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The Basics of Bioethics

by
Edition:
2nd
ISBN13:

9780130991614

ISBN10:
0130991619
Format:
Paperback
Pub. Date:
1/1/2003
Publisher(s):
Prentice Hall

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Summary

This briefsummary of the issues of biomedical ethics provides a balanced, systematic, unbiased framework designed to help health professionals an lay people understand and analyze a wide rangeof topics that are currently controversial in medicine ;or that are likely to arise in the future.   Broad in scope, it considers ethical systems from variousreligious and secular traditions, including those of non-western cultures such as Asian religious and secular traditions. Topics include the history of codes of ethics; the definition of death, abortion, animal rights and welfare; problems in deciding what will benefit patients; confidentiality, truth-telling, informed consent; the care of the terminally ill; genetics, birth technologies; and problems of social ethics, including resource allocation, organ transplant, and human subjects research.   For use in allied health fields.

Author Biography

Robert M. Veatch is Professor of Medical Ethics and former director of the Kennedy Institute of Ethics, Georgetown University.

Table of Contents

List of Cases
xi
List of Figures
xii
Preface xiii
A Map of the Terrain of Ethics
1(12)
The Levels of Moral Discourse
2(8)
The Level of the Case
2(1)
Rules and Rights (Codes of Ethics)
3(2)
Normative Ethics
5(2)
Metaethics
7(3)
A Full Theory of Bioethics
10(1)
Key Concepts
11(1)
Bibliography
12(1)
Works on Basic Ethics
12(1)
Works on Biomedical Ethics
12(1)
The Hippocratic Oath and Its Challengers: A Brief History
13(15)
The Hippocratic Tradition
13(5)
The Hippocratic Oath
13(3)
Modern Codes in the Hippocratic Tradition
16(2)
The Collapse of the Hippocratic Tradition
18(5)
Codes and Oaths Breaking with the Hippocratic Tradition
19(2)
Sources from Outside Professional Medicine
21(2)
Key Concepts
23(2)
Endnotes for chapter 2
25(1)
Bibliography
26(2)
Defining Death, Abortion, And Animal Welfare: The Basis of Moral Standing
28(19)
Persons, Humans, and Individuals: The Language of Moral Standing
29(5)
The Concept of Moral Standing
29(2)
Moral and Nonmoral Uses of the Term Person
31(3)
Moral and Nonmoral Uses of the Word Human
34(1)
Defining Death
34(6)
A Cardiac Definition of Death
35(2)
A Whole-Brain-Oriented Definition of Death
37(1)
The Higher-Brain Definition of Death
38(1)
Definitions and Moral Standing
39(1)
Abortion
40(2)
Symmetry between Definition of Death and Abortion
40(1)
Possible Basis for a Breakdown in the Symmetry
41(1)
The Moral Status of Non-Human Animals
42(2)
Key Concepts
44(1)
Endnotes for chapter 3
44(1)
Bibliography
45(2)
The Definition of Death
45(1)
Abortion
45(1)
Moral Standing of Non-human Animals
45(2)
Problems in Benefitting and Avoiding Harm to the Patient
47(17)
What Counts as a Benefit?
47(7)
Subjective vs. Objective Estimates of Benefit and Harm
47(4)
Medical vs. Other Personal Benefits
51(2)
Conflicting Goals within the Medical Sphere
53(1)
Ways to Balance Benefits and Harms
54(4)
Bentham and Arithmetic Summing
54(1)
Comparing the Ratio of Benefits to Harms
55(2)
First of All, Do No Harm
57(1)
The Problem of Medical Paternalism
58(3)
Key Concepts
61(1)
Endnotes for chapter 4
62(1)
Bibliography
62(2)
The Ethics of Respect for Persons: Lying, Cheating, and Breaking Promises and Why
64(24)
Physicians Have Considered Them Ethical
64(2)
The Principle of Fidelity
66(5)
The Ethics of Confidentiality
67(4)
The Principle of Autonomy and the Doctrine of Informed Consent
71(9)
The Concept of Autonomy
72(1)
Positive and Negative Rights
73(1)
Informed Consent, Autonomy, and Therapeutic Privilege
74(3)
Standards of Disclosure for Consent to Be Adequately Informed
