Homosexual desire in revolutionary Russia: the regulation of sexual and gender dissent

philosopher, David Cooper, on the "Frankensteinian" nature of biotechnology. Other "technologies" are apparent herefinancial, managerial, professional, and legal, among them-but these are not implied in the opening statement, nor do they come within the analytical scope of the volume. Rather, as the subtitle has it, the theme is 'From paternalism to autonomy?'-the question mark signifying an effort to transform into a "useful heuristic" (p. 8) an otherwise commonplace historical structuring for medical ethics in the twentieth century. Yet, notwithstanding the philosopher Susan Lowe's well-penned castigation of the concept of autonomy as "fundamentally misconceived" and a "show of rhetoric" (p. 129) in relation to physician-assisted suicide, none of the contributors seeks historically to unpack the idea of patient autonomy, nor explain socially and culturally what may have been displaced by its rise to prominence. All too readily they fall back upon describing the displacement of the medical profession's paternalistic authority and privilege-a possibly historically misinformed notion, which in places here is presented even with a whiff of nostalgia. This is not to suggest that the contributors have nothing new, interesting or insightful to say on ethics in medicine. Not least through German comparisons, they contribute significantly to this still too little known and under-researched area. Andrew Morrice explores the rise (c. 1900) and the demise (post-1945) of the British Medical Association's Central Ethical Committee, exposing how class-based codes of gentility in Britain counted formore than ethics as such in the profession's patrol of its boundaries. AndreasHolger Maehle, on the emergence of doctors' ethics in Germany in the late nineteenth century, stakes a greater (if still limited) claim for some "real ethics" among the profession by referring to controversies over issues of "confidentiality" and "informed consent". The latter is more fully articulated in the German context through the contrasting evidence presented by Cay-Rudiger Prill and Marianne Sinn in relation to consent to surgical procedures, on the one hand, and cQnsent to autopsies, on the other-different stories born of different professional relations. However, as Lutz Sauerteig makes clear in his useful chronicle of compulsory sickness insurance in Germany, at the root of most medical morality and doctor-patient relations is money. Sauerteig has nothing directly to say on medical ethics. His object, rather, is to trace how, within the German sickness insurance system, a discourse on social progress and a practice of greater equality of access to health care gave way in the 1970s to a rhetoric ofmarket economics and a reality for the German working population of paying "an unnecessarily large proportion of its income for a financially inadequate health care system" (p. 68). Ulrich Trohler's chapter on the national and international codes governing human experimentation since 1947 also hints at important recent shifts in discourse. Most intriguing is the move away from "rights" to the more flexible (and corruptible) concept of "human dignity". Trohler makes too little of the political economics behind this trend, but his chapter, like Sauerteig's, serves at least to remind us that medical ethics, like technology, is more fruitfully pursued intellectually when treated as socially constitutive, rather than causal. Its real motor always lies elsewhere, in places where this volume, alas, largely fails to reach.