Book reviews

Russland als Vielvolkerreich. Entstehung, Geschichte, Zerfall. Andreas Kappeler. München, Germany: C. H. Beck, 1992, 395 pp, bibliography, index.

A Traveller's Companion to Central Asia. Kathleen Hopkirk. London: John Murray, 1993, 292 pp, £16.

Samarkand and Bukhara. John Lawton. Photographs by Francesco Venturi. London: Tauris Parke Books, 1992, 128 pp, £16.95. Mirror of the Orient. Roland and Sabrina Michaud. London: Thames and Hudson, 1992, 96 pp, £12.95, paperback.

The Continuing Conflict in Kashmir. Regional Conflict in Jeopardy. Iftikhar H. Malik. London: Research Institute for the Study of Conflict and Terrorism, 1993, 25 pp, £10.     

Moral atrophy in the welfare state

The welfare state is often accused of being counterproductive: as the scope of public responsibility expands, private morality (especially altruism and benevolence) atrophies. This essay surveys psychological findings for evidence, which turns out to be broadly consistent with either of two models of moral development, each bearing distinct policy implications. The model of morally keeping in practice that is implicit in the term moral atrophy suggests the need for frequent opportunities to exercise moral skills, which would seem inconsistent with the welfare state. Alternatively, the model of moral character-building favoured by both philosophers and ordinary discourse would require only occasional reminders of one's moral principles. On this model, benevolence could usefully supplement the welfare state.     

Book reviews

Transcaucasian Boundaries John F. Wright, Suzanne Goldenberg and Richard Schofield (editors) London: UCL Press, 1996, 248pp, £40 and £14.95

The Russian Policy Debate on Central Asia Irina Zviagelskaia London: Royal Institute of International Affairs, 1995, X, 41 pp, £12.50

CIS Integration Trends: Russia and the Former Soviet South Mark Webber London: Royal Institute of International Affairs, 1997, IX, 72 pp, £12.50 Both distributed by Plimbridge Distributors Ltd, Estover Road, Plymouth. Devon PL6 7PZ, and in North America by the Brookings Institutional Press, Washington DC.

Russia and Azerbaijan: A Borderland in Transition Tadeusz Swietochowski New York: Columbia University Press, 1995, xvi, 290 pp, $34.95

The Soviet Socialist Republic of Iran, 1920–1921 Cosroe Chaqueri Pittsburgh, Pa: University of Pittsburgh Press, 1995, xvii, 649 pp, $75.00

Bibliography of Islamic Central Asia Yuri Bregel (editor and compiler) Bloomington, Indiana: Research Institute for Inner Asian Studies, Indiana University, 1995, in three volumes: Pt. I, LXXTV+773 pp; Pt. II, XLIII+774–1512 pp; Pt. III, XXXII+1513–2276 pp, $299

Mohieddin Alempour. A Tajik Visionary Baqer Moin (editor) London: BBC Persian Service, Bush House, 1997, illus, 140 pp, £20

Tatar Costume M. Zavyalova Kazan: Zaman Publishers Fund Turan, 1996, illus, 252 pp, $50     

The need to know versus the right to know: privacy of patient medical data in an information-based society

"Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret."(1) "Safeguards to privacy in individual health care information are imperative to preserve the health care delivery relationship and the integrity of the patient record."(2) As early as the fourth and fifth centuries B.C., Hippocrates contemplated the importance of medical information to the care and treatment of patients. His oath suggests that privacy of a patient's medical information creates the foundation upon which a patient reposes trust in his or her physician. While defining the earliest version of the physician-patient privilege, the oath does not envision the extent of modern day access to healthcare information. A patient's relationship with the modern healthcare delivery system often includes a team of physicians, nurses, and other clinical support personnel. This relationship extends beyond direct caregivers and may include healthcare administrators, payor organizations, and persons unfamiliar with a patient's identity, such as researchers and public health officials. Accessing a patient's medical information links these participants to the patient's healthcare delivery relationship. The Hippocratic Oath does not contemplate such broad access, nor does it contemplate the emerging privacy crisis resulting from the application of computer technology to medical record storage and retrieval. The combination of broad access, individual privacy rights, and computer technology requires a rethinking of measures designed to protect the realities of the modern medical information society.