77(3)
The Principle of Veracity: Lying and the Duty to Tell the Truth
80(4)
The Change in Physician Attitudes
80(1)
Accounting for the Change in Attitudes
80(4)
Key Concepts
84(1)
Endnotes for chapter 5
85(1)
Bibliography
86(2)
The Principle of Avoiding Killing
88(17)
Active Killing vs. Allowing to Die
89(7)
Distinguishing Active Killing from Allowing to Die
90(4)
New Legal Initiatives for Physician-Assisted Suicide
94(2)
Stopping vs. Not Starting
96(1)
The Distinction Between Direct and Indirect Killing
97(1)
The Distinction Between Ordinary and Extraordinary Means
98(4)
The Meaning of the Terms
98(1)
The Criteria for Classifying Treatments Morally Expendable
99(1)
The Subjectivity of All Benefit and Harm Assessments
100(1)
Withholding Food, Fluids, CPR, and Medications
101(1)
Key Concepts
102(1)
Endnotes for chapter 6
103(1)
Bibliography
103(2)
Death and Dying: the Incompetent Patient
105(16)
Formerly Competent Patients
106(7)
The Principle of Autonomy Extended
106(1)
Substituted Judgment
107(1)
Going Beyond Advance Directives
107(2)
Mechanisms for Expressing Wishes
109(2)
Issues to Be Addressed in an Advance Directive
111(2)
Never-Competent Patients without Family or Other Pre-existing Surrogates
113(2)
The Principles
113(1)
The Legal Standard
113(1)
Who Should Be the Surrogate?
114(1)
Never-Competent Patients with Family Surrogates
115(4)
What Is the Standard Underlying This Family Discretion?
116(3)
Key Concepts
119(1)
Endnotes
119(1)
Bibliography
119(2)
Social Ethics of Medicine: Allocation of Resources, Transplantation, and Human Subjects Research
121(27)
The Need for a Social Ethic for Medicine
121(5)
The Limits of the Ethics of Individual Relations
121(1)
The Social Ethical Principles for Medical Ethics
122(4)
Allocation of Health Care Resources
126(8)
The Demand for Health Care Services
126(1)
The Inevitability of Rationing
127(1)
Ethical Responses to the Pressures for Cost Containment
128(6)
The Role of the Clinician in Allocation Decisions
134(2)
Organ Transplantation
136(4)
Is Performing Transplants ``Playing God''?
136(1)
Procurement of Organs
137(1)
Organ Allocation
137(3)
Research Involving Human Subjects
140(3)
Distinguishing Research and Innovative Therapy
140(1)
Social Ethics for Research Involving Human Subjects
141(2)
Key Concepts
143(1)
Endnotes for chapter 8
144(1)
Bibliography
145(3)
Social Ethical Theory
145(1)
Allocation of Scarce Medical Resources
145(1)
Organ Transplantation
146(1)
Research Involving Human Subjects
147(1)
Human Control of Life: Genetics, Birth Technologies and Modifying Human Nature
148(19)
The Human as Created and as Creator
149(1)
Medical Manipulation as Playing God
149(1)
Having Dominion over the Earth
150(1)
Genetics and the Control of Human Reproduction
150(14)
Genetics
150(8)
New Reproductive Technologies
158(6)
Key Concepts
164(1)
Endnotes for chapter 9
164(1)
Bibliography
165(2)
Resolving Conflicts among Principles
167(17)
Different Concepts of Duty
168(2)
Absolute, Exceptionless Duties
168(1)
Prima Facie Duties
169(1)
Duty Proper
170(1)
Theories of Conflict Resolution
170(9)
Single Principle Theories
170(1)
Ranking (Lexically Ordering) Principles
171(1)
Balancing
172(1)
Combining Ranking and Balancing
172(3)
Ways of Reconciling Social Utility and Justice
175(4)
Translating Principles to Rules
179(2)
Conclusion
181(1)
Key Concepts
182(1)
Endnotes
182(1)
Bibliography
183(1)
The Virtues in Bioethics
184(9)
Virtue Lists
185(3)
Professional Virtues
186(1)
Secular Virtues
187(1)
Religious Virtues
187(1)
Care as a Virtue
188(1)
Problems with the Virtues
188(2)
The Wrong Virtue Problem
189(1)
The Naked Virtue Problem
189(1)
Conclusion
190(1)
Key Concepts
191(1)
Bibliography
191(2)
Appendix 193(2)
Hippocratic Oath
193(1)
Principles of Medical Ethics (2001) of the American Medical Association
194(1)
Index 195

