Medicine's changing economics have already fundamentally, permanently altered the relationship between physician and patient, E. Haavi Morreim argues. Physicians must weigh a patient's interests against the legitimate, competing claims of other patients, of payers, of society as a whole, and sometimes even of the physician himself.

Focusing on actual situations in the clinical setting, Morreim explores the complex moral problems that current economic realities pose for the practicing physician. She redefines the moral obligations of both physicians and patients, traces the specific effects of these redefined obligations on clinical practice, and explores the implications for patients as individuals and for national health policy. Although the book focuses on health care in the United States, physicians everywhere are likely to face many of the same basic issues of clinical ethics, because every system of health care financing and distribution today is constrained by finite resources.

From June of 1941 through the following summer, Fredericka Martin lived with her husband, Dr. Samuel Berenberg, on remote St. Paul Island in Alaska. During that time, Martin delved into the complex history of the Unangan people, and Before the Storm draws from her personal accounts of that year and her research to present a fascinating portrait of a time and a people facing radical change. A government-ordered evacuation of all Aleuts from the island in the face of World War II, which Martin recounts in her journal, proved but the first step in a long struggle by native peoples to gain independence, and, as editor Raymond L. Hudson explains, Martin came to play a significant role in the effort.

”Every social mechanism appears to have a dual potential for good and evil. Prepayment for medical care is no exception. On the one hand, it provides assurance of necessary care as a safeguard to health, economic well-being, and peace of mind. On the other hand, it opens the way to wasteful and harmful care, to price inflation, and to concealed redistributions in socially undesirable directions. The problem is to devise a plan that allows us to reap the most advantages while we incur the fewest drawbacks.”

Benefits in Medical Care Programs is a comprehensive treatment of this problem. Dr. Donabedian begins with a clear and straight forward analysis of his own assumptions about the social mandate for medical care benefits, the objectives of medical care programs, and the magnitude and distribution of the unmet need that these programs are designed to alleviate. The problem of defining and measuring the need for care is considered within the con text of the data yielded by alternative definitions. The analysis then shifts to the impact of benefits on certain key features of the medical care system.

Program benefits are weighed against program objectives, and policy implications are drawn from this comparison. We are shown what can and cannot be accomplished through medical care benefits and what goals are served by specific aspects of existing or proposed plans. Although Dr. Donabedian counsels a fairly thorough reform of existing systems, he remains skeptical about the possibility of designing a perfect system, and he does not hesitate to point out that increased access to care "increases exposure to both what is good and what is bad in our system of medical care. . . The machinery of medical care has a sinister potential for those who fall into it in the wrong place at the wrong time.

Dr. Donabedian's previous book Aspects of Medical Care Administration has been called the "bible" of its field. Benefits in Medical Care Programs should prove equally invaluable.

The deprivations and cruelty of slavery have overshadowed our understanding of the institution's most human dimension: birth. We often don't realize that after the United States stopped importing slaves in 1808, births were more important than ever; slavery and the southern way of life could continue only through babies born in bondage.

In the antebellum South, slaveholders' interest in slave women was matched by physicians struggling to assert their own professional authority over childbirth, and the two began to work together to increase the number of infants born in the slave quarter. In unprecedented ways, doctors tried to manage the health of enslaved women from puberty through the reproductive years, attempting to foster pregnancy, cure infertility, and resolve gynecological problems, including cancer.

Black women, however, proved an unruly force, distrustful of both the slaveholders and their doctors. With their own healing traditions, emphasizing the power of roots and herbs and the critical roles of family and community, enslaved women struggled to take charge of their own health in a system that did not respect their social circumstances, customs, or values. Birthing a Slave depicts the competing approaches to reproductive health that evolved on plantations, as both black women and white men sought to enhance the health of enslaved mothers--in very different ways and for entirely different reasons.

Birthing a Slave is the first book to focus exclusively on the health care of enslaved women, and it argues convincingly for the critical role of reproductive medicine in the slave system of antebellum America.