Daniel Callahan, New Brunswick, NJ, Rutgers University Press, 1998, 330 pages, US$17.00.

Daniel Callahan has for many years been arguing against the technological current of medicine. Equally importantly, he has been a stern critic of the style of bioethical argument which would celebrate new technologies before asking questions about their point, and which would assess technologies piecemeal, rather than as contributions to a larger health and health care context. This approach makes him relatively unusual in bioethics and public policy circles, although names such as Thomas McKeown and Ivan Illich also come to mind.

Unlike McKeown and Illich, however, Callahan places a strong emphasis on self limitation by consumers as much as by providers of health care. His explicitly moral challenge to the “demand side” of health care expansion is powerful, taking a stance where most analysts would prefer not to tread—the evaluation of …