a wonderfully appealing job title) with the American President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in the early 1980s. The book is aimed at a wide audience—lawyers, judges, health care workers, health policy makers, moral philosophers, and bioethicists. It is of broader interest as well—resolution of questions that arise in the making of treatment decisions for incompetent persons are likely to touch all of us, not necessarily or only in our professional capacities, but almost certainly in our relationships with others who are or become incompetent, and as individuals facing that possibility ourselves. Although much of the book is an expansion of material the authors had written earlier and the legal references are almost exclusively to American cases, nonetheless, it remains useful for its thoughtful approach to determinations of competence and for its review and analysis of the premises underlying various models of decision-making for incompetent patients. With proposals to regulate substitute decision-making in health care piling one on the other at a rapid pace in Canada now, it becomes all too easy to focus on the mechanics of the particular