Excerpts

When the first edition ofThe Basics of Bioethicsappeared in the final weeks of the twentieth century, no current, brief survey existed that was a suitable introduction to the field. Textbooks, anthologies, casebooks, and single-authored works were available to provide perspective on the issues of bioethics, but there was no introduction to the field of bioethics under several hundred pages in length. The first edition served that purpose. It was intended for health professionals and lay people who wanted an introduction to the issues in a relatively small edition suitable for use in short courses in schools of medicine, nursing, and the other health professions; continuing professional education; undergraduate courses in philosophy, religion, and the social sciences; and in adult education.Since the publication of the first edition a great deal has happened in the fast-moving field of bioethics. We have cloned the first human being, isolated stem cells with the potential for generating new genetically matched organs for transplant, formulated new patients' bills of rights, and issued a major revision of the international code for human subjects research. We have also seen the first case of killing a patient with genetic experimentation, seen rationing of health care become common, and (in the Netherlands) formally authorized physician killing of patients for mercy without fear of prosecution.We have also seen some progress in the slower-paced discipline of formal ethical analysis. More agreement exists on the need to move back and forth at different levels of ethical analysis--moving from bedside case discussion up to statements of rules and codes and on up to the more abstract levels of normative ethics dealing with ethical principles and virtues. There is more agreement now that it matters less where one starts roaming through the different levels of ethical discourse and more agreement that all levels should be encountered before an ethical conclusion is firm. There is more interest in alternative approaches--in an ethic of virtue to supplement an ethic focusing on actions; more interest in something called "care theory" and in feminist approaches to bioethics.In short, there is a need for a new edition, still at the introductory level but updated both with new developments in clinical medicine and in ethical analysis. This second edition adds two completely new chapters. The first chapter is designed for the reader who has not been exposed to formal ethical theory. It provides a "map" of the ethical terrain, a schema outlining four levels of moral discourse or ethical analysis. This scheme is summarized in the new diagram that appears on the inside of the front and back covers of the book. On this diagram virtually every dispute in bioethics can be mapped.Some disagreements exist at one of the levels. For example, much of bioethics in the late decades of the twentieth century involved controversies over which ethical principles prevailed. This can be seen in the central shaded boxes at the level of "Normative Ethics" in the diagram. Other disputes involve questions of whether to resolve moral controversies by working at this normative level or at some other level (by applying a code of ethics or by focusing on an individual case, for instance). Portions of this central diagram of the "Four Levels of Moral Discourse" is reproduced in various chapters when the ethical controversies of bioethics are presented in greater detail. I hope this diagram will help to clarify, especially to the reader not trained in ethical analysis, exactly what the basis is for moral disagreements in the field of biomedical ethics.The second completely new chapter is the last one, "The Virtues in Bioethics." Discussion of the virtues of the physician are as old as the profession of medicine itself. The Hippocratic Oath touted the virtues of "purity" and "holiness"; the ancient Confucian m


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